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Hagan CR, Anderson AR, Hensley CP. Lumbar Spine and Neural Tissue Mobilizations Improve Outcomes in Runners Presenting With Foot/Ankle Pathology: A Case Series. J Sport Rehabil 2024; 33:549-555. [PMID: 39159927 DOI: 10.1123/jsr.2024-0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 05/29/2024] [Accepted: 06/10/2024] [Indexed: 08/21/2024]
Abstract
CONTEXT Foot/ankle pain is common among runners. Inadequate management of runners with foot/ankle pain can lead to lost training time, competition removal, and other activity limitations. Neurodynamics, which refers to the integrated biomechanical, physiological, and structural function of the nervous system during movement, can be overlooked in patients with foot/ankle pain. Although a link between the cervical spine, neurodynamics, and upper quarter pain has been studied, less is known about the relationship between the lumbar spine and lower quarter. This case series describes the successful management of 3 runners with foot/ankle pain. CASE PRESENTATIONS Three female runners (ages 23, 24, and 45 y) presented to physical therapy with foot/ankle pain and difficulty running. Each patient had positive examination findings with local foot/ankle testing. A comprehensive lumbar spine examination demonstrated impairments in range of motion and joint mobility that were hypothesized to be contributing. Positive lower quarter neurodynamic tests were also found. MANAGEMENT AND OUTCOMES All patients were treated with nonthrust lumbar spine mobilization and lower quarter neural tissue mobilization. Changes in the Patient-Specific Functional Scale, Numerical Pain Rating Scale, Lower Extremity Functional Scale, and Global Rating of Change occurred after intervention targeting the lumbar spine and lower-extremity neurodynamics in all patients. CONCLUSIONS This case series demonstrates the importance of including a thorough lumbar spine examination and neurodynamic testing to identify appropriate interventions while managing patients with foot/ankle pain, even when patients have signs indicative of local ankle/foot pathology. These examination procedures should be performed particularly when a patient is not responding to management targeting local foot/ankle structures.
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Affiliation(s)
- Christopher R Hagan
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
| | - Alexandra R Anderson
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
- The Physical Therapy Academy, Chicago, IL, USA
| | - Craig P Hensley
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
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2
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Cabezas-Yagüe E, Martínez-Pozas O, Gozalo-Pascual R, Muñoz Blanco E, Lopez Paños R, Jiménez-Ortega L, Cuenca-Zaldívar JN, Sánchez Romero EA. Comparative effectiveness of Maitland Spinal Mobilization versus myofascial techniques on pain and symptom severity in women with Fibromyalgia syndrome: A quasi-randomized clinical trial with 3-month follow up. Musculoskelet Sci Pract 2024; 73:103160. [PMID: 39182326 DOI: 10.1016/j.msksp.2024.103160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 07/27/2024] [Accepted: 08/05/2024] [Indexed: 08/27/2024]
Abstract
OBJECTIVE The aim of this experimental study was to determine which manual therapy approach is more effective in addressing health status by improving symptoms (sensory, cognitive, emotional, and social) in patients with fibromyalgia. MATERIAL AND METHODS A quasi-randomized clinical trial with 3-month follow-up was conducted in 52 female patients (age 52.5 ± 8.1 years) affected by rheumatologist-diagnosed Fibromyalgia and evaluated at the Asociación de Fibromialgia y Síndrome de Fatiga Crónica (AFINSYFACRO) in Móstoles and AFIBROM, Madrid, Spain. Two manual therapy approaches were applied: the myofascial technique approach (MTA) and Maitland Mobilization Approach (MMA). The study examined the following outcomes: Widespread Pain, Symptom Severity, Impact on Quality of Life, Perceived Pain, Sensitization-Associated Pain, Sleep Quality, Physical Activity, and Psychological, Cognitive, and Emotional Factors. Patient Satisfaction was also assessed. RESULTS No significant differences were found between groups over time for most variables. However, the MTA group showed significant improvements in pain intensity, central sensitization, general health, sleep quality, and anxiety compared with the MMA group. CONCLUSIONS Despite the lack of between-group differences in all variables over time, MTA may be useful in the treatment of fibromyalgia, reducing pain, central sensitization, and negative emotional symptoms, as well as improving general health and sleep quality. Due to problems during the study, randomization was abandoned. This problem becomes a virtue by taking advantage of the situation to apply statistical compensation methods, which will serve as a guide for future research that suffers from this problem. We suggest the inclusion of longer follow-up periods in future studies.
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Affiliation(s)
- Elena Cabezas-Yagüe
- Department of Rehabilitation, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670, Madrid, Spain; Department of Physical Therapy, Faculty of Medicine, CEU-San Pablo University, 28003, Madrid, Spain
| | - Oliver Martínez-Pozas
- Interdisciplinary Research Group on Musculoskeletal Disorders, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670, Villaviciosa de Odón, Spain; Escuela Internacional de Doctorado, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28933, Alcorcón, Spain; Physiotherapy and Orofacial Pain Working Group, Sociedad Española de Disfunción Craneomandibular y Dolor Orofacial (SEDCYDO), 28009, Madrid, Spain
| | | | - Elisa Muñoz Blanco
- Department of Physical Therapy, Faculty of Medicine, CEU-San Pablo University, 28003, Madrid, Spain
| | - Raquel Lopez Paños
- Unidad de Fisioterapia de Neurorrehabilitación y Control Motor, Ruber Internacional Paseo de La Habana 43, 28036, Madrid, Spain
| | - Laura Jiménez-Ortega
- Department of Psychobiology, Complutense University of Madrid, 28040, Madrid, Spain; Psychology and Orofacial Pain Working Group, Sociedad Española de Disfunción Craneomandibular y Dolor Orofacial (SEDCYDO), 28009, Madrid, Spain; Center of Human Evolution and Behavior, UCM-ISCIII, 28029 Madrid, Spain
| | - Juan Nicolás Cuenca-Zaldívar
- Interdisciplinary Research Group on Musculoskeletal Disorders, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670, Villaviciosa de Odón, Spain; Grupo de Investigación en Fisioterapia y Dolor, Departamento de Fisioterapia, Facultad de Enfermería y Fisioterapia, Universidad de Alcalá, 28801, Alcalá de Henares, Spain; Research Group in Nursing and Health Care, Puerta de Hierro Health Research Institute-Segovia de Arana (IDIPHISA), 28222, Majadahonda, Spain; Physical Therapy Unit, Primary Health Care Center "El Abajón", 28231, Las Rozas de Madrid, Spain
| | - Eleuterio A Sánchez Romero
- Department of Rehabilitation, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670, Madrid, Spain; Interdisciplinary Research Group on Musculoskeletal Disorders, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670, Villaviciosa de Odón, Spain; Physiotherapy and Orofacial Pain Working Group, Sociedad Española de Disfunción Craneomandibular y Dolor Orofacial (SEDCYDO), 28009, Madrid, Spain; Research Group in Nursing and Health Care, Puerta de Hierro Health Research Institute-Segovia de Arana (IDIPHISA), 28222, Majadahonda, Spain.
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3
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Aspinall SL, Nim C, Hartvigsen J, Cook CE, Skillgate E, Vogel S, Hohenschurz-Schmidt D, Underwood M, Rubinstein SM. Waste not, want not: call to action for spinal manipulative therapy researchers. Chiropr Man Therap 2024; 32:16. [PMID: 38745213 PMCID: PMC11092111 DOI: 10.1186/s12998-024-00539-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 05/01/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Research waste is defined as research outcomes with no or minimal societal benefits. It is a widespread problem in the healthcare field. Four primary sources of research waste have been defined: (1) irrelevant or low priority research questions, (2) poor design or methodology, (3) lack of publication, and (4) biased or inadequate reporting. This commentary, which was developed by a multidisciplinary group of researchers with spinal manipulative therapy (SMT) research expertise, discusses waste in SMT research and provides suggestions to improve future research. MAIN TEXT This commentary examines common sources of waste in SMT research, focusing on design and methodological issues, by drawing on prior research and examples from clinical and mechanistic SMT studies. Clinical research is dominated by small studies and studies with a high risk of bias. This problem is compounded by systematic reviews that pool heterogenous data from varying populations, settings, and application of SMT. Research focusing on the mechanisms of SMT often fails to address the clinical relevance of mechanisms, relies on very short follow-up periods, and has inadequate control for contextual factors. CONCLUSIONS This call to action is directed to researchers in the field of SMT. It is critical that the SMT research community act to improve the way research is designed, conducted, and disseminated. We present specific key action points and resources, which should enhance the quality and usefulness of future SMT research.
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Affiliation(s)
| | - Casper Nim
- Medical Research Unit, Spine Centre of Southern Denmark, University Hospital of Southern Denmark, Middelfart, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Center for Muscle and Joint Health, Department of Sport Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Jan Hartvigsen
- Center for Muscle and Joint Health, Department of Sport Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Chiropractic Knowledge Hub, Odense, Denmark
| | - Chad E Cook
- Department of Orthopaedics, Department of Population Health Sciences, Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Eva Skillgate
- Department of Health Promotion Science, Sophiahemmet University, Stockholm, Sweden
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Naprapathögskolan, Scandinavian College of Naprapathic Manual Medicine, Stockholm, Sweden
| | - Steven Vogel
- Research Centre, University College of Osteopathy, London, UK
| | - David Hohenschurz-Schmidt
- Research Centre, University College of Osteopathy, London, UK
- Pain Research, Department of Surgery & Cancer, Imperial College London, London, UK
| | - Martin Underwood
- Warwick Clinical Trials Unit, Warwick Medical School, Coventry, UK
- University Hospitals of Coventry and Warwickshire, Coventry, UK
| | - Sidney M Rubinstein
- Department of Health Sciences, Faculty of Science and Amsterdam Movement Science Research Institute, Vrije Universiteit, Amsterdam, the Netherlands
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Gagnon P, Dunning J, Bliton P, Charlebois C, Henry N, Gorby P, Mourad F. Dry needling in the management of chronic tension-type headache associated with levator scapulae syndrome: A case report. Clin Case Rep 2024; 12:e8858. [PMID: 38689684 PMCID: PMC11060885 DOI: 10.1002/ccr3.8858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 03/08/2024] [Accepted: 04/04/2024] [Indexed: 05/02/2024] Open
Abstract
Key Clinical Message The use of DN to the muscular trigger points and distal periosteal enthesis of the levator scapulae may be a useful adjunct intervention within a multi-modal plan of care for the management of work-related chronic tension-type headaches associated with LSS. Abstract Chronic tension-type headaches (CTTH) have a lifetime prevalence of 42% and account for more lost workdays than migraine headaches. Dry needling (DN) is being increasingly used by physical therapists in the management of CTTH; however, to date, the supporting evidence is limited. The purpose of this case report was to describe how three sessions of DN targeting myofascial trigger points in the levator scapulae (LS) muscle and its distal enthesis was used to treat a 63-year-old male patient who presented with work-related CTTH associated with levator scapulae syndrome (LSS). The patient was treated for five visits over the course of 2 months. At discharge and 6-month follow-up, the patient reported full resolution of symptoms. Self-report outcomes included the numeric pain rating scale and the Neck Disability Index. The use of DN to the LS muscle and its distal enthesis may be a valuable addition to a multi-modal plan of care in the treatment of work-related CTTH associated with LSS.
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Affiliation(s)
- Peter Gagnon
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical TherapyMontgomeryAlabamaUSA
- Physical Therapy of BoulderBoulderColoradoUSA
| | - James Dunning
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical TherapyMontgomeryAlabamaUSA
- Montgomery Osteopractic Physical Therapy & AcupunctureMontgomeryAlabamaUSA
| | - Paul Bliton
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical TherapyMontgomeryAlabamaUSA
- William S. Middleton VA HospitalMadisonWisconsinUSA
| | - Casey Charlebois
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical TherapyMontgomeryAlabamaUSA
- Arcadia UniversityGlensidePennsylvaniaUSA
| | - Nathan Henry
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical TherapyMontgomeryAlabamaUSA
- Physio RoomColorado SpringsColoradoUSA
| | - Patrick Gorby
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical TherapyMontgomeryAlabamaUSA
- Gorby Osteopractic Physiotherapy, Colorado Springs, COColorado SpringsColoradoUSA
| | - Firas Mourad
- Department of PhysiotherapyLUNEX International University of Health, Exercise and SportsDifferdangeLuxembourg
- Luxembourg Health & Sport Sciences Research Institute ASBLDifferdangeLuxembourg
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Salniccia F, de Vidania S, Martinez-Caro L. Peripheral and central changes induced by neural mobilization in animal models of neuropathic pain: a systematic review. Front Neurol 2024; 14:1289361. [PMID: 38249743 PMCID: PMC10797109 DOI: 10.3389/fneur.2023.1289361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/13/2023] [Indexed: 01/23/2024] Open
Abstract
Introduction Neural mobilization (NM) is a physiotherapy technique involving the passive mobilization of limb nerve structures with the aim to attempt to restore normal movement and structural properties. In recent years, human studies have shown pain relief in various neuropathic diseases and other pathologies as a result of this technique. Improvement in the range of motion (ROM), muscle strength and endurance, limb function, and postural control were considered beneficial effects of NM. To determine which systems generate these effects, it is necessary to conduct studies using animal models. The objective of this study was to gather information on the physiological effects of NM on the peripheral and central nervous systems (PNS and CNS) in animal models. Methods The search was performed in Medline, Pubmed and Web of Science and included 8 studies according to the inclusion criteria. Results The physiological effects found in the nervous system included the analgesic, particularly the endogenous opioid pathway, the inflammatory, by modulation of cytokines, and the immune system. Conclusion On the basis of these results, we can conclude that NM physiologically modifies the peripheral and central nervous systems in animal models.
