Osteopathy and physiotherapy compared to physiotherapy alone on fatigue in long COVID: Study protocol for a pragmatic randomized controlled superiority trial.

Objective: Fatigue is among the most common symptoms of the long-term effects of coronavirus (long COVID). This study aims to compare the effectiveness of osteopathic manipulative treatment (OMT) combined with physiotherapy treatment (PT) compared to PT alone on fatigue and functional limitations after two months post randomization in adults with long COVID. Methods: This is a study protocol for a two-arm, assessor-blinded, pragmatic randomized controlled superiority trial. Seventy-six participants will be randomly allocated to OMT + PT or PT. The PT includes usual care interventions including motor and respiratory exercises targeting cardiorespiratory and skeletal muscle functions. The OMT entails direct and indirect musculoskeletal, viceral and cranial techniques. Patients will be evaluated before and after a 2-month intervention program, and at 3-month follow-up session. Primary objectives comprise fatigue and functional limitations at 2-month post randomization as assessed by the fatigue severity scale and the Post-COVID Functional State scale. Secondary objectives comprise fatigue and functional limitations at 3 months, and the perceived change post-treatment as assessed by the Perceived Change Scale (PCS-patient). Registration: This protocol was registered (NCT05012826) and received ethical approval (38342520.7.0000.5235). Participant recruitment began in August 2021 and is expected to conclude in July 2023. Publication of the results is anticipated in 2023.

Hypoalgesic effects of specific vs non-specific cervical manipulation in healthy subjects: a randomized crossover trial.

BACKGROUND: Joint manipulation is generally used to reduce musculoskeletal pain; however, evidence has emerged challenging the effects associated with the specificity of the manipulated vertebral segment. The aim of this study was to verify immediate hypoalgesic effects between specific and non-specific cervical manipulations in healthy subjects. METHOD: Twenty-one healthy subjects (18-30 years old; 11 males, 10 females) were selected to receive specific cervical manipulation at the C6-7 segment (SCM) and non-specific cervical manipulation (NSCM) in aleatory order. A 48h interval between manipulations was considered. Pressure pain threshold (PPT) was measured pre- and post-manipulation with a digital algometer on the dominant forearm. RESULTS: The SCM produced a significant increase in the PPT (P < 0.001) however no difference was observed in the PPT after the NCSM (P = 0.476). The difference between the two manipulation techniques was 37.26 kPa (95% CI: 14.69 to 59.83, p = 0.002) in favor of the SCM group CONCLUSION: Specific cervical manipulation at the C6-7 segment appears to increase PPT on the forearm compared to non-specific cervical manipulation in healthy subjects.

High-velocity, low-amplitude manipulation (HVLA) does not alter three-dimensional position of sacroiliac joint in healthy men: A quasi-experimental study.

The impact of high-velocity, low-amplitude (HVLA) manipulations on the behavior of sacroiliac joint (SIJ) mobility in individuals submitted to an osteopathic intervention has not been sufficiently investigated. Furthermore, there is no standard agreement on the description of the acute effects of HLVA with regards to the mobility of the SIJ through three-dimensional motion analysis. The purpose of this study was to analyse possible alterations in the mobility of the SIJ pre- and post-manipulation of the ilium bone in healthy men. Thirty healthy male patients aged between 18 and 35 years were examined and divided into two groups: manipulation (MN) and placebo (PL) groups. SIJ movement was assessed through a three-dimensional motion analysis system before and after osteopathic manipulation of the anterior ilium bone, during hip flexion. Statistical analysis was performed using the Kolmogorov-Smirnov normality test, and Fisher's exact test was used to observe associations of interest in the mobility of the SIJ. Finally, the t-test was used to analyse values of mobility of the SIJ pre- and post-manipulation (p < 0.05). Non-significant differences were observed in SIJ mobility. In MN the means were pre-manipulation right SIJ 39.98 mm ±â€¯10.82 [CI - 29.16-50.8] and post- 42.85 mm ±â€¯27.17 [CI - 15.68-70.02] with p = 0.61. Pre-manipulation left SIJ 41.73 mm ±â€¯15.34 [CI 10.89-82.99] and post- 39.97 mm ±â€¯14.70 [CI - 24.67-54.07] with p = 0.39. HVLA does not alter the mobility of SIJ under these conditions. Further studies under different conditions, with patients that report pain, are required to fully understand the behavior of the SIJ after HVLA manipulation.

