Ischemic compression and joint mobilisation for the treatment of nonspecific myofascial foot pain: findings from two quasi-experimental before-and-after studies.

OBJECTIVE: The aim of this study was to evaluate the efficacy of myofascial therapy involving ischemic compression on trigger points in combination with mobilization therapy on patients with chronic nonspecific foot pain. STUDY DESIGN: Two quasi-experimental before-and-after studies involving two different baseline states. METHOD: Foot pain patients at a private clinic were divided into two separate cohorts: A, custom orthotic users; and B, non-users. In Study A, 31 users received 15 experimental treatments consisting of ischemic compressions on trigger points and mobilization of articulations through the foot immediately after study enrollment. In study B, ten non-users were prescribed a soft prefabricated insole and were monitored for five weeks before subsequently receiving 15 experimental treatments after the initial five-week delay. OUTCOME MEASURES: The Foot Function Index (FFI) and patients' perceived improvement score (PIS) on a scale from 0% to 100%. RESULTS: The Study A group (n=31) maintained a significant reduction in the FFI at all three follow-up evaluations. Mean improvement from baseline in FFI was 47%, 49% and 56% at 0, 1 and 6 months, respectively, post-treatment. Mean PIS was 58%, 57%, and 58%, again at 0, 1 and 6 months post-treatment. For the Study B group, mean improvement in FFI was only 19% after the monitoring period, and 64% after the experimental treatment period. Mean PIS was 31% after monitoring, and 78% after experimental treatment. In repeated measures analyses, experimental treatment was associated with a significant main effect in both of these before-and after studies (all P values<0.01). CONCLUSION: Combined treatment involving ischemic compression and joint mobilization for chronic foot pain is associated with significant improvements in functional and self-perceived improvement immediately and at up to six-months post-treatment. Further validation of this treatment approach within a randomized controlled trial is needed.

OBJECTIF: L'objectif de la présente étude est d'évaluer l'efficacité de la thérapie myofasciale impliquant une compression ischémique sur des points gâchettes combinée à une thérapie de mobilisation chez les patients souffrant de douleurs chroniques non spécifiques au pied. PLAN D'ÉTUDE: Deux études quasi expérimentales avant/après sur deux états de référence différents. MÉTHODOLOGIE: On a formé deux groupes avec les patients souffrant de douleurs au pied d'une clinique privée. A : les utilisateurs d'orthèses adaptées. B : ceux qui n'en utilisent pas. Dans l'étude A, 31 utilisateurs ont reçu 15 traitements expérimentaux impliquant une compression ischémique sur des points gâchettes et une mobilisation des articulations du pied immédiatement après l'inscription à l'étude. Dans l'étude B, 10 nonutilisateurs ont reçu une prescription de semelle souple préfabriquée et ont fait l'objet d'un suivi de 5 semaines. Après les 5 semaines de suivi, ils ont reçu 15 traitements expérimentaux. MESURES DES RÉSULTATS: L'index de fonction du pied (IFP) et l'amélioration perçue par le patient (APP) sur une échelle de 0 % à 100 %. RÉSULTATS: Le groupe de l'étude A (n=31) a montré une diminution importante de l'IFP aux trois évaluations de suivi. L'amélioration moyenne selon la référence de l'IFP était de 47 %, 49 % et 56 % après 0, 1 et 6 mois respectivement. La moyenne d'APP était de 58 %, 57 % et de nouveau 58 % 0, 1 et 6 mois après le traitement. Le groupe de l'étude B a montré une amélioration moyenne de l'IFP de seulement 19 % après la période de suivi, et de 64 % après la période de traitements expérimentaux. La moyenne d'APP était de 31 % après le suivi et de 78 % après les traitements expérimentaux. Dans les analyses de mesures répétées, on associe le traitement expérimental à un effet principal important dans les deux études avant/après (toutes les valeurs P<0,01). CONCLUSION: Un traitement combiné impliquant une compression ischémique sur des points gâchettes et une mobilisation des articulations pour soulager des douleurs chroniques au pied est associé à des améliorations fonctionnelles importantes et une amélioration cernée par le patient sur une période allant d'immédiatement après le traitement jusqu'à six mois plus tard. Il est nécessaire d'effectuer un essai contrôlé aléatoire pour valider ce traitement.

A randomized controlled (intervention) trial of ischemic compression therapy for chronic carpal tunnel syndrome.

STUDY DESIGN: Randomized clinical trial. OBJECTIVE: The aim of this study was to evaluate the effect of ischemic compression therapy in the treatment of chronic carpal tunnel syndrome. METHOD: Fifty-five patients suffering from carpal tunnel syndrome were randomized to two groups. Thirty-seven patients received 15 experimental treatments which consisted of ischemic compressions at trigger points located in the axilla of the shoulder, the length of the biceps muscle, at the bicipital aponeurosis and at the pronator teres muscle in the hollow of the elbow. Eighteen patients received the control treatment involving ischemic compression on trigger points located in the deltoid muscle, supraspinatus muscle and infraspinatus muscle. Of the 18 patients forming the control group, 13 agreed to receive the experimental treatments after the 15 control treatments. Outcome measures included a validated 18-question questionnaire to assess the severity of symptoms and functional status in carpal tunnel syndrome, and a quantification of the patients' perceived improvement, using a scale from 0% to 100%. Outcome measures evaluations were completed at baseline, after 15 treatments, 30 days following the last treatment, and 6 months later. RESULTS: For the disability questionnaire, a significant reduction of symptoms was noted only in the experimental group. In the experimental group the outcome at baseline was 33.5 (SD, 10.3); after 15 treatments it was 18.6 (SD, 7.0). The control group outcome at baseline was 36.3 (SD, 15.2); after 15 treatments it was 26.4 (SD, 9.9) and after the crossover (15 control treatments plus 15 experimental treatments) 20.2 (SD, 12.2). A significant between group difference (P < 0.021) was noted in the patients' perceived improvement after 15 treatments: 67 (SD, 26) percent and 50 (SD, 25) percent respectively for the experimental and control groups. CONCLUSION: This practice-based clinical trial suggests that myofascial therapy using ischemic compression the length of the biceps, at the bicipital aponeurosis, at the pronator teres and at the subscapularis muscles could be a useful approach to reduce symptoms associated with the carpal tunnel syndrome. Patients' perceived improvement in functional capacities persisted over a 6-month period.