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Affiliation(s)
- Federico Salniccia
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Spain
| | - Silvia de Vidania
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Spain
| | - Leticia Martinez-Caro
- Facultad de Ciencias de la Salud, Universidad Internacional de La Rioja, Logroño, Spain
- Facultad de Ciencias Sociales Aplicadas y de la Comunicación, UNIE Universidad y Empresa, Madrid, Spain
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6
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Hoss IM, Pradal LDA, Leal TSDS, Bertolini GRF, Costa RM, Ribeiro LDFC. Articular mobilization promotes improvement in functional and inflammatory parameters in a gouty arthritis model. EINSTEIN-SAO PAULO 2023; 21:eAO0465. [PMID: 37909651 PMCID: PMC10586854 DOI: 10.31744/einstein_journal/2023ao0465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 06/12/2023] [Indexed: 11/03/2023] Open
Abstract
OBJECTIVE Gouty arthritis is characterized by painful inflammation due to the deposition of monosodium urate crystals in joint tissues. Despite available treatments, many patients experience ineffective management and adverse effects. This study evaluated a manual therapy protocol involving passive joint mobilization at the peak of inflammation in a gouty arthritis model using functional and inflammatory parameters. METHODS Twenty male Wistar rats, 12 weeks old, were divided into two groups (n=10 each): Gouty Arthritis and Control Groups, which were further subdivided into treated and untreated groups (n=5 each). The Gouty Arthritis Group received intraarticular knee injection of 50µL of monosodium urate crystals, while the Control Group received 50µL of phosphate buffered saline. The treatment involved a 9-minutes session of grade III joint mobilization (according to Maitland). Nociception, grip strength, and edema were evaluated before induction (EV0), 7 hours after assessment (EV1), immediately after treatment (EV2), and 1 hour after treatment (EV3). The animals were euthanized, and synovial fluid was collected to analyze leukocyte migration. RESULTS The model mimicked the signs of the Gouty Arthritis Group, with a decrease in the threshold of nociception and strength and an increase in edema and leukocyte count. The mobilization protocol significantly increased the nociceptive threshold and grip strength and reduced edema; however, it did not reverse the increase in leukocyte count. CONCLUSION Our results suggest that mobilization promotes analgesia and may modulate the inflammatory process owing to reduced edema and subtle attenuation of cell migration, which contributes to strength gain.
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Affiliation(s)
- Iranilda Moha Hoss
- Universidade Estadual do Oeste do ParanáCascavelPRBrazil Universidade Estadual do Oeste do Paraná, Cascavel, PR, Brazil.
| | - Lilian de Araujo Pradal
- Universidade Estadual do Oeste do ParanáCascavelPRBrazil Universidade Estadual do Oeste do Paraná, Cascavel, PR, Brazil.
| | - Taciane Stein da Silva Leal
- Universidade Estadual do Oeste do ParanáCascavelPRBrazil Universidade Estadual do Oeste do Paraná, Cascavel, PR, Brazil.
| | - Gladson Ricardo Flor Bertolini
- Universidade Estadual do Oeste do ParanáCascavelPRBrazil Universidade Estadual do Oeste do Paraná, Cascavel, PR, Brazil.
| | - Rose Meire Costa
- Universidade Estadual do Oeste do ParanáCascavelPRBrazil Universidade Estadual do Oeste do Paraná, Cascavel, PR, Brazil.
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Paraskevopoulos E, Plakoutsis G, Chronopoulos E, Maria P. Effectiveness of Combined Program of Manual Therapy and Exercise Vs Exercise Only in Patients With Rotator Cuff-related Shoulder Pain: A Systematic Review and Meta-analysis. Sports Health 2023; 15:727-735. [PMID: 36517977 PMCID: PMC10467476 DOI: 10.1177/19417381221136104] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
CONTEXT Therapeutic exercise is considered the mainstay in the management of rotator cuff-related shoulder pain (RCRSP). Manual therapy (MT) interventions have also shown to be effective in RCRSP. However, the benefits of adding MT along with exercise interventions for the management of RCRSP remain unknown. OBJECTIVE To evaluate the additional benefits of MT with exercise compared with exercise in isolation for the management of RCRSP. DATA SOURCES A search of PubMed, Scopus, PEDro, and EBSCO from the inception date of each database through April 20, 2022, was conducted for randomized trials comparing the additional effects of MT in exercise interventions compared with exercise alone for pain management and function in patients with RCRSP. Standardized mean differences (SMDs) and 95% CIs were calculated using a random-effects inverse variance model according to the outcome of interest and comparison group. Methodological quality was assessed with PEDro and quality of evidence with the grading of recommendations assessment, development and evaluation approach. STUDY DESIGN Meta-analysis of randomized controlled trials. LEVEL OF EVIDENCE Level 2. RESULTS Twelve articles were found eligible and 8 of them demonstrated high methodological quality. Eleven articles were included for quantitative analysis. Pain with movement was not significantly different between MT and exercise versus exercise alone (SMD [95% CI] = -0.15 [-0.41 to 0.12]; I2 = 0%), whereas pain at rest was significantly improved in the groups that used exercise only with a moderate effect size (SMD [95% CI] = 0.47 [0.04 to 0.89]; I2 = 75%). Furthermore, shoulder function was not significantly different between MT and exercise versus exercise alone in the short term (SMD [95% CI] = 0.23 [-0.22 to 0.69]; I2 = 88%) or the long term (SMD [95% CI] = -0.02 [-0.21 to 0.16]; I2 = 2%). CONCLUSION Adding MT to exercise interventions for the management of RCRSP is not more effective than exercise alone for pain and function in adult patients.
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Affiliation(s)
| | - George Plakoutsis
- Department of Physiotherapy, University of West Attica, Athens, Greece
| | - Efstathios Chronopoulos
- Second Department of Orthopaedics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Papandreou Maria
- Department of Physiotherapy, University of West Attica, Athens, Greece
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Martins DF, Sorrentino V, Mazzardo-Martins L, Reed WR, Santos ARS, Gadotti VM, Zamponi GW. Antihyperalgesic effect of joint mobilization requires Cav3.2 calcium channels. Mol Brain 2023; 16:60. [PMID: 37464359 PMCID: PMC10355051 DOI: 10.1186/s13041-023-01049-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 07/12/2023] [Indexed: 07/20/2023] Open
Abstract
The present study was undertaken to explore the relative contributions of Cav3.2 T-type channels to mediating the antihyperalgesic activity of joint manipulation (JM) therapy. We used the chronic constriction injury model (CCI) to induce peripheral neuropathy and chronic pain in male mice, followed by JM. We demonstrate that JM produces long-lasting mechanical anti-hyperalgesia that is abolished in Cav3.2 null mice. Moreover, we found that JM displays a similar analgesic profile as the fatty acid amide hydrolase inhibitor URB597, suggesting a possible converging mechanism of action involving endocannabinoids. Overall, our findings advance our understanding of the mechanisms through which JM produces analgesia.
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Affiliation(s)
- Daniel F Martins
- Experimental Neuroscience Laboratory (LaNEx), Postgraduate Program in Health Sciences, University of Southern Santa Catarina, Palhoça, SC, Brazil
- Programa de Pós-Graduação em Neurociências, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, Campus Universitário-Trindade, Florianópolis, SC, Brazil
| | - Victor Sorrentino
- Experimental Neuroscience Laboratory (LaNEx), Postgraduate Program in Health Sciences, University of Southern Santa Catarina, Palhoça, SC, Brazil
| | - Leidiane Mazzardo-Martins
- Experimental Neuroscience Laboratory (LaNEx), Postgraduate Program in Health Sciences, University of Southern Santa Catarina, Palhoça, SC, Brazil
- Programa de Pós-Graduação em Neurociências, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, Campus Universitário-Trindade, Florianópolis, SC, Brazil
| | - William R Reed
- Department of Physical Therapy, Rehabilitation Science Program, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Adair R S Santos
- Programa de Pós-Graduação em Neurociências, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, Campus Universitário-Trindade, Florianópolis, SC, Brazil
| | - Vinícius M Gadotti
- Departments of Clinical Neurosciences, and Physiology & Pharmacology, Hotchkiss Brain Institute, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, T2N 4N1, Canada
| | - Gerald W Zamponi
- Departments of Clinical Neurosciences, and Physiology & Pharmacology, Hotchkiss Brain Institute, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, T2N 4N1, Canada.
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9
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Karadjova M. Changes in range of motion and neurological symptoms in patients with thoracolumbar junction syndrome treated with spinal manipulations. MANUELLE MEDIZIN 2023. [DOI: 10.1007/s00337-023-00952-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
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10
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The Effectiveness of Neuromobilization in Patients With Cervical Radiculopathy: A Systematic Review With Meta-Analysis. J Sport Rehabil 2023; 32:325-334. [PMID: 36395760 DOI: 10.1123/jsr.2022-0259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 11/18/2022]
Abstract
CONTEXT Neuromobilization exercises (NE) could be a useful therapeutic tool to induce analgesia and increase function and range of motion (ROM) in patients with musculoskeletal pathologies with neuropathic components; however, the effectiveness of this intervention in patients with cervical radiculopathy (CR) is unknown. OBJECTIVE To determine the effectiveness of NE in CR on pain, function, and ROM. DESIGN Systematic review and meta-analysis. EVIDENCE ACQUISITION An electronic search was performed in the MEDLINE, Scopus, PEDro, and EBSCO databases from inception until June 2022. The authors included randomized clinical trials that evaluated the effectiveness of NE against control groups or other interventions that aimed to treat patients with CR. EVIDENCE SYNTHESIS Seven clinical trials met the eligibility criteria, and for the quantitative synthesis, 5 studies were included. For the studies that compared NE with a control group, the standardized mean difference for pain was -1.33/10 (95% confidence interval [CI], -1.80 to -0.86; P < .01; I2 = 0%), for function with the Neck Disability Index was -1.21/50 (95% CI, -1.67 to -0.75; P < .01; I2 = 0%), and for neck flexion and extensions was 0.66 (95% CI, 0.23 to 1.10; P < .01; I2 = 0%) and 0.47 (95% CI, 0.04 to 0.90; P < .01; I2 = 0%), respectively, with evidence of clinical effectiveness. These findings were based on moderate-quality evidence according to the Grading of Recommendation, Assessment, Development, and Evaluation rating. In studies that compared NE with other interventions, the meta-analysis failed to demonstrate the statistical or clinical superiority of NE. CONCLUSIONS Moderate quality of evidence suggests that NE may be superior to no treatment for pain, function, and ROM in patients with CR. In contrast, NE are not superior to other interventions in the same outcomes, based on low- to very low-quality evidence. More high-quality research is needed to assess the consistency of these results.