Osteopathic manipulation treatment versus therapeutic exercises in patients with chronic nonspecific low back pain: A randomized, controlled and double-blind study.

BACKGROUND: Osteopathic manipulation treatment is widely used in the clinical practice in the care of patients with chronic nonspecific low back pain, however, its benefits still seem uncertain. OBJECTIVE: This study aimed to verify the efficacy of osteopathic manipulation for chronic nonspecific low back pain. MATERIALS AND METHODS: Forty-two participants with chronic nonspecific low back pain were selected and randomized into two groups: active control group (ACG - n= 19) and osteopathic manipulation treatment group (OMTG - n= 23). Therapeutic exercises were performed with the ACG and osteopathic manipulation techniques with the OMTG. The interventions were carried out over 5 weeks of treatment, totaling 10 treatments for the ACG and 5 for the OMTG.The visual analogue scale (VAS) was used to measure chronic nonspecific low back pain and the Oswestry Disability Index 2.0, Tampa Scale of Kinesiophobia and Beck Depression Inventory were used to measure disability, kinesiophobia and depression, respectively. RESULTS: The final chronic nonspecific low back pain in both groups was significantly lower than the initial low back pain (p⩽ 0.01) and the final chronic nonspecific low back pain of the OMTG was significantly lower than that of the ACG (p= 0.001). CONCLUSION: This study demonstrated that the treatments were effective in both groups. However, the efficacy of the osteopathic manipulation treatment was greater than that of the therapeutic exercises.

A efetividade do tratamento osteopático na constipação intestinal: uma revisão sistemática / Effectiveness of the ostheopatic treatment in intestinal constipation: a systematic review

Introdução: a constipação intestinal é considerada uma doença funcional do intestino, caracterizada por uma desordem da motilidade gastrointestinal e por evacuações difíceis ou diminuídas. O tratamento e a prevenção devem ser individualizados, considerando as orientações comportamentais, além da possível intervenção farmacológica ou de terapias complementares como a osteopatia. Objetivos: revisar a literatura sobre os efeitos do tratamento osteopático na constipação intestinal. Metodologia: a pesquisa da literatura foi realizada nas bases de dados eletrônicas Portal CAPES, Bireme, Cochrane Library, Lilacs, Medline, PubMed e Scielo. Os 112 estudos utilizados nesta pesquisa seguiram os seguintes critérios de inclusão: publicações no período de 1989 a 2017; escritos em português, inglês e espanhol; artigos apresentados na íntegra, sem restrições sobre o tipo de estudo ou amostra. Resultados: a abordagem osteopática aplicada no tratamento da constipação tem como objetivo a melhora do funcionamento do intestino, influenciando o tônus do músculo liso e a mobilidade visceral, melhorando a função gastrointestinal e, indiretamente, normalizando o suprimento nervoso autossômico para a víscera. A fáscia é formada por uma matriz intracelular tridimensional de contiguidade, rica em mecanorreceptores, envolvendo e protegendo os tecidos e órgãos do corpo. Assim, resultados obtidos após a realização de técnicas osteopáticas, possivelmente, são compreendidos pelas propriedades mecânicas, autonômicas e neuromusculares. Conclusão: a osteopatia é um tratamento complementar para a constipação intestinal, melhorando os sintomas, reduzindo a gravidade dos quadros, diminuindo o tempo do trânsito colônico, aumentando a motilidade intestinal e a qualidade de vida dos pacientes.

