Which Multimodal Physiotherapy Treatment Is the Most Effective in People with Shoulder Pain? A Systematic Review and Meta-Analyses.

The study aimed to determine if combined physiotherapy treatments offer additional benefits over exercise-only programs for shoulder pain and to identify the most effective combined treatment. A systematic review, registered in PROSPERO (CRD42023417709), and meta-analyses were conducted. Quality analysis was performed using the PEDro scale on randomized clinical trials published from 2018 to 2023. Twenty articles met the inclusion criteria. The most commonly used combination was exercise plus manual therapy, without being statistically superior to exercise alone. The meta-analysis indicated that combining exercise with low-level laser therapy (mean difference of -1.06, 95% CI: -1.51 to -0.60) and high-intensity laser therapy (mean difference of -0.53, 95% CI: -1.12 to 0.06) resulted in the greatest reduction in SPADI scores. Adding manual therapy provided limited additional benefit (mean difference of -0.24, 95% CI: -0.74 to 0.27). Progressive exercise with advice or telerehabilitation yielded modest improvements. The multimodal meta-analysis for DASH scores showed significant improvement (mean difference of -1.06, 95% CI: -1.51 to -0.60). In conclusion, therapeutic exercise is the cornerstone of shoulder pain treatment, with the addition of laser therapy showing substantial benefits. Manual therapy and educational interventions offer some benefits but are not consistently superior. More rigorous studies are needed.

Impact of physical therapy techniques and common interventions on sleep quality in patients with chronic pain: A systematic review.

This systematic review aims to find effectful healthcare strategies, with special focus on drug-free interventions and physical therapy, as part of the treatment for sleep in patients with chronic musculoskeletal pain. Data search was conducted across seven scientific databases. This review is deposited in the Prospero International prospective register of systematic reviews (CRD42023452574). Seventeen RCTs from different healthcare fields complied with our inclusion criteria. Two RCTs investigated manual therapy, five RCTs therapeutic exercise, one RCT Fu's subcutaneous needling, two RCTs physical agents (one on balneotherapy and one on cryo-stimulation), two RCTs cognitive-behavioral therapy, and four RCTs pharmacological therapy and their effect on sleep quality and/or quantity in patients suffering from chronic pain. We included the four RCT's in this systematic review with the purpose to be able to compare natural interventions with allopathic ones. As allopathic interventions are more prone to have secondary negative effects than physical therapy, compare the two types of interventions could be in favor of choosing the most effective treatment with the least secondary negative effects. Additionally, two RCTs on neurofeedback and limbic neuromodulation were also included. The results of the included studies suggest that strategies such as manual therapy, therapeutic exercise, Fu's subcutaneous needling, balneotherapy, cryo-stimulation, neurofeedback, limbic neuromodulation, cognitive-behavioral therapy, and pharmacological therapies have positive effects on patients suffering from chronic pain and sleep disturbances, especially when they suffer musculoskeletal pain. Secondary negative effects were found for the possible overuse of certain medicines such as morphine, a huge problem in the United States. Sleep deficiency is an independent risk factor for many diseases, including chronic pain syndrome and therefore more studies are needed to find non-toxic interventions for people suffering sleep disorders associated with systemic diseases and pain.

A new perspective of frozen shoulder pathology; the interplay between the brain and the immune system.

Frozen shoulder (FS), also known as adhesive capsulitis of the shoulder (FS), is a fibrotic inflammatory process of unknown etiology whose main symptoms are pain, stiffness and the loss of joint mobility. These symptoms may be associated with pathologies such as diabetes, Dupuytren's syndrome and the prevalence of today's sedentary lifestyle. This literature review provides an overview of the epidemiology and pathogenesis of this pathology, as well as the mechanisms of lowgrade chronic inflammation and infection, insulin resistance, and omics-science associated with it. We also propose a new hypothesis related to the possibility that the GABAergic system could play a decisive role in the development of frozen shoulder and that therefore diabetes type 1, endocrinological autoimmune disorders and frozen shoulder are connected by the same pathophysiological mechanisms. If that is true, the combined presence of psycho-emotional stress factors and pathogenic immune challenges could be the main causes of frozen shoulder syndrome. Finally, we propose a series of possible intervention strategies based on a multifactorial etiological and mechanistic concept.

Effects of the menstrual cycle on the performance of female football players. A systematic review.