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11
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Syrgiamiotis C, Krekoukias G, Gkouzioti K, Hebron C. The Immediate Hypoalgesic Effect of Low and High Force Thoracic Mobilizations in Asymptomatic Subjects as Measured by Pain Pressure Thresholds (PPT). Diagnostics (Basel) 2023; 13:diagnostics13030544. [PMID: 36766649 PMCID: PMC9914839 DOI: 10.3390/diagnostics13030544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/27/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
Physiotherapists commonly use mobilizations for treating patients with thoracic spine pain (TSP). There is evidence to suggest that spinal mobilizations can decrease pain. Different doses of mobilization treatment are applied, however there is a paucity of evidence on the influence of these dosage parameters. The effect of different forces of treatment remains unknown. This study aimed to investigate whether there was a difference in the hypoalgesic effect of high and low force thoracic mobilizations. This single-blinded, randomized, within-subject, repeated measures, cross-over design recruited 28 asymptomatic participants. Participants received the experimental conditions of high (200 N) and low force (30 N) mobilizations to T6 at least 48 h apart. Pressure pain thresholds (PPTs) were measured before and immediately after each experimental intervention at three different standardized sites. The results demonstrated that high force thoracic mobilizations caused a significant increase in PPT measures compared to low force mobilizations. This effect was detected at all PPT sites. This study suggests that high force thoracic PA mobilizations cause a significantly greater hypoalgesic response in asymptomatic participants than low force thoracic mobilizations. The hypoalgesic response seems to be elicited not only locally at the site of the intervention, but in a widespread manner.
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Affiliation(s)
- Charilaos Syrgiamiotis
- Faculty of Health, School of Health Professions, University of Brighton, 49 Darley Road, Eastbourne BN20 7UR, UK
- Correspondence: (C.S.); (C.H.); Tel.: +30-210-6002258 (C.S.)
| | - Georgios Krekoukias
- Laboratory of Advanced Physiotherapy, Physiotherapy Department, School of Health & Care Sciences, University of West Attica (UNIWA), 12243 Athens, Greece
| | - Katerina Gkouzioti
- Faculty of Health, School of Health Professions, University of Brighton, 49 Darley Road, Eastbourne BN20 7UR, UK
| | - Clair Hebron
- Faculty of Health, School of Health Professions, University of Brighton, 49 Darley Road, Eastbourne BN20 7UR, UK
- Correspondence: (C.S.); (C.H.); Tel.: +30-210-6002258 (C.S.)
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Jayaseelan DJ, Sault JD, Fernandez-de-Las-Penas C. Manual therapy should not be on the sideline in the game of treating tendinopathy. J Man Manip Ther 2022; 30:309-314. [PMID: 35253631 PMCID: PMC9487951 DOI: 10.1080/10669817.2022.2047269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Tendinopathy is a common but difficult condition to manage in the orthopedic and sports settings. Despite strong evidence supporting exercise and load-management, a substantial proportion of individuals with the condition do not achieve a satisfactory long-term outcome. Tendinopathy can be associated with a number of impairments, including mobility deficits, muscle performance impairments, pain, and possible altered central pain processing - all of which are indications for manual therapy. Manual therapy has not been well described in the management of tendinopathy, even though its indications match the impairments associated with the condition. In this clinical perspective, the role of manual therapy in the management of tendinopathy is explored, with the intention of expanding possible treatment strategies for this challenging condition.
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Affiliation(s)
- Dhinu J. Jayaseelan
- Department of Health, Human Function and Rehabilitation Sciences, The George Washington University, Washington, DC, USA,CONTACT Dhinu J. Jayaseelan Department of Health, Human Function and Rehabilitation Sciences, The George Washington University, Washington, DC, USA
| | - Josiah D. Sault
- University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
| | - Cesar Fernandez-de-Las-Penas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcon, Spain
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13
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Immediate Effects of Long-Axis Talocrural Thrust Manipulation on the Length of the Anterior Talofibular and Calcaneofibular Ligaments Measured With Musculoskeletal Ultrasound Imaging. J Manipulative Physiol Ther 2022; 45:153-162. [PMID: 35753871 DOI: 10.1016/j.jmpt.2022.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 03/22/2022] [Accepted: 03/22/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of the present study was to measure the immediate effect of a thrust manipulation on the length of the anterior talofibular and calcaneofibular ligaments in healthy patients. METHODS A convenience sample of 47 healthy patients were recruited for this quasi-experimental study. The patients had an age range from 22 to 54 years, with a mean age of 30.36 years. There were 23 female patients and 24 male patients. Musculoskeletal ultrasound imaging was used to measure the length of the anterior talofibular and calcaneofibular ligaments before and immediately after a high-velocity long-axis thrust manipulation of the talocrural joint during various validated test positions. RESULTS A single long-axis thrust manipulation did not result in a significant change in the length of the anterior talofibular ligament (P = .325). Additionally, there was no significant difference in calcaneofibular length after a long-axis thrust manipulation (P = .26). CONCLUSION The results indicate that the length of the anterior talofibular and calcaneofibular ligament did not significantly change after a single long-axis thrust manipulation of the talocrural joint in healthy patients. It appears that the joint capsule of the talocrural joint reached end-range during the manipulation before the ligament undergoes plastic length changes; thus, the increase in joint range of motion after a thrust manipulation was probably not due to increased plastic length changes of the anterior talofibular and calcaneofibular ligaments.
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[6]-Shogaol Attenuates Oxaliplatin-Induced Allodynia through Serotonergic Receptors and GABA in the Spinal Cord in Mice. Pharmaceuticals (Basel) 2022; 15:ph15060726. [PMID: 35745645 PMCID: PMC9227032 DOI: 10.3390/ph15060726] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 06/02/2022] [Indexed: 01/27/2023] Open
Abstract
Although oxaliplatin is a well-known anti-cancer agent used for the treatment of colorectal cancer, treated patients often experience acute cold and mechanical allodynia as side effects. Unfortunately, no optimal treatment has been developed yet. In this study, [6]-shogaol (10 mg/kg, i.p.), which is one of the major bioactive components of Zingiber officinale roscoe (Z. officinale), significantly alleviated allodynia induced by oxaliplatin (6 mg/kg, i.p.) injection. Cold and mechanical allodynia were assessed by acetone drop and von Frey filament tests, respectively. The analgesic effect of [6]-shogaol was blocked by the intrathecal injection of 5-HT1A, 5-HT3, and GABAB receptor antagonists, NAN-190 (1 μg), MDL-72222 (15 μg), and CGP 55845 (10 μg), respectively. Furthermore, oxaliplatin injection lowered the GABA concentration in the superficial laminae of the spinal dorsal horn, whereas [6]-shogaol injection significantly elevated it. The GAD (glutamic acid decarboxylase) 65 concentration also increased after [6]-shogaol administration. However, pre-treatment of NAN-190 completely inhibited the increased GABA induced by [6]-shogaol in the spinal dorsal horn, whereas MDL-72222 partially blocked the effect. Altogether, these results suggest that [6]-shogaol could attenuate oxaliplatin-induced cold and mechanical allodynia through 5-HT1A and 5-HT3 receptor antagonists located in the GABAergic neurons in the spinal dorsal horn in mice.
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Is Cervical Stabilization Exercise Immediately Effective in Patients with Chronic Neck Pain and Upper Cervical Spine Dysfunction? Randomized Controlled Trial. Life (Basel) 2022; 12:life12050714. [PMID: 35629381 PMCID: PMC9147665 DOI: 10.3390/life12050714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/02/2022] [Accepted: 05/09/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose: To compare the effectiveness of a single exercise session with manual therapy techniques in the segments of the upper cervical spine (C0−1, C1−2 and C2−3), against a single exercise session in patients with chronic neck pain and mobility deficits in the upper cervical spine. Methods: A single-blind randomized controlled trial was performed. Fifty-eight patients were recruited (29 for the manual therapy and exercise group and 29 for the exercise group) who presented chronic neck pain and upper cervical spine dysfunction. The exercise focused on the deep muscles. The manual therapy combined manipulations and mobilizations with these exercises. Cervical range of motion, flexion-rotation test, pressure pain threshold and pain intensity were measured by a blind evaluator before and after the intervention. Results: Compared to pre-intervention, after intervention, the exercise group was significantly lower in terms of the range of motion, flexion-rotation test, and pressure pain threshold (p < 0.05). The manual therapy and exercise group improved in upper cervical flexion, the flexion-rotation test and intensity of pain (p < 0.05). Conclusions: It may be necessary to normalize the mobility of the upper cervical spine before cervical stabilization training, in patients with chronic neck pain and mobility deficits in the upper cervical spine.
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16
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Rodríguez-Sanz J, Malo-Urriés M, Lucha-López MO, López-de-Celis C, Pérez-Bellmunt A, Corral-de-Toro J, Hidalgo-García C. Comparison of an exercise program with and without manual therapy for patients with chronic neck pain and upper cervical rotation restriction. Randomized controlled trial. PeerJ 2021; 9:e12546. [PMID: 34900443 PMCID: PMC8627131 DOI: 10.7717/peerj.12546] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 11/04/2021] [Indexed: 11/20/2022] Open
Abstract
Background Cervical exercise has been shown to be an effective treatment for neck pain, but there is still a need for more clinical trials evaluating the effectiveness of adding manual therapy to the exercise approach. There is a lack of evidence on the effect of these techniques in patients with neck pain and upper cervical rotation restriction. Purpose To compare the effectiveness of adding manual therapy to a cervical exercise protocol for the treatment of patients with chronic neck pain and upper cervical rotation restriction. Methods Single-blind randomized clinical trial. Fifty-eight subjects: 29 for the Manual Therapy+Exercise (MT+Exercise) Group and 29 for the Exercise group. Neck disability index, pain intensity (0–10), pressure pain threshold (kPa), flexion-rotation test (°), and cervical range of motion (°) were measured at the beginning and at the end of the intervention, and at 3-and 6-month follow-ups. The MT+Exercise Group received one 20-min session of manual therapy and exercise once a week for 4 weeks and home exercise. The Exercise Group received one 20-min session of exercise once a week for 4 weeks and home exercise. Results The MT+Exercise Group showed significant better values post-intervention in all variables: neck disability index: 0% patient with moderate, severe, or complete disability compared to 31% in the Exercise Group (p = 0.000) at 6-months; flexion-rotation test (p = 0.000) and pain intensity (p = 0.000) from the first follow-up to the end of the study; cervical flexion (p = 0.002), extension (p = 0.002), right lateral-flexion (p = 0.000), left lateral-flexion (p = 0.001), right rotation (p = 0.000) and left rotation (p = 0.005) at 6-months of the study, except for flexion, with significative changes from 3-months of follow up; pressure pain threshold from the first follow-up to the end of the study (p values range: 0.003–0.000). Conclusion Four 20-min sessions of manual therapy and exercise, along with a home-exercise program, was found to be more effective than an exercise protocol and a home-exercise program in improving the neck disability index, flexion-rotation test, pain intensity, and pressure pain threshold, in the short, medium, and medium-long term in patients with chronic neck pain and upper rotation restriction. Cervical range of motion improved with the addition of manual therapy in the medium and medium-long term. The high dropout rate may have compromised the external validity of the study.
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Affiliation(s)
- Jacobo Rodríguez-Sanz
- Faculty of Medicine and Health Sciences. ACTIUM Anatomy Group. Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain
| | - Miguel Malo-Urriés
- Department of Physiatry and Nursing. Physiotherapy Research Unit. Faculty of Health Sciences, Universidad de Zaragoza, Zaragoza, Spain
| | - María Orosia Lucha-López
- Department of Physiatry and Nursing. Physiotherapy Research Unit. Faculty of Health Sciences, Universidad de Zaragoza, Zaragoza, Spain
| | - Carlos López-de-Celis
- Faculty of Medicine and Health Sciences. ACTIUM Anatomy Group. Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain.,Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Barcelona, Spain
| | - Albert Pérez-Bellmunt
- Faculty of Medicine and Health Sciences. ACTIUM Anatomy Group. Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain
| | - Jaime Corral-de-Toro
- Department of Physiatry and Nursing. Physiotherapy Research Unit. Faculty of Health Sciences, Universidad de Zaragoza, Zaragoza, Spain
| | - César Hidalgo-García
- Department of Physiatry and Nursing. Physiotherapy Research Unit. Faculty of Health Sciences, Universidad de Zaragoza, Zaragoza, Spain
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Nim CG, Downie A, O'Neill S, Kawchuk GN, Perle SM, Leboeuf-Yde C. The importance of selecting the correct site to apply spinal manipulation when treating spinal pain: Myth or reality? A systematic review. Sci Rep 2021; 11:23415. [PMID: 34862434 PMCID: PMC8642385 DOI: 10.1038/s41598-021-02882-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 11/08/2021] [Indexed: 11/09/2022] Open
Abstract
The concept that spinal manipulation therapy (SMT) outcomes are optimized when the treatment is aimed at a clinically relevant joint is commonly assumed and central to teaching and clinical use (candidate sites). This systematic review investigated whether clinical effects are superior when this is the case compared to SMT applied elsewhere (non-candidate sites). Eligible study designs were randomized controlled trials that investigated the effect of spinal manipulation applied to candidate versus non-candidate sites for spinal pain. We obtained data from four different databases. Risk of bias was assessed using an adjusted Cochrane risk of bias tool, adding four items for study quality. We extracted between-group differences for any reported outcome or, when not reported, calculated effect sizes from the within-group changes. We compared outcomes for SMT applied at a 'relevant' site to SMT applied elsewhere. We prioritized methodologically robust studies when interpreting results. Ten studies, all of acceptable quality, were included that reported 33 between-group differences-five compared treatments within the same spinal region and five at different spinal regions. None of the nine studies with low or moderate risk of bias reported statistically significant between-group differences for any outcome. The tenth study reported a small effect on pain (1.2/10, 95%CI - 1.9 to - 0.5) but had a high risk of bias. None of the nine articles of low or moderate risk of bias and acceptable quality reported that "clinically-relevant" SMT has a superior outcome on any outcome compared to "not clinically-relevant" SMT. This finding contrasts with ideas held in educational programs and clinical practice that emphasize the importance of joint-specific application of SMT.