Introduction: the intestinal constipation is considered a functional bowel disease, characterized by a gastrointestinal motility disorder and difficult or reduced evacuation. The treatment and prevention must be individualized, taking into consideration the behavioral orientation, besides a possible pharmacological intervention or complementary therapies such as osteopathy. Objective: review the literature on the effects of osteopathic treatment in intestinal constipation. Methodology: the research on literature was done using database of Portal CAPES, Bireme, Cochrane Library, Lilacs, Medline, PubMed and Scielo. The 112 studies used in this research followed these criteria of inclusion: publications from 1989 to 2017, in Portuguese, English and Spanish; articles presented in full, with no restrictions about the type of study or sample. Results: the osteopathic approach applied in the constipation treatment aims at a better functioning of the intestine, influencing the smooth muscle tonus and visceral mobility, thus improving the gastrointestinal function and indirectly normalizing the autosomal nervous supply for the viscera. A three-dimensional intracellular matrix forms the fascia in contiguity, which is abundant in mechanoreceptors, covering and protecting the tissues and organs in the body. Therefore, the results obtained after performing the osteopathic techniques are possibly understood by the mechanical, autonomic and neuro- muscular proprieties. Conclusion: osteopathy is a complementary treatment for intestinal constipation, improving the symptoms, reducing the severity of the condition, decreasing the time of colon transit and increasing the intestinal motility as well as the patients quality of life.

High-velocity low-amplitude manipulation (thrust) and athletic performance: a systematic review / Manipulação em alta velocidade/baixa amplitude e desempenho atlético: uma revisão sistemática

Abstract Introduction: The high demand level in sports has encouraged the search for strategies to increase the yield. In this context, manual therapy through high-velocity low-amplitude (thrust) has been employed in many sports. Despite the adhesion of manual therapists in clinical practice, there were no systematic reviews on this topic. Objective: To evaluate the effects of thrust on the performance of athletes in relation to the outcomes hand-grip strength, jump height and running speed. Methods: The databases used in the search were MEDLINE / PUBMED, LILACS, CINAHL, PEDro, WEB OF SCIENCE, CENTRAL and SCOPUS, and Randomized controlled trials were included, whose participants were professionals or recreational athletes and had thrust as intervention. The methodological quality of the studies was assessed using the PEDro scale of 10 points. Intervention effects were determined by the mean difference and confidence interval. The data analysis was done in the descriptive form due to the heterogeneity found among studies. Results: Five trials were included with a total of 95 individuals. The methodological quality of studies was low, with an average value of 5.6 on the PEDro scale. It was found two articles for each outcome, but in none of them was presented differences between the experimental and control groups considering the confidence interval. Conclusion: The current evidence is insufficient to determine the use or nonuse the MAVBA in sports in order to improve performance.

Resumo Introdução: O elevado nível de exigência no meio esportivo tem incentivado a busca por estratégias para aumentar o rendimento. Nesse contexto, a terapia manual através da Manipulação em Alta e Velocidade e Baixa Amplitude (MAVBA) tem sido empregada em vários esportes. Apesar da adesão dos terapeutas manuais na prática clínica, não foram encontradas revisões sistemáticas acerca do tema. Objetivo: Avaliar os efeitos da manipulação de alta velocidade e baixa amplitude sobre o desempenho de atletas. Métodos: As bases de dados utilizadas na busca foram MEDLINE/PUBMED, LILACS, CINAHL, PEDro, WEB OF SCIENCE, CENTRAL e SCOPUS. Foram incluídos Ensaios Randomizados e Controlados, cujos participantes eram atletas profissionais ou recreacionais, que aplicaram a MAVBA como intervenção. A qualidade metodológica dos estudos foi avaliada por meio da Escala PEDro. Os efeitos da intervenção foram determinados através da diferença de média e do respectivo intervalo de confiança (IC). A análise dos dados foi realizada de maneira descritiva, em virtude da heterogeneidade encontrada entre os estudos. Resultados: Cinco ensaios foram incluídos com um total de 95 indivíduos. A qualidade metodológica dos estudos foi baixa, com uma média de 5.6 na Escala de PEDro. Foram encontrados dois artigos para cada desfecho, e em nenhum deles foi detectada diferença entre o grupo experimental e controle quando levado em consideração o IC. Conclusão: A evidência atual é insuficiente para determinar o uso ou o não uso da MAVBA em com objetivo de melhorar o desempenho esportivo.

