Spine stabilization exercises are not superior to flexion exercises for ultrasound-detected muscle thickness changes in patients with chronic low back pain and lumbar spondylolisthesis.

INTRODUCTION: exercise programs can reduce pain and improve functionality in patients with degenerative spondylolisthesis and chronic low back pain. However, there is still no consensus surrounding the superiority of any specific routine for exercise-induced trophic changes of lumbar muscles. The aim was to compare the changes in the primary lumbar stabilizing muscle thickness after spine stabilization exercises and flexion exercises in patients with spondylolisthesis and chronic low back pain. MATERIAL AND METHODS: prospective, longitudinal and comparative study was carried out. Twenty-one treatment-naive patients with a diagnosis of both chronic low back pain and degenerative spondylolisthesis over the age of 50 were included. A physical therapist taught participants either spine stabilization exercises or flexion exercises to execute daily at home. The thickness of the primary lumbar muscles was measured through ultrasound (at rest and contraction) at baseline and three months. A Mann-Whitney U test and Wilcoxon signed-rank test were performed for comparisons, and Spearman's rank correlation coefficients were calculated for associations. RESULTS: we did not find statistically between the exercise programs: all patients presented significant changes in the thickness of the multifidus muscle but in none of the other evaluated muscles. CONCLUSION: there is no difference between spine stabilization exercises and flexion exercises after three months in terms of the changes in muscle thickness evaluated by ultrasound.

INTRODUCCIÓN: el ejercicio reduce el dolor y mejora la funcionalidad en pacientes con dolor crónico lumbar y espondilolistesis degenerativa. Sin embargo, no existe a la fecha un consenso sobre la superioridad de algún programa de ejercicio para inducir cambios tróficos de los músculos estabilizadores lumbares, por lo que el objetivo fue comparar el trofismo de estos músculos mediante ultrasonido, con dos programas de ejercicio distintos: estabilización vertebral versus ejercicios flexores. MATERIAL Y MÉTODOS: estudio prospectivo, longitudinal y comparativo, en veintiún pacientes mayores de 50 años, con dolor crónico lumbar y espondilolistesis degenerativa. Se entrenó a los pacientes para la ejecución diaria de ejercicio: estabilización lumbar o ejercicios flexores, los cuales fueron asignados por aleatorización como parte de un ECA en desarrollo. El trofismo muscular fue evaluado mediante ultrasonido al inicio y a tres meses. Las pruebas de U de Mann-Whitney y prueba de Wilcoxon se usaron para comparaciones entre grupos y para correlaciones se usaron los coeficientes de correlación de Spearman. RESULTADOS: todos los pacientes presentaron ganancia en el trofismo de los músculos multífidos a tres meses, pero sin diferencias entre grupos de tratamiento. No se detectaron cambios significativos en el resto de los músculos evaluados. CONCLUSIÓN: no encontramos diferencia significativa entre los ejercicios de estabilización lumbar y los ejercicios flexores, a tres meses de seguimiento, en términos de los cambios tróficos medidos por ultrasonido de los músculos estabilizadores lumbares.

Efectos del láser de baja potencia en el tratamiento de la parálisis facial periférica aguda / Effects of low power laser in the treatment of acute peripheral facial paralysis

Introducción. La parálisis facial periférica es una afección altamente incidente, que puede generar complicaciones discapacitantes. No existe un tratamiento único para la misma. El láser infrarrojo es efectivo en la recuperación de la estructura y función de los nervios periféricos, aunque hay pocos estudios que exploren su utilidad clínica en la parálisis facial periférica. Material y métodos Se realizó un ensayo clínico aleatorizado doble ciego controlado. Se incluyeron pacientes mayores de 18 años con diagnóstico de parálisis facial periférica idiopática de menos de 7 días de evolución, sin tratamiento previo. Fueron distribuidos aleatoriamente en 2 grupos, uno con tratamiento rehabilitador convencional más placebo y otro con láser de GaAsAl de λ 830nm a dosis de 20J/cm2 en la emergencia del nervio facial. Se evaluó de forma ciega la fuerza muscular, la presencia de disacusia, disgeusia y epífora a los 0, 15, 30 y 60 días. Resultados. Se incluyeron 21 pacientes, 10 en el grupo control y 11 en el experimental. Ambos grupos tuvieron mejoría significativa en la fuerza muscular antes y después (p<0,001). Al compararlos entre ellos, el grupo de láser alcanzó una recuperación del 94,84% y el grupo control del 87,83% (p=0,24), en cuanto a la disgeusia, disacusia y epífora ambos grupos mostraron mejoría del 100%. Conclusión. El láser de baja potencia resultó exento de riesgo y con un efecto clínico moderado respecto a la recuperación de la fuerza muscular, no así respecto a la epífora, disgeusia y disacusia (AU)