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Affiliation(s)
- Casper G Nim
- Medical Research Unit, Spine Center of Southern Denmark, University Hospital of Southern Denmark, Odense, Denmark. .,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
| | - Aron Downie
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park, Australia
| | - Søren O'Neill
- Medical Research Unit, Spine Center of Southern Denmark, University Hospital of Southern Denmark, Odense, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Gregory N Kawchuk
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Stephen M Perle
- School of Chiropractic, College of Health Sciences, University of Bridgeport, Bridgeport, USA
| | - Charlotte Leboeuf-Yde
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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18
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Pérez-Bellmunt A, Casasayas-Cos O, López-de-Celis C, Rodríguez-Sanz J, Rodríguez-Jiménez J, Ortiz-Miguel S, Meca-Rivera T, Fernández-de-las-Peñas C. Effects of Dry Needling of Latent Trigger Points on Viscoelastic and Muscular Contractile Properties: Preliminary Results of a Randomized Within-Participant Clinical Trial. J Clin Med 2021; 10:jcm10173848. [PMID: 34501299 PMCID: PMC8432234 DOI: 10.3390/jcm10173848] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/19/2021] [Accepted: 08/24/2021] [Indexed: 02/07/2023] Open
Abstract
This study aimed to evaluate changes in neuromuscular function and pain perception in latent trigger points (TrPs) in the gastrocnemius muscle after a single session of dry needling. A randomized within-participant clinical trial was conducted. Fifty volunteers with latent TrPs in the gastrocnemius muscles were explored. Each extremity was randomly assigned to a control or experimental (dry needling) group. Viscoelastic parameters and contractile properties were analyzed by tensiomyography. Ankle dorsiflexion range of motion was assessed with the lunge test. Pressure pain thresholds (PPT) and pain perceived were also analyzed. The results observed that three viscoelastic proprieties (myotonometry) showed significant differences in favor of the experimental extremity in the lateral gastrocnemius: stiffness (p = 0.02), relaxation (p = 0.045), and creep (p = 0.03), but not in the medial gastrocnemius. No changes in tensiomyography outcomes were found. The control extremity showed a higher increase in PPTs (i.e., decrease in pressure pain sensitivity) than the experimental extremity (p = 0.03). No significant effects for range of motion or strength were observed. In general, gender did not influence the effects of dry needling over latent TrPs in the gastrocnemius muscle. In conclusion, a single session of dry needling was able to change some parameters of neuromuscular function, such as muscle tone, relaxation, pressure pain sensitivity, and creep in the lateral (but not medial) gastrocnemius but did not improve strength or range of motion.
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Affiliation(s)
- Albert Pérez-Bellmunt
- Basic Sciences Department, Universitat Internacional de Catalunya, 08195 Sant Cugat del Vallès, Spain; (A.P.-B.); (O.C.-C.); (J.R.-S.); (S.O.-M.); (T.M.-R.)
- ACTIUM Functional Anatomy Group, 08017 Barcelona, Spain
| | - Oriol Casasayas-Cos
- Basic Sciences Department, Universitat Internacional de Catalunya, 08195 Sant Cugat del Vallès, Spain; (A.P.-B.); (O.C.-C.); (J.R.-S.); (S.O.-M.); (T.M.-R.)
- ACTIUM Functional Anatomy Group, 08017 Barcelona, Spain
| | - Carlos López-de-Celis
- Basic Sciences Department, Universitat Internacional de Catalunya, 08195 Sant Cugat del Vallès, Spain; (A.P.-B.); (O.C.-C.); (J.R.-S.); (S.O.-M.); (T.M.-R.)
- ACTIUM Functional Anatomy Group, 08017 Barcelona, Spain
- Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain
- Correspondence: (C.L.-d.-C.); (C.F.-d.-l.-P.)
| | - Jacobo Rodríguez-Sanz
- Basic Sciences Department, Universitat Internacional de Catalunya, 08195 Sant Cugat del Vallès, Spain; (A.P.-B.); (O.C.-C.); (J.R.-S.); (S.O.-M.); (T.M.-R.)
- ACTIUM Functional Anatomy Group, 08017 Barcelona, Spain
| | - Jorge Rodríguez-Jiménez
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain;
- Cátedra de Investigación y Docencia en Fisioterapia: Terapia Manual y Punción Seca, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
| | - Sara Ortiz-Miguel
- Basic Sciences Department, Universitat Internacional de Catalunya, 08195 Sant Cugat del Vallès, Spain; (A.P.-B.); (O.C.-C.); (J.R.-S.); (S.O.-M.); (T.M.-R.)
- ACTIUM Functional Anatomy Group, 08017 Barcelona, Spain
| | - Toni Meca-Rivera
- Basic Sciences Department, Universitat Internacional de Catalunya, 08195 Sant Cugat del Vallès, Spain; (A.P.-B.); (O.C.-C.); (J.R.-S.); (S.O.-M.); (T.M.-R.)
- ACTIUM Functional Anatomy Group, 08017 Barcelona, Spain
| | - César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain;
- Cátedra de Investigación y Docencia en Fisioterapia: Terapia Manual y Punción Seca, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
- Correspondence: (C.L.-d.-C.); (C.F.-d.-l.-P.)
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19
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de-la-Puente-Ranea L, Gil-Martínez A, Rodríguez-Lopez O, González-Gutiérrez P, Mangas-Guijarro MÁ, Navarro-Fernández G. Manual therapy and exercise for patients with cluster headache. EXCLI JOURNAL 2021; 20:948-955. [PMID: 34177410 PMCID: PMC8222635 DOI: 10.17179/excli2021-3763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 05/21/2021] [Indexed: 11/10/2022]
Abstract
The aim of this case series is to clarify if a physiotherapy program can reduce the frequency, intensity and duration of the headache episodes in patients with cluster headache. A 7-case series with cluster headache patients was conducted. Every subject received physiotherapy treatment based on manual therapy and exercise, maintaining pharmacological treatment prescribed by the neurologist. Frequency, intensity and duration of the episodes, pressure pain thresholds (PPT) and psychological variables were measured 5 times: pre-intervention, post-intervention, 1 month follow-up, 2 months follow-up and 3 months follow-up. Two of the seven subjects decreased their frequency of headaches over 50 % and another in 16,67 %. There were no significant changes in duration or intensity. Results also showed an improvement in impact of headache in 6 of 7 cases. Those cases that decreased more their headache frequency also decreased their pain catastrophizing. A program of physiotherapy based in manual therapy and exercise, might be an effective and safe complement to decrease the frequency of the episodes of CH in short-term (4 months follow-up) including interdisciplinary working with neurologists and other health care professionals.
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Affiliation(s)
- Lucía de-la-Puente-Ranea
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
- Instituto de Rehabilitación Funcional, Centro Superior de Estudios Universitarios La Salle, Madrid, Spain
| | - Alfonso Gil-Martínez
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
- Instituto de Rehabilitación Funcional, Centro Superior de Estudios Universitarios La Salle, Madrid, Spain
- CranioSPain Research Group, Centro Superior de Estudios Universitarios La Salle, Madrid, Spain
- Unidad de Fisioterapia, Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | - Oscar Rodríguez-Lopez
- Instituto de Rehabilitación Funcional, Centro Superior de Estudios Universitarios La Salle, Madrid, Spain
- Departamento de Fisioterapia, CEU San Pablo, Madrid, Spain
| | - Pablo González-Gutiérrez
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Gonzalo Navarro-Fernández
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
- Instituto de Rehabilitación Funcional, Centro Superior de Estudios Universitarios La Salle, Madrid, Spain
- CranioSPain Research Group, Centro Superior de Estudios Universitarios La Salle, Madrid, Spain
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20
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da Silva FBO, Santos MDCQ, Borella da Silva TC, Facchini D, Kolberg A, Barros RR, Silveira EMS, Kroth A, Duarte FCK, Vassoler JM, Kolberg C, Partata WA. Spine adjusting instrument (Impulse®) attenuates nociception and modulates oxidative stress markers in the spinal cord and sciatic nerve of a rat model of neuropathic pain. PAIN MEDICINE 2021; 23:761-773. [PMID: 33993301 DOI: 10.1093/pm/pnab167] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Oxidative stress plays an important role in neuropathic pain. Spinal manipulative therapy (SMT) can exert beneficial effects in pain outcomes in humans and animal models. SMT can also modulate oxidative stress markers in both humans and animals. We aimed to determine the effect of Impulse®-assisted SMT (ISMT) on nociception and oxidative stress biomarkers in the spinal cord and sciatic nerve of rats with neuropathic pain (NP). METHODS NP was induced by chronic constriction injury (CCI) of the sciatic nerve. Animals were randomly assigned to naive, sham (rats with sciatic nerve exposure but without ligatures) and CCI, with and without ISMT. ISMT was applied onto the skin area corresponding to the spinous process of L4-L5, 3 times/week, for 2 weeks. Mechanical threshold, latency to paw withdrawal to thermal stimulus and oxidative stress biomarkers in spinal cord and sciatic nerve were the main outcomes evaluated. RESULTS ISMT significantly increased mechanical threshold and withdrawal latency after CCI. In the spinal cord, ISMT prevented the increase of pro-oxidative superoxide anion generation and hydrogen peroxide levels. Lipid hydroperoxide levels both in the spinal cord and in the sciatic nerve were attenuated by ISMT. Total antioxidant capacity increased in the spinal cord and sciatic nerve of CCI rats with and without ISMT. CCI and ISMT did not significantly change the total thiol content of the spinal cord. CONCLUSIONS Our findings suggest reduced oxidative stress in the spinal cord and/or nerve may be an important mechanism underlying a therapeutic effect of SMT to manage NP non-pharmacologically.
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Affiliation(s)
- Francielle B O da Silva
- Laboratório de Neurobiologia Comparada, Departamento de Fisiologia, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande, do Sul
| | - Maria do Carmo Q Santos
- Laboratório de Neurobiologia Comparada, Departamento de Fisiologia, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande, do Sul
| | - Thaisla Cristiane Borella da Silva
- Laboratório de Neurobiologia Comparada, Departamento de Fisiologia, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande, do Sul
| | | | - Angela Kolberg
- Laboratório de Neurobiologia Comparada, Departamento de Fisiologia, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande, do Sul
| | - Rodrigo R Barros
- Departamento de Engenharia Mecânica, Faculdade de Engenharia Mecânica, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande, do Sul
| | - Elza M S Silveira
- Laboratório de Neurobiologia Comparada, Departamento de Fisiologia, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande, do Sul
| | - Adarly Kroth
- Área Ciências da Vida, Universidade do Oeste de Santa Catarina, Joaçaba, Santa Catarina
| | - Felipe C K Duarte
- Division of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Jakson M Vassoler
- Departamento de Engenharia Mecânica, Faculdade de Engenharia Mecânica, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande, do Sul
| | - Carolina Kolberg
- Laboratório de Neurobiologia Comparada, Departamento de Fisiologia, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande, do Sul
| | - Wania A Partata
- Laboratório de Neurobiologia Comparada, Departamento de Fisiologia, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande, do Sul
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21
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Yaguchi J, Yaguchi S. Sea urchin larvae utilize light for regulating the pyloric opening. BMC Biol 2021; 19:64. [PMID: 33820528 PMCID: PMC8022552 DOI: 10.1186/s12915-021-00999-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 03/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Light is essential for various biological activities. In particular, visual information through eyes or eyespots is very important for most of animals, and thus, the functions and developmental mechanisms of visual systems have been well studied to date. In addition, light-dependent non-visual systems expressing photoreceptor Opsins have been used to study the effects of light on diverse animal behaviors. However, it remains unclear how light-dependent systems were acquired and diversified during deuterostome evolution due to an almost complete lack of knowledge on the light-response signaling pathway in Ambulacraria, one of the major groups of deuterostomes and a sister group of chordates. RESULTS Here, we show that sea urchin larvae utilize light for digestive tract activity. We found that photoirradiation of larvae induces pyloric opening even without addition of food stimuli. Micro-surgical and knockdown experiments revealed that this stimulating light is received and mediated by Go(/RGR)-Opsin (Opsin3.2 in sea urchin genomes) cells around the anterior neuroectoderm. Furthermore, we found that the anterior neuroectodermal serotoninergic neurons near Go-Opsin-expressing cells are essential for mediating light stimuli-induced nitric oxide (NO) release at the pylorus. Our results demonstrate that the light>Go-Opsin>serotonin>NO pathway functions in pyloric opening during larval stages. CONCLUSIONS The results shown here will lead us to understand how light-dependent systems of pyloric opening functioning via neurotransmitters were acquired and established during animal evolution. Based on the similarity of nervous system patterns and the gut proportions among Ambulacraria, we suggest the light>pyloric opening pathway may be conserved in the clade, although the light signaling pathway has so far not been reported in other members of the group. In light of brain-gut interactions previously found in vertebrates, we speculate that one primitive function of anterior neuroectodermal neurons (brain neurons) may have been to regulate the function of the digestive tract in the common ancestor of deuterostomes. Given that food consumption and nutrient absorption are essential for animals, the acquirement and development of brain-based sophisticated gut regulatory system might have been important for deuterostome evolution.