Reflexões sobre o emprego da osteopatia nas políticas públicas de saúde no Brasil / Reflections on the use of osteopathy in public health policies in Brazil

The National Policy on Integrative and Complementary Practices was regulated by the Ministry of Health as a part of health changes in Brazil. The COFFITO was in charge to regulate the practice of osteopathy by trained physiotherapists. The aim of this review was a reflection about osteopathy integrated to public health policies. This is a literature review which the descriptors: osteopathy, musculoskeletal disorders, physical therapy, holistic therapies, complementary therapies and public policies. We concluded that osteopathy added to the techniques applied in the treatment of musculoskeletal disorders and orthopedic disorders showed satisfactory therapeutic effects to individuals. Its effects arise on physical, social and economic aspects, justifying their participation in the public health policies in Brazil, since these results are in line with the concept of health adopted by WHO, which substantiates the existence of SUS. The Brazilian political structure of health seems to be interesting alternative to the practice of osteopathy with the low income population, although there is lack of knowledge by population and health professionals.(AU)

A Política Nacional de Práticas Integrativas e Complementares foi regulamentada pelo Ministério da Saúde em continuidade às mudanças sobre a saúde no Brasil. A esta política pública se soma o COFFITO ao regulamentar a prática da osteopatia por fisioterapeutas capacitados. Objetiva-se então fazer uma reflexão sobre a osteopatia integrada às políticas públicas de saúde. Trata-se de uma revisão a partir de levantamento literário e em periódicos online com os descritores: osteopatia, disfunções osteomioarticulares, fisioterapia, terapias holísticas, terapias complementares e políticas públicas. Concluiu-se que a osteopatia compõe o quadro de técnicas aplicadas no tratamento de disfunções musculoesqueléticas e transtornos de ordem ortopédica apresentando efeitos terapêuticos satisfatórios aos indivíduos. Seus efeitos decorrem sobre aspectos físicos, sociais e econômicos, justificando a sua participação nas políticas públicas de saúde no Brasil, uma vez que estes resultados se encontram em consonância com o conceito de saúde adotado pela OMS, o qual fundamenta a existência do SUS. A estrutura política da saúde no Brasil parece ser alternativa interessante para a prática da osteopatia junto à população de baixa renda, embora haja escassez de conhecimento tanto por parte da população quanto pelos profissionais de saúde. (AU)

Osteopatia craniana na função auditiva / Cranial osteopathy in hearing function

Osteopatia é a ciência que trata o sistema músculo-ósteo-articular e sua relação com os outros órgãos e sistemas. Poucas são as pesquisa que falam da interação da osteopatia na função auditiva, sendo assim um desafio para a comunidade científica na elaboração de novos trabalhos. O objetivo de nosso estudo foi identificar a influência da osteopatia craniana na função auditiva de indivíduos hígidos. Participaram da pesquisa 17 voluntários que passaram por uma anamnese com o fonoaudiólogo para verificação dos critérios de inclusão e exclusão. Logo após foi realizado o exame de imitanciometria de forma bilateral, em seguida, foi aplicado um protocolo de osteopatia contendo as seguintes manobras: Sutherland contra o movimento, Sutherland a favor do movimento e Ear Pull aplicados na orelha direita e mantendo-se a esquerda como controle. Os dados foram analisados por meio do teste Anova two-way, com post hoc de Bonfferroni e p < 0,05. Foi obtido como resultado a sensibilização dos músculos tensor do tímpano e estapédio evidenciado através da imitanciometria devido a redução do reflexo acústico na frequência auditiva de 500Hz da orelha direita (a frequência média antes foi de 93,53 ± 1,70 e depois foi de 89,41 ± 1,81 (p = 0,0101). Houve uma sensibilização do reflexo com consequente repercussão na função auditiva, de modo que os avaliados foram capazes de disparar o reflexo com níveis sonoros mais baixos. O principal achado da influência da osteopatia na função auditiva a sensibilização dos músculos estapédio e tensor do tímpano. Essa alteração se deu apenas na primeira frequência (500 Hz), frequência principal da fala, no momento inicial da ativação sonora a nível de ouvido médio e sua interface com a cóclea, favorecendo a melhoria da audição. (AU)