Background: Women's football has been booming for a few years now, which has led to an increase in the expectation of the players' performance, leading to a more detailed study of women's physiology in the field of sports. Objectives: To analyze the scientific evidence on the influence of menstruation on the performance of female footballers, as well as to analyze the methodological quality of the studies included in this review. Materials and methods: The possible hormonal effects of the menstrual cycle phases on the performance of female footballers were analyzed. The databases used to conduct the searches were Pubmed, Scopus, Virtual Health Library, Web of Science, EBSCO and the Cochrane Library. All included studies met the inclusion criteria. The Cochrane risk of bias tool was used. This systematic review protocol was registered at the International Prospective Register of Systematic Reviews (PROSPERO: CRD42023390652). Results: A total of nine clinical trials were included in this review. A low quality of evidence was observed in the studies. Not all the results support the idea that the menstrual cycle phases can alter the performance of female footballers. Conclusion: This systematic review shows that there is a great deal of controversy about the influence of the menstrual cycle phases on the performance of female footballers. Studies are focused on solely biological factors and gender is normally no part of those studies. Further research with larger samples, and taking not only biological but also sociological factors, are necessary to determine the effects of menstruation on the performance of female footballers.

Physical Activity, Insulin Resistance and Cancer: A Systematic Review.

INTRODUCTION: Insulin resistance (IR), a key aspect of type 2 diabetes and a defining characteristic of obesity and its associated conditions, emerges as a mechanistic pathway potentially implicated in cancer pathophysiology. This presents an appealing intervention target for cancer patients. The objective of this study is to conduct a systematic review, examining the scientific evidence regarding the impact of physical activity on modifying insulin resistance in individuals with cancer. METHODS: The selection criteria were specific: only randomized controlled clinical trials published in the last 13 years and written in English or Spanish were included. The databases utilized for the search included PubMed, Scopus, Cochrane Library, EBSCO, and WEB OF SCIENCE. The protocol for this review was duly registered in the International Register of Systematic Reviews (CRD42023435002). The final search was conducted on 14 May 2023. RESULTS: The outcomes were assessed using the tool proposed by the Cochrane Handbook to evaluate the risk of bias in the included studies. Among the 12 studies incorporated, 8 demonstrated a low risk of bias, two had an unclear risk of bias, and the remaining two showed a high risk of bias. The variety of exercise types used across all studies was extensive, making definitive conclusions challenging. Physical activity was linked to enhanced insulin sensitivity in seven studies, while five studies showed no significant changes in insulin resistance between the intervention and control groups. Importantly, none of the interventions employed in the included studies exhibited adverse effects on the study participants. CONCLUSIONS: The role of exercise as a medicine against insulin resistance has been evidenced in many different studies, mostly related to obesity and cardiovascular diseases. Engaging in physical activity could be a healthy option to combat the effects of insulin resistance in cancer patients, although evidence is weak and limited, according to the results of our systemic review. We further found that literature is lacking at the level of optimal doses, timing, and type of exercise. More studies are needed with more defined PA programs in type and length.

Adhesive Capsulitis of the Ankle (Frozen Ankle): An Infrequent Syndrome.

Adhesive capsulitis, characterized by progressive fibrosis, causes a gradual, painful loss of both active and passive articular motion, leading to the final contracture of the joint capsule. The condition commonly referred to as "frozen ankle" (FA), which Goldman was the first to use, relates to the ankle joint and is challenging to both diagnose and treat. Data acquired from people who suffer from this type of damage in other joints such as the shoulder, hip, and wrist also exists. Despite the fact that a well-defined model for the medical management of FA does not exist, a wide spectrum of local treatments, both surgical and non-surgical, exist. This review gives an overview of the current scientific position of the frozen ankle in terms of evolutionary factors, etiology, the different mechanisms of action involved, current treatment options, and other possible interventions based on recent discoveries of pathophysiological mechanisms. The application of extracorporeal shockwave therapy, stretching exercises, and corticosteroid injections combined with physical therapy modalities that enhance pain management, range of motion, and functional capacity is highly advisable for the treatment of adhesive capsulitis, commonly known as "frozen joints". Furthermore, the addition of interventions both impacting and analyzing chronic hypoxia, low-grade inflammation, and sedentary life is proposed.

Effectiveness of Treatments That Alter Metabolomics in Cancer Patients-A Systematic Review.