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Affiliation(s)
- Junko Yaguchi
- Shimoda Marine Research Center, University of Tsukuba, 5-10-1 Shimoda, Shizuoka, 415-0025, Japan
| | - Shunsuke Yaguchi
- Shimoda Marine Research Center, University of Tsukuba, 5-10-1 Shimoda, Shizuoka, 415-0025, Japan.
- PRESTO, JST, 4-1-8 Honcho, Kawaguchi, 332-0012, Japan.
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Efficacy of Manual Therapy on Facilitatory Nociception and Endogenous Pain Modulation in Older Adults with Knee Osteoarthritis: A Case Series. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11041895] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background: manual therapy (MT) has been shown to have positive effects in patients with osteoarthritis (OA)-related pain, and its use in clinical settings is recommended. However, the mechanisms of action for how these positive effects occur are not yet well understood. The aim of the present study was to investigate the influence of MT treatment on facilitatory nociception and endogenous pain modulation in patients with knee OA related pain. Methods: Twenty-eight patients with knee OA were included in this study. Pain intensity using the numerical pain rating scale (NPRS), temporal summation (TS), conditioned pain modulation (CPM), and local (knee) and distant (elbow) hyperalgesia through the pressure pain threshold (PPT), were assessed to evaluate the pain modulatory system. Patients underwent four sessions of MT treatments within 3 weeks and were evaluated at the baseline, after the first session and after the fourth session. Results: the MT treatment reduced knee pain after the first session (p = 0.03) and after the fourth session (p = 0.04). TS decreased significantly after the fourth session of MT (p = 0.02), while a significant increase in the CPM assessment was detected after the fourth session (p = 0.05). No significant changes in the PPT over the knee and elbow were found in the follow-ups. Conclusions: The results from our study suggest that MT might be an effective and safe method for improving pain and for decreasing temporal summation.
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Butts R, Legaspi O, Nocera-Mekel A, Dunning J. Physical therapy treatment of a pediatric patient with symptoms consistent with a spinal cord injury without radiographic abnormality: A retrospective case report. J Bodyw Mov Ther 2021; 27:455-463. [PMID: 34391271 DOI: 10.1016/j.jbmt.2021.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 12/22/2020] [Accepted: 01/13/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND A spinal cord injury without radiographic abnormality (SCIWORA) is a relatively uncommon event that occurs in children following cervical trauma primarily due to sports-related injuries or physical abuse. CASE DESCRIPTION This case report describes an 11-year-old wrestler that developed signs and symptoms consistent with a SCIWORA following neck trauma during competition. Despite all diagnostic tests being inconclusive, the patient demonstrated increased cervical, thoracic, and lumbar paraspinal tone along with pain, loss of sensation, loss of mobility, and weakness of the lower extremities. As a result, the patient was confined to a wheelchair and required maximum assistance to transfer and ambulate with a walker. The patient was referred to physical therapy nine days after the traumatic event, where he received interferential current with moist heat, myofascial release of paraspinal muscles, functional exercise, gait training, and spinal manipulative therapy targeting the cervical, thoracic, and lumbar vertebrae. OUTCOME After 13 physical therapy treatments over 5-weeks, the patient was able to ambulate independently and perform all activities of daily living without pain or functional limitation. The following case report outlines this patient's successful journey toward recovery. CONCLUSION This case report suggests that spinal manipulative therapy may be a safe and effective intervention when used within a multi-modal treatment strategy for patients with signs and symptoms consistent with SCIWORA. Moreover, spinal manipulative therapy may be considered a beneficial treatment in some pediatric patients. However, this report describes a single patient, and further research is required on the use of spinal manipulation in this patient population.
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Affiliation(s)
- Raymond Butts
- Research Physical Therapy Specialists, Columbia, SC, USA; American Academy of Manipulative Therapy, Montgomery, AL, USA.
| | | | | | - James Dunning
- American Academy of Manipulative Therapy, Montgomery, AL, USA; Montgomery Osteopractic Physiotherapy and Acupuncture Clinic, Montgomery, AL, USA
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Rodríguez-Sanz J, Malo-Urriés M, Lucha-López MO, Pérez-Bellmunt A, Carrasco-Uribarren A, Fanlo-Mazas P, Corral-de-Toro J, Hidalgo-García C. Effects of the Manual Therapy Approach of Segments C0-1 and C2-3 in the Flexion-Rotation Test in Patients with Chronic Neck Pain: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020753. [PMID: 33477316 PMCID: PMC7829773 DOI: 10.3390/ijerph18020753] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 01/13/2021] [Accepted: 01/15/2021] [Indexed: 12/13/2022]
Abstract
Background: Flexion-rotation test predominantly measures rotation in C1-2 segment. Restriction in flexion-rotation may be due to direct limitation in C1-2, but also to a premature tightening of the alar ligament as a result of lack of movement in C0-1 or C2-3. The aim of this study was to compare the effect of a 20-min single cervical exercise session, with or without manual therapy of C0-1 and C2-3 segment in flexion-rotation test, in patients with chronic neck pain and positive flexion-rotation test. Methods: Randomized controlled clinical trial in 48 subjects (24 manual therapy+exercise/24 exercise). Range of motion and pain during flexion-rotation test, neck pain intensity and active cervical range of motion were measured before and after the intervention. Results: Significant differences were found in favour of the manual therapy group in the flexion-rotation test: right (p < 0.001) and left rotation (p < 0.001); pain during the flexion-rotation test: right (p < 0.001) and left rotation (p < 0.001); neck pain intensity: (p < 0.001); cervical flexion (p < 0.038), extension (p < 0.010), right side-bending (p < 0.035), left side-bending (p < 0.002), right rotation (p < 0.001), and left rotation (p < 0.006). Conclusions: Addition of one C0-C1 and C2-C3 manual therapy session to cervical exercise can immediately improve flexion-rotation test and cervical range of motion and reduce pain intensity.
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Affiliation(s)
- Jacobo Rodríguez-Sanz
- Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, C/Josep Trueta s/n, Sant Cugat del Vallés, 08195 Barcelona, Spain; (A.P.-B.); (A.C.-U.)
- Correspondence: ; Tel.: +34-636-13-67-89
| | - Miguel Malo-Urriés
- Departamento de Fisiatría y Enfermería, Unidad de Investigación en Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Zaragoza, C/Domingo Miral, s/n, 50009 Zaragoza, Spain; (M.M.-U.); (M.O.L.-L.); (P.F.-M.); (J.C.-d.-T.); (C.H.-G.)
| | - María Orosia Lucha-López
- Departamento de Fisiatría y Enfermería, Unidad de Investigación en Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Zaragoza, C/Domingo Miral, s/n, 50009 Zaragoza, Spain; (M.M.-U.); (M.O.L.-L.); (P.F.-M.); (J.C.-d.-T.); (C.H.-G.)
| | - Albert Pérez-Bellmunt
- Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, C/Josep Trueta s/n, Sant Cugat del Vallés, 08195 Barcelona, Spain; (A.P.-B.); (A.C.-U.)
| | - Andoni Carrasco-Uribarren
- Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, C/Josep Trueta s/n, Sant Cugat del Vallés, 08195 Barcelona, Spain; (A.P.-B.); (A.C.-U.)
| | - Pablo Fanlo-Mazas
- Departamento de Fisiatría y Enfermería, Unidad de Investigación en Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Zaragoza, C/Domingo Miral, s/n, 50009 Zaragoza, Spain; (M.M.-U.); (M.O.L.-L.); (P.F.-M.); (J.C.-d.-T.); (C.H.-G.)
| | - Jaime Corral-de-Toro
- Departamento de Fisiatría y Enfermería, Unidad de Investigación en Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Zaragoza, C/Domingo Miral, s/n, 50009 Zaragoza, Spain; (M.M.-U.); (M.O.L.-L.); (P.F.-M.); (J.C.-d.-T.); (C.H.-G.)
| | - César Hidalgo-García
- Departamento de Fisiatría y Enfermería, Unidad de Investigación en Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Zaragoza, C/Domingo Miral, s/n, 50009 Zaragoza, Spain; (M.M.-U.); (M.O.L.-L.); (P.F.-M.); (J.C.-d.-T.); (C.H.-G.)
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Regular physical activity reduces the percentage of spinally projecting neurons that express mu-opioid receptors from the rostral ventromedial medulla in mice. Pain Rep 2020; 5:e857. [PMID: 33294758 PMCID: PMC7717783 DOI: 10.1097/pr9.0000000000000857] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/13/2020] [Accepted: 08/24/2020] [Indexed: 01/02/2023] Open
Abstract
Introduction Regular physical activity/exercise is an effective nonpharmacological treatment for individuals with chronic pain. Central inhibitory mechanisms, involving serotonin and opioids, are critical to analgesia produced by regular physical activity. The rostral ventromedial medulla (RVM) sends projections to the spinal cord to inhibit or facilitate nociceptive neurons and plays a key role in exercise-induced analgesia. Objective The goal of these studies was to examine if regular physical activity modifies RVM-spinal cord circuitry. Methods Male and female mice received Fluoro-Gold placed on the spinal cord to identify spinally projecting neurons from the RVM and the nucleus raphe obscurus/nucleus raphe pallidus, dermorphin-488 into caudal medulla to identify mu-opioid receptors, and were immunohistochemically stained for either phosphorylated-N-methyl-d-aspartate subunit NR1 (p-NR1) to identify excitatory neurons or tryptophan hydroxylase (TPH) to identify serotonin neurons. The percentage of dermorphin-488-positive cells that stained for p-NR1 (or TPH), and the percentage of dermorphin-488-positive cells that stained for p-NR1 (or TPH) and Fluoro-Gold was calculated. Physically active animals were provided running wheels in their cages for 8 weeks and compared to sedentary animals without running wheels. Animals with chronic muscle pain, induced by 2 intramuscular injections of pH 4.0, were compared to sham controls (pH 7.2). Results Physically active animals had less mu-opioid-expressing neurons projecting to the spinal cord when compared to sedentary animals in the RVM, but not the nucleus raphe obscurus/nucleus raphe pallidus. No changes were observed for TPH. Conclusions These data suggest that regular exercise alters central facilitation so that there is less descending facilitation to result in a net increase in inhibition.