Osteopathy is the science which treats the musculoskeletal osteoarticular system and its relationship with other organs and systems. Few researches show interaction of osteopathy in hearing function, and thus is a challenge to the scientific community in developing new works about it. The aim of our study was to identify the influence of cranial osteopathy in hearing function in healthy individuals. Seventeen volunteers were interviewed with the audiologist to check the criteria for inclusion and exclusion. After that was performed bilaterally impedance and the protocol containing the following maneuvers of cranial osteopathy was applied: Sutherland in opposition to the free movement, Sutherland for free movement and ear Pull applied on the right ear and keeping the left as control. Data were analyzed using the Two-way Anova with post hoc Bonfferroni p < 0.05. As a result we obtained the sensitization of tensor tympani and stapedius muscles which was evidenced in the immittancetesting due to a decrease of acoustic reflex in hearing frequency of 500 Hz right ear (the average frequency before was 93.53 ± 1.70 and then was 89.411 ± 1.81 (p = 0.0101). There was a reflex sensitization, with consequent impact on the hearing function, so that the evaluated were capable of firing the reflection with lower sound levels. We can say that we achieved success in our study aims with the primary finding of the influence of hearing function in osteopathy responsiveness of stapedius and tensor tympani. This change occurred only in the first frequency (500 Hz), the speak frequency, at the time of the initial sound activation level of middle ear and its interface with the cochlea, favoring the improvement of hearing. (AU)

Influência da manipulação osteopática na amplitude de rotação da coluna cervical em indivíduos com cervicalgia mecânica crônica / Influence of manipulation at range of rotation of the cervical spine in chronic mechanical neck pain

JUSTIFICATIVA E OBJETIVOS: A amplitude de movimento do pescoço pode ser reduzida pela presença de disfunções vertebrais e miofasciais, as quais podem ser tratadas pela manipulação osteopática por meio da técnica articulatória rítmica cervical. O objetivo deste estudo foi verificar se a manipulação osteopática, através da técnica articulatória rítmica gera aumento da amplitude de rotação cervical mensurada por fleximetria. MÉTODOS: A casuística foi constituída de 58 indivíduos de ambos os gêneros, com idade média de 36±6,5 anos, com cervicalgia mecânica crônica, que foram submetidos de maneira randomizada à fleximetria controle da rotação cervical, à manipulação osteopática, por meio da técnica articulatória rítmica, ao repouso de 5 minutos e à fleximetria estudo da rotação cervical. RESULTADOS: A comparação entre as médias das fleximetrias de rotação cervical através do teste t de Student para dados pareados, ao nível de significância de 0,05 (5%), mostrou que houve aumento significativo da rotação cervical em todos os casos (p<0,05) passando de 151,4º para 162,5º no arco total de movimento (aumento de 7,3%). CONCLUSÃO: Os resultados foram dentro do esperado, confirmando que a manipulação osteopática, através da técnica articulatória rítmica gerou aumento significativo da amplitude de rotação cervical em todos os casos, podendo servir de tratamento de doenças que se relacionam à redução da mobilidade vertebral, como cervicalgia e osteoartrite cervical.