Introduction. Peripheral facial paralysis is a very pathological condition that may generate disabling complications. There is no unique treatment for it. Infrared low power laser is effective in recovering the structure and function of peripheral nerves, although few studies have been conducted on its clinical use in peripheral facial paralysis. Material and methods. We performed a randomized double-blind controlled trial. Inclusion criteria were patients older than 18 years with a diagnosis of idiopathic peripheral facial paralysis of less than 7 days duration, with no previous treatment. The patients were randomized into two groups, one with conventional rehabilitation treatment plus placebo and another with GaAsAl of λ 830nm laser at doses of 20 joules/cm2 in the emergence of the facial nerve. Muscle strength, disacusia, dysgeusia and epiphora were evaluated in a blinded way at 0, 15, 30 and 60 days. Results. Twenty-one patients were included, 10 in the control group and 11 in the experimental one. Both groups showed significant improvement in muscle strength before and after treatment (P<.001). When a comparison was made between the groups, the laser group achieved recovery of 94.84% vs 87.83% in the control group (P=.24). Regarding dysgeusia, disacusia and epiphora, both groups showed 100% improvement. Conclusion. Low-power laser was safe and had a moderate clinical effect on the recovery of muscle strength, but not for the epiphora, dysgeusia and disacusia (AU)

Effect of polymerized-type I collagen in knee osteoarthritis. II. In vivo study.

BACKGROUND: Polymerized-Type I Collagen (Polymerized-Collagen) is an anti-inflammatory and a tissue regenerator biodrug. The aim of the study was to evaluate the efficacy and safety of intra-articular injections of Polymerized-Collagen in patients with knee osteoarthritis (OA). METHODS AND DESIGN: Patients (n=53) were treated with 12 intra-articular injections of 2 mL of Polymerized-Collagen (n=27) or 2 mL of placebo (n=26) during 6 months. Follow up period was 6 months. The primary endpoints included Western Ontario and McMaster University Osteoarthritis Index, Lequesne index, and pain intensity on a visual analogue scale (VAS). Secondary outcomes were patient global score, investigator global score and drug evaluation. Clinical improvement was determined if the decrease in pain exceeds 20 mm on a VAS and patients achieved at least 20% of improvement from baseline. Urinary levels of C-terminal crosslinking telopeptide of collagen type II (CTXII) and serum high-sensitivity C-reactive protein (hsCRP) were determined by enzyme immunoassays. Statistical analysis was performed by intention to treat. RESULTS: Polymerized-Collagen was safe and well tolerated. Patients had a statistically significant improvement (P<0.05) from baseline vs. Polymerized-Collagen and vs. placebo at 6 months in: Lequesne Index (13.1+/-0.5 vs. 7.1+/-0.7 vs. 9.6+/-0.8; P=0.027), WOMAC (9.0+/-0.5 vs. 4.0+/-0.6 vs. 5.80+/-0.8; P=0.032), patient VAS (60.0+/-2.6 vs. 20.6+/-2.4 vs. 36.1+/-4.5; P=0.003), physician VAS (49.8+/-1.9 vs. 16.8+/-2.9 vs. 29.8+/-2.9; P=0.002), patient global score (1.08+/-0.1 vs. 2.7+/-0.1 vs. 1.9+/-0.2; P=0.028) and analgesic usage (30.1+/-9.4 vs. 11.0+/-3.4 vs. 17.9+/-4.9; P=0.001). This improvement was persistent during the follow up. A threefold increase in CTXII was determined in placebo group. No differences were found on hs CRP and incidence of adverse events between groups. CONCLUSION: Polymerized-Collagen is safe and effective in the treatment of knee OA.