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Arribas-Romano A, Fernández-Carnero J, Molina-Rueda F, Angulo-Diaz-Parreño S, Navarro-Santana MJ. Efficacy of Physical Therapy on Nociceptive Pain Processing Alterations in Patients with Chronic Musculoskeletal Pain: A Systematic Review and Meta-analysis. PAIN MEDICINE (MALDEN, MASS.) 2020; 21:2502-2517. [PMID: 32100027 DOI: 10.1093/pm/pnz366] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/20/2023]
Abstract
INTRODUCTION Chronic musculoskeletal pain is a major health, social, and economic problem. Most of the subjects who suffer from chronic musculoskeletal pain present processes of central sensitization. Temporal summation and conditioned pain modulation are the two most commonly used clinical measures of this. The objective of this review is to evaluate the effects of physical therapy on temporal summation (TS) and conditioned pain modulation (CPM) in patients with chronic musculoskeletal pain. METHODS This is a systematic review and meta-analysis. We searched the MEDLINE, EMBASE, CINAHL, EBSCO, PubMed, PEDro, Cochrane Collaboration Trials Register, Cochrane Database of Systematic Reviews, and SCOPUS databases. Different mesh terms and key words were combined for the search strategy, with the aim of encompassing all studies that have used any type of physical therapy treatment in patients with chronic musculoskeletal pain and have measured both TS and CPM. RESULTS Eighteen studies remained for qualitative analysis and 16 for quantitative analysis. Statistically significant differences with a 95% confidence interval (CI) were obtained for TS (-0.21, 95% CI = -0.39 to -0.03, Z = 2.50, P = 0.02, N = 721) and CPM (0.34, 95% CI = 0.12 to 0.56, Z = 2.99, P = 0.003, N = 680) in favor of physical therapy as compared with control. Manual therapy produces a slight improvement in TS, and physical therapy modalities in general improve CPM. No significant differences between the subgroups of the meta-analysis were found. The methodological quality of the studies was high. CONCLUSIONS Physical therapy produces a slight improvement in central sensitization (CS)-related variables, with TS decreased and CPM increased when compared with a control group in patients with CMP. Only significant differences in TS were identified in the manual therapy subgroup.
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Affiliation(s)
- Alberto Arribas-Romano
- Escuela Internacional de Doctorado, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
- Physiotherapy and Pain Research Center. General Foundation of the University of Alcalá, Madrid, Spain
| | - Josué Fernández-Carnero
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Madrid, Spain
- La Paz Hospital Institute for Health Research, IdiPAZ, Madrid, Spain
- Grupo Multidisciplinar de Investigación & Tratamiento del Dolor, Grupo de Excelencia Investigadora URJC-Banco de Santander, Madrid, Spain
- Motion in Brains Research Group, Institute of Neuroscience and Movement Sciences (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autonoma de Madrid, Madrid, Spain
| | - Francisco Molina-Rueda
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Madrid, Spain
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Does the Addition of Manual Therapy Approach to a Cervical Exercise Program Improve Clinical Outcomes for Patients with Chronic Neck Pain in Short- and Mid-Term? A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186601. [PMID: 32927858 PMCID: PMC7558520 DOI: 10.3390/ijerph17186601] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/26/2020] [Accepted: 09/02/2020] [Indexed: 01/23/2023]
Abstract
Chronic neck pain is one of today’s most prevalent pathologies. The International Classification of Diseases categorizes four subgroups based on patients’ associated symptoms. However, this classification does not encompass upper cervical spine dysfunction. The aim is to compare the short- and mid-term effectiveness of adding a manual therapy approach to a cervical exercise protocol in patients with chronic neck pain and upper cervical spine dysfunction. Fifty-eight subjects with chronic neck pain and upper cervical spine dysfunction were recruited (29 = Manual therapy + Exercise; 29 = Exercise). Each group received four 20-min sessions, one per week during four consecutive weeks, and a home exercise regime. Upper flexion and flexion-rotation test range of motion, neck disability index, craniocervical flexion test, visual analogue scale, pressure pain threshold, global rating of change scale, and adherence to self-treatment were assessed at the beginning, end of the intervention and at 3- and 6-month follow-ups. The Manual therapy + Exercise group statistically improved short- and medium-term in all variables compared to the Exercise group. Four 20-min sessions of Manual therapy + Exercise along with a home-exercise program is more effective in the short- to mid-term than an exercise protocol and a home-exercise program for patients with chronic neck pain and upper cervical dysfunction.
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Savva C, Kleitou M, Efstathiou M, Korakakis V, Stasinopoulos D, Karayiannis C. The effect of lumbar spine manipulation on pain and disability in Achilles tendinopathy. A case report. J Bodyw Mov Ther 2020; 26:214-219. [PMID: 33992247 DOI: 10.1016/j.jbmt.2020.08.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 07/08/2020] [Accepted: 08/29/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND/PURPOSE Cervical and thoracic spine manipulation has been found to reduce tendon pain and disability in lateral epicondylalgia and rotator cuff tendinopathy. Based on these findings, the application of lumbar spine manipulation may also provide similar improvements in Achilles tendinopathy (AT). Therefore, the purpose of this study was to evaluate the effect of lumbar spine manipulation on pain and disability in a patient experiencing AT. CASE DESCRIPTION A 44 years old male ex-football player presented with a 20-year history of persistent Achilles tendon pain (ATP) consistent with AT diagnosis. The patient attended 12 treatment sessions receiving a high-velocity, low amplitude lumbar spine manipulation. Outcome measures were collected at baseline, 2 weeks, 4 weeks, 3 months and 6 months and included pain in visual analogue scale, the American Orthopedic Foot and Ankle Score, the 36-Item Short Form Health Survey and the Victorian Institute of Sport Assessment-Achilles questionnaire. Pressure pain threshold was also assessed using an electronic pressure algometer. OUTCOMES Improvement in all outcome measures was noted 6-months post intervention. Outcome measures indicated substantial improvements in both the patient's pain and disability. The patient was able to perform activities of daily living without difficulties, suggesting higher level of function and quality of life at 6-months post initial evaluation. CONCLUSION These findings have demonstrated the positive effects of lumbar spine manipulation on ATP and disability. Further studies, specifically clinical trials investigating the effect of lumbar spine manipulation or combining this technique with exercises and functional activities are suggested.
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Affiliation(s)
- Christos Savva
- Department of Health Science, Diogenous 6, Engomi, European University, Nicosia, Cyprus.
| | - Michalis Kleitou
- Department of Health Science, Diogenous 6, Engomi, European University, Nicosia, Cyprus
| | - Michalis Efstathiou
- Department of Life and Health Science, 46 Makedonitissas Avenue, Engomi, University of Nicosia, Cyprus
| | | | - Dimitris Stasinopoulos
- Department of Physiotherapy, 11521, Aleksandras Avenue, University of West Attica, Athens, Greece
| | - Christos Karayiannis
- Department of Health Science, Diogenous 6, Engomi, European University, Nicosia, Cyprus
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The Association Between Conditioned Pain Modulation and Manipulation-induced Analgesia in People With Lateral Epicondylalgia. Clin J Pain 2020; 35:435-442. [PMID: 30801339 PMCID: PMC6467555 DOI: 10.1097/ajp.0000000000000696] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Conditioned pain modulation (CPM) and manipulation-induced analgesia (MIA) may activate similar neurophysiological mechanisms to mediate their analgesic effects. This study assessed the association between CPM and MIA responses in people with lateral epicondylalgia. MATERIALS AND METHODS Seventy participants with lateral epicondylalgia were assessed for CPM followed by MIA. A single assessor measured pressure pain thresholds (PPT) before, during, and after cold water immersion (10°C) of the asymptomatic hand and contralateral lateral glide (CLG) mobilization of the neck. For analyses, linear mixed models evaluated differences in CPM and MIA responses. Pearson partial correlations and regression analyses evaluated the association between CPM and MIA PPT. RESULTS There was a significant increase (CPM and MIA, P<0.001) in PPT from baseline during the interventions (CPM mean: 195.84 kPa for elbow and 201.87 kPa for wrist, MIA mean: 123.01 kPa for elbow and 126.06 kPa for wrist) and after the interventions (CPM mean: 126.06 kPa for elbow, 114.24 kPa for wrist, MIA mean: 123.50 kPa for elbow and 122.16 kPa for wrist). There were also significant moderate and positive partial linear correlations (r: 0.40 to 0.54, P<0.001) between CPM and MIA measures, controlling for baseline measures. Regression analyses showed that CPM PPT was a significant predictor of MIA PPT (P<0.001) and the models explained between 73% and 85% of the variance in MIA PPT. DISCUSSION This study showed that CPM and MIA responses were significantly correlated and that the CPM response was a significant predictor of MIA response.
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Motealleh A, Barzegar A, Abbasi L. The immediate effect of lumbopelvic manipulation on knee pain, knee position sense, and balance in patients with patellofemoral pain: A randomized controlled trial. J Bodyw Mov Ther 2020; 24:71-77. [PMID: 32826011 DOI: 10.1016/j.jbmt.2020.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 09/27/2019] [Accepted: 01/28/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Patellofemoral pain (PFP) is a common musculoskeletal disorder. Quadriceps and core muscle neuromuscular control impairments are frequently associated with PFP. Lumbopelvic manipulation (LPM) has been shown to improve quadriceps and core muscle activation and decrease their inhibition, but changes in balance and knee joint position sense (JPS) after this intervention remain unknown. OBJECTIVE To determine whether LPM decreases knee pain and JPS error and increases balance performance in patients with PFP. DESIGN Randomized controlled trial. SETTING Biomechanics laboratory at a rehabilitation science research center. METHODS Forty-four patients with PFP participated in this study that randomly divided into two equal groups. One group received LPM and the other received sham LPM (positioning with no thrust) in a single session. At baseline and immediately after the intervention, the outcomes of pain using a visual analog scale, balance using the modified star excursion balance test (mSEBT), and JPS at 20° and 60° of knee flexion using a Biodex dynamometer. RESULTS There was a statistically significant improvement in pain, balance control (anterior direction) and JPS in the LPM group immediately after the intervention. In addition, we observed significant differences between groups in pain, balance control (anterior direction) and JPS at 60° of knee flexion immediately after the intervention. CONCLUSION A single session of LPM immediately improved balance control, knee JPS, and pain in patients diagnosed with PFP. CLINICAL REHABILITATION IMPACT Findings suggest that LPM may be used as a therapeutic tool for immediate improvement of symptoms of PFP. However, more research is needed to determine long term results.
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Affiliation(s)
- Alireza Motealleh
- Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Barzegar
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Leila Abbasi
- Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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Lima CR, Martins DF, Reed WR. Physiological Responses Induced by Manual Therapy in Animal Models: A Scoping Review. Front Neurosci 2020; 14:430. [PMID: 32457570 PMCID: PMC7227122 DOI: 10.3389/fnins.2020.00430] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 04/08/2020] [Indexed: 12/29/2022] Open
Abstract
Background: Physiological responses related to manual therapy (MT) treatment have been investigated over decades using various animal models. However, these studies have not been compiled and their collective findings appraised. The purpose of this scoping review was to assess current scientific knowledge on the physiological responses related to MT and/or simulated MT procedures in animal models so as to act as a resource to better inform future mechanistic and clinical research incorporating these therapeutic interventions. Methods: PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane, Embase, and Index of Chiropractic Literature (ICL) were searched from database inception to August 2019. Eligible studies were: (a) published in English; (b) non-cadaveric animal-based; (c) original data studies; (d) included a form of MT or simulated MT as treatment; (e) included quantification of at least one delivery parameter of MT treatment; (f) quantification of at least one physiological measure that could potentially contribute to therapeutic mechanisms of action of the MT. MT studies were categorized according to three main intervention types: (1) mobilization; (2) manipulation; and (3) massage. Two-phase screening procedures were conducted by a pair of independent reviewers, data were extracted from eligible studies and qualitatively reported. Results: The literature search resulted in 231 articles of which 78 met inclusion criteria and were sorted by intervention type. Joint mobilization induced changes in nociceptive response and inflammatory profile, gene expression, receptor activation, neurotransmitter release and enzymatic activity. Spinal manipulation produced changes in muscle spindle response, nocifensive reflex response and neuronal activity, electromyography, and immunologic response. Physiological changes associated with massage therapy included autonomic, circulatory, lymphatic and immunologic functions, visceral response, gene expression, neuroanatomy, function and pathology, and cellular response to in vitro simulated massage. Conclusion: Pre-clinical research supports an association between MT physiological response and multiple potential short-term MT therapeutic mechanisms. Optimization of MT delivery and/or treatment efficacy will require additional preclinical investigation in which MT delivery parameters are controlled and reported using pathological and/or chronic pain models that mimic neuromusculoskeletal conditions for which MT has demonstrated clinical benefit.
