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Purpose Chronic pelvic pain syndrome (CPPS) is permanent pelvic pain of unknown etiology. Current theories suggest a multifactorial origin for CPPS, including urinary pathologies, psychosocial factors, prostate inflammation, infection, central sensitization of the nervous system, and muscular contractures or fibrosis. As there are no defined treatment protocols for CPPS, a multimodal approach is recommended. The objective of this study was to evaluate the impact of a manual therapy treatment protocol on pain, urinary symptoms, and overall quality of life. Materials and Methods Twenty-three men aged 47.36 ± 10.11 years were recruited consecutively by urologists practicing at two hospitals. All men presented prostatic tenderness with no other positive clinical history, urine cultures, or echography studies. Patients underwent six manual therapy sessions (three during the first week and three every two weeks after that) performed by a single osteopath or physiotherapist. The intervention protocol addressed the treatment of muscle structures, fascial mechanics, vascularization, innervation, emotional factors, and the need for information. The questionnaires used to evaluate outcomes included the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), the International Prostate Symptoms Score (IPSS), and a Visual Analog Scale (VAS) for pain, and the Hospital Anxiety and Depression Scale (HADS). Data were evaluated using Chi-squared or paired difference tests by an external researcher. Results The mean NIH-CPSI scores recorded for our study cohort decreased by 7.69 points (30.92%; p<0.0005; 95% CI 4.02-10.52). IPSS measurements decreased by 3.20 points (22.18%; p=0.009; 95% CI 1.00-6.09), although the item addressing quality of life decreased by 1.67 points only (31.99%; p<0.0005; 95% CI 0.94-2.33). The VAS score also decreased by 2.20 points (38.6%; p<0.0005; 95% CI 1.45-2.73). Changes in HADS scores were not statistically significant. Conclusions Based on patient responses, this case series revealed that manual therapy improved urinary symptoms, pain, and quality of life.
RESUMO
Objetivos: Observar la relación entre degeneración del cartílago fémoro-rotuliano y la disfunción rotatoria tibial, en pacientes afectos de condropatía rotuliana unilateral. Material y Métodos: De una muestra de 133 sujetos se seleccionaron 50 sujetos, a los que se les aplicaron evaluaciones manuales y radiológicas (medición goniométrica en rotación tibial y radiología) para observación del posicionamiento rotuliano, mediante la medición del ángulo de congruencia y el desplazamiento transversal de la rotula. Resultados: Se observan diferencias significativas entre la rodilla afectada y la rodilla sana, tanto al comparar la rotación interna tibial, como la rotación externa tibial (p< 0,0001). En relación a la posición de la rótula, cuando se encuentra afectada la rotación interna, observamos una angulación de la rótula en sentido lateral (con respecto a la rodilla sana). Cuando está afectada la rotación externa o ambas rotaciones conjuntas, la rótula se angula hacia medial (con respecto a la rodilla sana) (p<0,02). En relación al desplazamiento lateral, no observamos resultados significativos. Conclusiones: Los procesos degenerativos del cartílago articular fémoro-rotuliano se asocian con una disfunción rotatoria tibial. Existe un sentido de angulación concreto asociado a cada tipo de afectación de rotación determinada, y tendencia a que la rótula se angule y se desplace de una manera distinta en la rodilla afecta, comparada con la rodilla sana (AU)
Objectives: To observe the relationship between degeneration of the femur-patellar cartilage and the rotating tibial dysfunction, in patients suffering from unilateral patellar chondropathy. Material and methods: From a sample of 133 subjects, 50 subjects were selected, to whom manual and radiological tests were applied (goniometric measurement in tibial and radiological rotation) for observation of patellar positioning by the measurement of the angle of congruence and lateral displacement of the patella. Results: Significant differences are observed between the affected knee and the healthy knee, both when comparing internal tibial rotation and external tibial rotation (p <0.0001). In connection with the patella position, when internal rotation is affected, we observe a lateral angulation of the patella (with regard to the healthy knee). When external rotation or both joint rotations are affected, the patella is angled inward (with respect to the healthy knee) (p <0.02). With regard to lateral displacement, we observed no significant results. Conclusions: The degenerative processes of the femur-patellar joint cartilage are associated with rotational or tibial dysfunction. There is a sense of concrete angulation associated with each type of affectation of determined rotation, and a tendency for the patella to angulate and move differently to the affected knee when compared to the healthy knee (AU)