BACKGROUND AND OBJECTIVES: Neck range of motion may be decreased by vertebral and myofascial dysfunctions, which may be treated with osteopathic manipulation through the cervical rhythmic articulatory technique. This study aimed at verifying whether osteopathic manipulation with rhythmic articulatory technique improves cervical rotation range measured by fleximetry. METHODS: The group was made up of 58 individuals of both genders, mean age of 36±6.5 years, with chronic mechanical neck pain, who were randomized to cervical rotation control fleximetry, to osteopathic manipulation through the rhythmic articulatory technique, to 5-minute rest and to cervical rotation study fleximetry. RESULTS: The comparison of cervical rotation fleximetry means through Student's t test for paired data at significance level of 0.05 (5%) has shown significant cervical rotation improvement in all cases (p<0.05), going from 151.4º to 162.5º in total movement arch (7.3% improvement). CONCLUSION: Results were as expected, confirming that osteopathic manipulation using the rhythmic articulatory technique generates significant improvement of cervical rotation range in all cases and may be an alternative to treat diseases related to vertebral mobility reduction, such as neck pain and cervical osteoarthritis.

Efeito imediato da manipulação osteopática tibiotársica no equilíbrio estático de mulheres jovens / Immediate effect of manipulation of talocrural joint in static balance in young women / Efecto inmediato de la manipulación de la articulación talocrural en equilibrio estático en mujeres jóvenes

Objetivou-se verificar o efeito imediato da manipulação osteopática para anterioridade tibiotársica sobre o equilíbrio estático, em mulheres jovens. Metodologia: Vinte mulheres foram divididas igualmente em dois grupos: manipulação do tornozelo (GMT) e controle (GC). Analisou-se o deslocamento ântero-posterior (Y) e médio-lateral (X), de olhos abertos e fechados, em um Baropodômetro. Resultados: Na análise intergrupos, o GMT apresentou maior oscilação (eixos X e Y), em todos os momentos, comparado ao GC (p<0,05). Nas comparações intragrupo, o GMT apresentou aumento significativo da oscilação no eixo Y, pós-intervenção, com olhos abertos (p<0,05). Conclusão: A manipulação para anterioridade tibiotársica diminuiu, imediatamente, o equilíbrio estático ântero-posterior no GMT com os olhos abertos.

Objective: To investigate the immediate effect of osteopathic manipulation of talocrural joint for anterior talocrural, on static balance, in young women. Methods: Twenty women were divided into two groups: manipulation of talocrural (MTG) and control (CG). It was analyzed the anterior-posterior (Y) and mediolateral (X) displacement with open and closed eyes in a baropodometry. Results: In the intergroup analysis, the oscillation showed higher in MTG (X and Y axes), at all times, compared to CG (p<0,05). In intragroup comparisons, the MTG increased significantly in the Y axis of oscillation, after intervention, with open eyes (p<0,05). Conclusion: The manipulation of talocrural joint decreased immediately the static anteroposterior balance in GMT with his eyes open.

Objetivo: Investigar el efecto inmediato de la manipulación osteopática de la articulación talocrural para anterioridad talocrural, en equilibrio estático, en mujeres jóvenes. Métodos: Veinte mujeres fueron divididas en dos grupos: manipulación talocrural (GMT) y control (GC). Se analizó los desplazamientos anterior-posterior (Y) y mediolateral (X) con los ojos abiertos y cerrados en un baropodometro. Resultados: Entre los grupos, la oscilación se mostró superior en GMT (ejes X e Y) (p<0,05). Intragrupo, en el GMT oscilación la aumento significativamente en el eje Y, después de la intervención, con los ojos abiertos (p<0,05). Conclusión: La manipulación de la articulación talocrural disminuyó de inmediato el equilibrio anteroposterior estático en GMT con los ojos abiertos.