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Affiliation(s)
- Carla Rigo Lima
- Rehabilitation Science Program, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Daniel Fernandes Martins
- Postgraduate Program in Health Sciences, Experimental Neuroscience Laboratory (LaNEx), University of Southern Santa Catarina, Palhoça, Brazil
| | - William Ray Reed
- Rehabilitation Science Program, University of Alabama at Birmingham, Birmingham, AL, United States.,Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, United States
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Weber Ii KA, Wager TD, Mackey S, Elliott JM, Liu WC, Sparks CL. Evidence for decreased Neurologic Pain Signature activation following thoracic spinal manipulation in healthy volunteers and participants with neck pain. NEUROIMAGE-CLINICAL 2019; 24:102042. [PMID: 31670070 PMCID: PMC6831903 DOI: 10.1016/j.nicl.2019.102042] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/18/2019] [Accepted: 10/17/2019] [Indexed: 12/19/2022]
Abstract
The use of brain-based models of pain were explored in two clinical studies. Neurologic pain signature activation decreased following spinal manipulation. Spinal manipulation altered the processing of pain-related brain activity. We provide evidence for a centrally mediated therapeutic action of spinal manipulation. Brain-based models have potential as objective clinical biomarkers of pain.
Background Context Spinal manipulation (SM) is a common treatment for neck and back pain, theorized to mechanically affect the spine leading to therapeutic mechanical changes. The link between specific mechanical effects and clinical improvement is not well supported. SM's therapeutic action may instead be partially mediated within the central nervous system. Purpose To introduce brain-based models of pain for spinal pain and manual therapy research, characterize the distributed central mechanisms of SM, and advance the preliminary validation of brain-based models as potential clinical biomarkers of pain. Study Design Secondary analysis of two functional magnetic resonance imaging studies investigating the effect of thoracic SM on pain-related brain activity: A non-controlled, non-blinded study in healthy volunteers (Study 1, n = 10, 5 females, and mean age = 31.2 ± 10.0 years) and a randomized controlled study in participants with acute to subacute neck pain (Study 2, n = 24, 16 females, mean age = 38.0 ± 15.1 years). Methods Functional magnetic resonance imaging was performed during noxious mechanical stimulation of the right index finger cuticle pre- and post-intervention. The effect of SM on pain-related activity was studied within brain regions defined by the Neurologic Pain Signature (NPS) that are predictive of physical pain. Results In Study 1, evoked mechanical pain (p < 0.001) and NPS activation (p = 0.010) decreased following SM, and the changes in evoked pain and NPS activation were correlated (rRM2 = 0.418, p = 0.016). Activation within the NPS subregions of the dorsal anterior cingulate cortex (dACC, p = 0.012) and right secondary somatosensory cortex/operculum (rS2_Op, p = 0.045) also decreased following SM, and evoked pain was correlated with dACC activity (rRM2 = 0.477, p = 0.019). In Study 2, neck pain (p = 0.046) and NPS (p = 0.033) activation decreased following verum but not sham SM. Associations between evoked pain, neck pain, and NPS activation, were not significant and less clear, possibly due to inadequate power, methodological limitations, or other confounding factors. Conclusions The findings provide preliminary evidence that SM may alter the processing of pain-related brain activity within specific pain-related brain regions and support the use of brain-based models as clinical biomarkers of pain.
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Affiliation(s)
- Kenneth A Weber Ii
- Systems Neuroscience and Pain Lab, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA, United States.
| | - Tor D Wager
- Psychology and Neuroscience, Center for Neuroscience, Institute of Cognitive Science, University of Colorado Boulder, Boulder, CO, United States
| | - Sean Mackey
- Systems Neuroscience and Pain Lab, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA, United States
| | - James M Elliott
- Northern Sydney Local Health District, The Kolling Research Institute and The Faculty of Health Sciences, The University of Sydney, St. Leonards, NSW, Australia
| | - Wen-Ching Liu
- Center for Collaborative Brain Research, Department of Radiology, OSF HealthCare Saint Francis Medical Center, Peoria, IL, United States
| | - Cheryl L Sparks
- Center of Expertise, Rehabilitation and Occupational Health, OSF HealthCare, Peoria, IL, United States; School of Physical Therapy, South College, Knoxville, TN, United States
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Alkhawajah HA, Alshami AM. The effect of mobilization with movement on pain and function in patients with knee osteoarthritis: a randomized double-blind controlled trial. BMC Musculoskelet Disord 2019; 20:452. [PMID: 31627723 PMCID: PMC6800493 DOI: 10.1186/s12891-019-2841-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 09/20/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Few studies have investigated the effects of mobilization with movement (MWM) in patients with knee osteoarthritis (OA) compared to other procedures. Sham procedures are generally more appropriate control than using no or usual treatments. Moreover, studies investigating the widespread hypoalgesic effects of MWM in patients with knee OA are lacking. The aim was to investigate the effect of MWM on function and pain in patients with knee OA compared to sham MWM. METHODS This is a randomized double-blind (patients and assessor) controlled trial. Forty adult patients with knee OA of grade II and above were recruited to receive either MWM treatment or sham MWM for the knee. The outcome measures included the following: a visual analogue scale (VAS) for pain, the pressure pain threshold (PPT) test, the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index, the timed up and go (TUG) test, knee strength and knee range of motion (ROM). The measurements were taken at baseline, immediately after intervention and 2 days later. RESULTS Compared with sham MWM, MWM resulted in greater immediate improvement in pain [mean difference (95% CI): - 2.2 (- 2.8, - 1.6)], PPT at both the knee [176 (97, 254)] and shoulder [212 (136, 288)], TUG time [- 1.6 (- 2.1, - 1.1)], knee flexor strength [2.0 (1.3, 2.7)] and extensor strength [5.7 (4.1, 7.2)] and knee flexion ROM [12.8 (9.6, 15.9)] (all, p < 0.001) but not knee extension ROM [- 0.8 (- 1.6, 0.1)] (p = 0.067). After 2 days of intervention, patients who received MWM also demonstrated a greater improvement in pain [- 1.0 (- 1.8, - 0.1)], PPT at the shoulder [107 (40, 175)], TUG time [- 0.9 (- 1.4, - 0.4)], knee flexor strength [0.9 (0.2, 1.7)] and extensor strength [2.9 (2.1, 3.9)] and knee flexion ROM [8.3 (4.7, 11.9)] (all, p ≤ 0.026). However, WOMAC scores and knee extension ROM showed no evidence of change at any stage after intervention (p ≥ 0.067). CONCLUSIONS MWM provided superior benefits over sham MWM in terms of local and widespread pain, physical function (walking), knee flexion and extension muscle strength and knee flexion ROM for at least 2 days in patients with knee OA. TRIAL REGISTRATION ClinicalTrials.gov ( NCT02865252 ), registered on August 12, 2016.
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Affiliation(s)
- Hani A Alkhawajah
- Department of Physiotherapy, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, P.O Box 40244, Khobar, 31952, Saudi Arabia.
| | - Ali M Alshami
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, P.O. Box 2435, Dammam, 31441, Saudi Arabia
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Gyer G, Michael J, Inklebarger J, Tedla JS. Spinal manipulation therapy: Is it all about the brain? A current review of the neurophysiological effects of manipulation. JOURNAL OF INTEGRATIVE MEDICINE-JIM 2019; 17:328-337. [DOI: 10.1016/j.joim.2019.05.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 04/22/2019] [Indexed: 12/19/2022]
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Thomas E, Cavallaro AR, Mani D, Bianco A, Palma A. The efficacy of muscle energy techniques in symptomatic and asymptomatic subjects: a systematic review. Chiropr Man Therap 2019; 27:35. [PMID: 31462989 PMCID: PMC6710873 DOI: 10.1186/s12998-019-0258-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 05/16/2019] [Indexed: 01/01/2023] Open
Abstract
Background Muscle energy techniques are applied to reduce pain and increase range of motion. These are applied to a variety of pathological conditions and on asymptomatic subjects. There is however limited knowledge on their effectiveness and which protocol may be the most beneficial. Objective The aim of this review is to determine the efficacy of muscle energy techniques (MET) in symptomatic and asymptomatic subjects. Design Systematic Review. Methods A literature search was performed using the following database: Cochrane Library, MEDLINE, NLM Pubmed and ScienceDirect. Studies regarding MET in asymptomatic and symptomatic patients were considered for investigation. The main outcomes took into account range of motion, chronic and acute pain and trigger points. Two trained investigators independently screened eligible studies according to the eligibility criteria, extracted data and assessed risk of bias. Randomized control trials (RCT's) were analyzed for quality using the PEDro scale. Results A total of 26 studies were considered eligible and included in the quantitative synthesis: 14 regarding symptomatic patients and 12 regarding asymptomatic subjects. Quality assessment of the studies through the PEDro scale observed a "moderate to high" quality of the included records. Conclusions MET are an effective treatment for reducing chronic and acute pain of the lower back. MET are also effective in treating chronic neck pain and chronic lateral epicondylitis. MET can be applied to increase range of motion of a joint when a functional limitation is present. Other techniques seem to be more appropriate compared to MET for trigger points.
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Affiliation(s)
- Ewan Thomas
- 1Sport and Exercise Sciences Research Unit, University of Palermo, Via Giovanni Pascoli 6, 90144 Palermo, Italy.,International Academy of Osteopathic Medicine, AISeRCO, Palermo, Italy
| | | | - Diba Mani
- 3Department of Integrative Physiology, University of Colorado, Boulder, CO USA.,4Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL USA
| | - Antonino Bianco
- 1Sport and Exercise Sciences Research Unit, University of Palermo, Via Giovanni Pascoli 6, 90144 Palermo, Italy
| | - Antonio Palma
- 1Sport and Exercise Sciences Research Unit, University of Palermo, Via Giovanni Pascoli 6, 90144 Palermo, Italy
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Lascurain-Aguirrebeña I, Newham DJ, Galindez-Ibarbengoetxea X, Casado-Zumeta X, Lertxundi A, Critchley DJ. Association between sympathoexcitatory changes and symptomatic improvement following cervical mobilisations in participants with neck pain. A double blind placebo controlled trial. Musculoskelet Sci Pract 2019; 42:90-97. [PMID: 31075730 DOI: 10.1016/j.msksp.2019.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/25/2019] [Accepted: 05/01/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND sympathoexcitation observed with passive cervical mobilisations may imply activation of an endogenous pain inhibition system resulting in hypoalgesia. However, research is mostly in asymptomatic participants and there is very limited evidence of a relationship between sympathoexcitation and symptomatic improvement in people with clinical pain. OBJECTIVE to investigate the effects of cervical mobilisations on the sympathetic nervous system in participants with neck pain, and to explore the relationship between symptomatic improvement and sympathoexcitation. DESIGN double-blind randomised controlled trial. METHOD 40 participants with neck pain (aged 20-69 years, 25 female) were randomly allocated to either cervical mobilisations or motionless placebo. Skin conductance was measured before, during, and after intervention. After interventions were completed, their credibility was assessed. Participants were classified as responders or non-responders according to global symptom change. RESULTS participants receiving mobilisations were more likely to be classified as responders (odds ratio: 4.33, p = 0.03) and demonstrated greater change in most outcome measures of sympathoexcitation from baseline to during the intervention but not from during to after the intervention. There was no association between sympathoexcitation and symptomatic improvement. Mobilisations and placebo were equally credible. CONCLUSIONS These findings suggest sympathoexcitatory changes may be caused by an orienting response unrelated to the activation of an endogenous pain inhibition system Alternatively, the observed lack of an association may be explained by the existence of various mechanisms for pain relief. This study used single outcome measures of sympathoexcitation and symptomatic improvement and other measures may reveal different things. CLINICALTRIALS. GOV NUMBER M10/2016/095.
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Affiliation(s)
- Ion Lascurain-Aguirrebeña
- Division of Health and Social Care Research, Faculty of Life Sciences & Medicine, King's College London, London, SE1 1UL, United Kingdom; Department of Physiology, Faculty of Medicine & Infirmary, University of the Basque Country UPV/EHU, Leioa, 48940, Spain.
| | - Di J Newham
- Centre of Human & Applied Physiological Sciences, Faculty of Life Sciences & Medicine, King's College London, London, SE1 1UL, United Kingdom.
| | - Xabier Galindez-Ibarbengoetxea
- Department of Physiology, Faculty of Medicine & Infirmary, University of the Basque Country UPV/EHU, Leioa, 48940, Spain.
| | | | - Aitana Lertxundi
- Department of Preventive Medicine and Public Health, University of the Basque Country UPV/EHU, Leioa, 48940, Spain; Health Research Institute, Biodonostia, San Sebastian, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Barcelona, Spain.
| | - Duncan J Critchley
- Division of Health and Social Care Research, Faculty of Life Sciences & Medicine, King's College London, London, SE1 1UL, United Kingdom.