INTRODUCTION: Cancer is the leading cause of death worldwide, with the most frequent being breast cancer in women, prostate cancer in men and colon cancer in both sexes. The use of metabolomics to find new biomarkers can provide knowledge about possible interventions based on the presence of oncometabolites in different cancer types. OBJECTIVES: The primary purpose of this review is to analyze the characteristic metabolome of three of the most frequent cancer types. We further want to identify the existence and success rate of metabolomics-based intervention in patients suffering from those cancer types. Our conclusions are based on the analysis of the methodological quality of the studies. METHODS: We searched for studies that investigated the metabolomic characteristics in patients suffering from breast cancer, prostate cancer or colon cancer in clinical trials. The data were analyzed, as well as the effects of specific interventions based on identified metabolomics and one or more oncometabolites. The used databases were PubMed, Virtual Health Library, Web of Science, EBSCO and Cochrane Library. Only nine studies met the selection criteria. Study bias was analyzed using the Cochrane risk of bias tool. This systematic review protocol was registered at the International Prospective Register of Systematic Reviews (PROSPERO: CRD42023401474). RESULTS: Only nine studies about clinical trials were included in this review and show a moderate quality of evidence. Metabolomics-based interventions related with disease outcome were conflictive with no or small changes in the metabolic characteristics of the different cancer types. CONCLUSIONS: This systematic review shows some interesting results related with metabolomics-based interventions and their effects on changes in certain cancer oncometabolites. The small number of studies we identified which fulfilled our inclusion criteria in this systematic review does not allow us to draw definitive conclusions. Nevertheless, some results can be considered as promising although further research is needed. That research must focus not only on the presence of possible oncometabolites but also on possible metabolomics-based interventions and their influence on the outcome in patients suffering from breast cancer, prostate cancer or colon cancer.

Efficacy of combined strategies of physical activity, diet and sleep disorders as treatment in patients with chronic shoulder pain. A systematic review.

Introduction: The objective of this systematic review was to analyze the existing scientific evidence on the influence of dietary strategies, exercise, and sleep disorders on the symptomatology of patients with chronic shoulder pain, as well as to assess the methodological quality of the literature collected. Methods: The selection criteria were as follows: we included randomized controlled clinical trials written in English that investigated the effects of such interventions in patients with chronic shoulder pain and excluded studies where pre-operative rehabilitation or rehabilitation combined with corticosteroid injections was performed. We searched six databases Pubmed, Cochrane Library, Web of Science, CINAHL, Sportdiscus and Scopus, using the keywords "shoulder pain," "fasting," "physical therapy modalities," "rehabilitation," "exercise," "circadian clocks," and "chronic pain" to select randomized controlled clinical trials conducted in humans and written in English. The last search was conducted on 24/01/2023. (PROSPERO:CRD42023379925). Results: We used the tool proposed by the Cochrane Handbook to assess the risk of bias in the included studies of the 17 studies included, nine had a high risk of bias, two studies had an unclear risk of bias, and the remaining six studies had a low risk of bias. A total of 17 articles were selected, including 10 studies that showed a positive influences of exercise on chronic shoulder pain and five studies that showed a negative influence of sleep disorders on this patient profile. The remaining two articles analyzed the influence of nutritional strategies and metabolic problems in patients with chronic shoulder pain. The total sample size of the 17 included articles amounted to 9,991 individuals. Discussion: Studies confirm that exercise generates a hypoalgesic effect that improves chronic shoulder pain, functionality, and quality of life. Although dietary strategies and sleep disorders are known to influence chronic shoulder pain, there is a lack of studies that conduct interventions on these problems to assess how chronic shoulder pain varies.

Efficacy of Photobiomodulation Therapy in the Treatment of Pain and Inflammation: A Literature Review.

The main objective of this literature review was to analyze the efficacy of (PBM) therapy application on subjects with chronic pain and inflammation, and furthermore, to evaluate the methodological quality of the collected literature. The search was conducted using five databases: PubMed, ProQuest, Scopus, Web of Science, and PEDro. The keywords "low level laser therapy", "chronic pain", and "inflammation" provided the selection of RCTs that were published within the last 5 years, conducted in humans, and written in English. The PEDro Internal Validity Scale (IVS) checklist was used to evaluate the risk of bias in the included studies. A total of 11 articles were selected, all of them RCTs. Of the articles, five showed that PBM positively influences chronic pain, while another showed the same but only in the short term. In two other articles, the patient's inflammation improved markedly. In one article there was no improvement in chronic pain and in another, there was no improvement in inflammation. Four articles demonstrated that PBM is beneficial in acute pain. Furthermore, six studies were given an "excellent" score and the remaining five a "good" score based on the IVS. Photobiomodulation has beneficial effects on chronic pain and inflammation, although more research needs to be completed in this line for this to be clarified as the existence of RCTs on this subject is limited.