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Shigetoh H, Osumi M, Morioka S. Experimental Pain Is Alleviated by Manual Traction Itself Rather than Subjective Bias in the Knee: A Signal Detection Analysis. PAIN MEDICINE 2019; 20:1347-1354. [PMID: 30649492 DOI: 10.1093/pm/pny290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Manual traction is used for pain relief, but it is not clear whether the pain relief effect of manual traction is due to sensitivity or to subjective bias. The differences between manual traction and touch have also been unclear. OBJECTIVES We used signal detection theory to investigate whether manual traction and touch were effective for pain relief, and we compared the pain relief effect between manual traction and touch. DESIGN Repeated measures and single blinding. METHODS Twenty healthy adult volunteers performed an intensity judgment task immediately before and after each intervention. The intervention was either manual traction or touch for 10 minutes. We measured the intensity judgment task's signal detection measures of hit rates, false alarm rates, sensitivity (d'), and response bias (C) in an Aδ fiber-mediated pain condition and C fiber-mediated pain condition. RESULTS Manual traction did not provide a significant level of change, but its effect sizes differed. In our comparison of the effect sizes, manual traction tended to reduce the hit rate and altered the sensitivity value rather than the response bias in Aδ fiber-mediated pain. There was no significant difference in the amount of change in the hit rate between touch and manual traction regarding Aδ fiber-mediated pain and C fiber-mediated pain. CONCLUSIONS In terms of effect sizes, manual traction was effective for the pain relief of the first pain by producing a change in pain sensitivity rather than by subjective bias. Manual traction reduced the first pain, whereas touch reduced the first pain and second pain.
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Affiliation(s)
- Hayato Shigetoh
- Department of Neurorehabilitation, Graduate School of Health Science, Kio University, Nara, Japan
| | - Michihiro Osumi
- Neuro Rehabilitation Research Center, Kio University, Nara, Japan
| | - Shu Morioka
- Department of Neurorehabilitation, Graduate School of Health Science, Kio University, Nara, Japan.,Neuro Rehabilitation Research Center, Kio University, Nara, Japan
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Araujo FX, Scholl Schell M, Ferreira GE, Pessoa MDV, Pinho AS, Plentz RDM, Silva MF. Short-Term Effects of Different Rates of Thoracic Mobilization on Pressure Pain Thresholds in Asymptomatic Individuals: A Randomized Crossover Trial. J Chiropr Med 2019; 18:33-41. [PMID: 31193227 DOI: 10.1016/j.jcm.2018.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 07/18/2018] [Accepted: 10/28/2018] [Indexed: 11/26/2022] Open
Abstract
Objective The primary aim of this study was to determine the effects of different rates of thoracic spine passive accessory intervertebral mobilization (PAIVM) on pressure pain threshold (PPT) at T4. The secondary aim was to investigate the widespread effects of different rates of thoracic PAIVM. Methods Twenty asymptomatic participants were randomly assigned to 3 experimental conditions: posteroanterior rotatory thoracic PAIVM at 2 Hz, 0.5 Hz, and placebo. Each participant received all 3 experimental conditions in a random order with a washout period of at least 48 hours between each procedure. The PPT was measured in 3 different points: pre-treatment, immediately after, and 15 minutes after the treatment at C7 and T4 spinous process, first interossei dorsal on the right and left hands and tibial tuberosity bilaterally. A repeated-measures analysis of covariance adjusted by baseline values was used to assess between-group differences at each point. Pairwise comparisons were adjusted for multiple tests with a Bonferroni correction. A P value < .05 was considered significant. Results There was no between-group differences on PPT at T4 when comparing 0.5 Hz (mean difference -0.29; 95% CI -0.99 to 0.42; P = .999) or 2 Hz (mean difference -0.37; 95% CI -1.1 to 0.33; P = .528) to placebo. Conclusion None of the mobilization techniques in this study (0.5 Hz, 2 Hz, and placebo) showed a significant change of PPT both locally and at distant sites at any point in asymptomatic participants.
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Affiliation(s)
- Francisco X Araujo
- Masters Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil.,Physical Therapy Department, Centro Universitário Ritter dos Reis/UniRitter, Porto Alegre, Brazil
| | - Mauricio Scholl Schell
- Physical Therapy Department, Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil
| | - Giovanni E Ferreira
- Masters Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil
| | - Mariana D V Pessoa
- Physical Therapy Department, Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil
| | - Alexandre S Pinho
- Physical Therapy Department, Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil
| | - Rodrigo D M Plentz
- Masters Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil
| | - Marcelo F Silva
- Masters Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil
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Abstract
Spinal manipulative therapy, including low-velocity variable-amplitude spinal manipulation (LVVA-SM), relieves chronic low back pain, especially in patients with neuropathic radiating leg pain following peripheral nervous system insult. Understanding the underlying analgesic mechanisms requires animal models. The aim of the current study was to develop an animal model for the analgesic actions of LVVA-SM in the setting of peripheral neuropathic pain. Adult male Sprague-Dawley rat sciatic nerve tibial and common peroneal branches were transected, sparing the sural branch (spared nerve injury, SNI). After 15-18 days, rats were assigned randomly to one of three groups (n=9 each group): LVVA-SM at 0.15-or 0.16-Hz or Control. LVVA-SM (20° flexion at the L5 vertebra with an innovative motorized treatment table) was administered in anesthetized rats for 10 min. Control rats were administered anesthesia and positioned on the treatment table. After 10, 25, and 40 min, the plantar skin of the hindpaw ipsilateral to SNI was tested for mechanical sensitivity (paw withdrawal threshold to a logarithmic series of Semmes-Weinstein monofilaments) and cold sensitivity (duration of paw lifting, shaking, and/or licking to topical acetone application). SNI produced behavioral signs of mechanical and cold allodynia. LVVA-SM reduced mechanical, but not cold, hypersensitivity compared with Control (0.15-Hz: P=0.04 at 10 min; 0.16-Hz: P<0.001 at 10 min, P=0.04 at 25 min). The analgesic effect of LVVA-SM in chronic low back pain patients with neuropathic leg pain can be reverse-translated to a rat model Video abstract: http://links.lww.com/WNR/A453.
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Navarro-Fernández G, de-la-Puente-Ranea L, Gandía-González M, Gil-Martínez A. Endogenous Neurostimulation and Physiotherapy in Cluster Headache: A Clinical Case. Brain Sci 2019; 9:brainsci9030060. [PMID: 30870974 PMCID: PMC6468612 DOI: 10.3390/brainsci9030060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/06/2019] [Accepted: 03/08/2019] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE The aim of this paper is to describe the progressive changes of chronic cluster headaches (CHs) in a patient who is being treated by a multimodal approach, using pharmacology, neurostimulation and physiotherapy. SUBJECT A male patient, 42 years of age was diagnosed with left-sided refractory chronic CH by a neurologist in November 2009. In June 2014, the patient underwent a surgical intervention in which a bilateral occipital nerve neurostimulator was implanted as a treatment for headache. METHODS Case report. RESULTS Primary findings included a decreased frequency of CH which lasted up to 2 months and sometimes even without pain. Besides this, there were decreased levels of anxiety, helplessness (PCS subscale) and a decreased impact of headache (HIT-6 scale). Bilateral pressure pain thresholds (PPTs) were improved along with an increase in strength and motor control of the neck muscles. These improvements were present at the conclusion of the treatment and maintained up to 4 months after the treatment. CONCLUSIONS A multimodal approach, including pharmacology, neurostimulation and physiotherapy may be beneficial for patients with chronic CHs. Further studies such as case series and clinical trials are needed to confirm these results.
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Affiliation(s)
- Gonzalo Navarro-Fernández
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid 28023, Spain.
- Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimiento, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid 28023, Spain.
| | - Lucía de-la-Puente-Ranea
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid 28023, Spain.
| | | | - Alfonso Gil-Martínez
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid 28023, Spain.
- Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimiento, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid 28023, Spain.
- Hospital La Paz Institute for Health Research, Madrid 28046, Spain.
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Bond BM, Kinslow CD, Yoder AW, Liu W. Effect of spinal manipulative therapy on mechanical pain sensitivity in patients with chronic nonspecific low back pain: a pilot randomized, controlled trial. J Man Manip Ther 2019; 28:15-27. [PMID: 30935324 DOI: 10.1080/10669817.2019.1572986] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Objectives: The long-term goal of our study is to improve the understanding of the biological mechanisms associated with spinal manipulative therapy (SMT) in low back pain.Methods: This project involved a pilot randomized, blinded clinical trial (ClinicalTrials.gov registration number NCT03078114) of 3-week SMT in chronic nonspecific low back pain (CNSLBP) patients. We recruited 29 participants and randomly assigned them into either a SMT (n = 14) or sham SMT (n = 15) group. Pre- and postintervention, we quantified the effect of SMT on clinical outcomes (Numeric Pain Rating Scale and Oswestry Disability Index) and pressure pain threshold (PPT) at local (lumbar spine), regional (lower extremity), and remote (upper extremity) anatomical sites.Results: We observed a significant main effect for time signifying reduced hypersensitivity (increased PPT) at local (p = .015) and regional (p = .014) locations at 3 weeks. Furthermore, we found significant main effects of time indicating improvements in pain (p < .001) and disability (p = .02) from baseline among all participants regardless of intervention. However, no between-group differences were observed in PPT, clinical pain, or disability between the SMT and sham SMT groups over 3 weeks.Conclusions: After 3 weeks of SMT or sham SMT in CNSLBP patients, we found hypoalgesia at local and remote sites along with improved pain and low back-related disability.Level of Evidence: 1b.
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Affiliation(s)
- Bryan M Bond
- Department of Physical Therapy, University of Saint Mary, Leavenworth, KS, USA
| | - Chris D Kinslow
- Department of Physical Therapy, University of Saint Mary, Leavenworth, KS, USA
| | - Adam W Yoder
- Department of Physical Therapy, University of Saint Mary, Leavenworth, KS, USA
| | - Wen Liu
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, USA
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Albin SR, Koppenhaver SL, Bailey B, Blommel H, Fenter B, Lowrimore C, Smith AC, McPoil TG. The effect of manual therapy on gastrocnemius muscle stiffness in healthy individuals. Foot (Edinb) 2019; 38:70-75. [PMID: 30665198 PMCID: PMC6815100 DOI: 10.1016/j.foot.2019.01.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 12/24/2018] [Accepted: 01/09/2019] [Indexed: 02/04/2023]
Abstract
STUDY DESIGN Randomized clinical trial. BACKGROUND Muscle stiffness is a potential complication after injury and has been shown to be a risk factor for injury in healthy individuals. OBJECTIVES The primary purpose of this study was to assess the short-term effects of manual therapy (MT) on muscle stiffness of the gastrocnemius in both a relaxed and contracted state. The secondary purpose was to assess the reliability of a novel clinical tool (MyotonPRO) to measure muscle stiffness in the gastrocnemius in both a passive and contracted state. METHODS Eighty-four consecutive healthy individuals were randomized to receive Manual Therapy (MT group) directed at the right-side ankle and foot or no treatment (CONTROL group). Muscle stiffness of the gastrocnemius was assessed bilaterally in all participants at baseline and then immediately after intervention in a relaxed and contracted state. Group (MT vs. CONTROL) by side (ipsilateral vs. contralateral) by time (pre vs. post) effects were compared through a 3-way interaction utilizing mixed model ANOVA. Reliability of the MyotonPRO was assessed with two-way mixed model intraclass correlation coefficients. RESULTS There was a significant 3-way interaction for muscle stiffness of the gastrocnemius in a relaxed state (p<0.01), but not contracted state (p=0.54). All conditions had increased resting muscle stiffness from pre to post measures except for the ipsilateral limb of the MT group. There was not a significant interaction for muscle stiffness in a contracted state. Reliability estimates (ICC) for muscle stiffness measures ranged between 0.898 and 0.986. CONCLUSION The change in muscle stiffness of the gastrocnemius in a relaxed state depended upon whether individuals received MT. Muscle stiffness measures were highly reliable based on single measurements. LEVEL OF EVIDENCE Therapy, level 2.
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Affiliation(s)
- Stephanie R. Albin
- Regis University, Denver, CO, United States,Corresponding author. (S.R. Albin)
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Is spinal mobilization effective for low back pain?: A systematic review. Complement Ther Clin Pract 2019; 34:51-63. [DOI: 10.1016/j.ctcp.2018.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 11/04/2018] [Accepted: 11/04/2018] [Indexed: 12/14/2022]
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Heneghan NR, Davies SE, Puentedura EJ, Rushton A. Knowledge and pre-thoracic spinal thrust manipulation examination: a survey of current practice in the UK. J Man Manip Ther 2018; 26:301-309. [PMID: 30455557 PMCID: PMC6237157 DOI: 10.1080/10669817.2018.1507269] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES The perceived relative safety of thoracic thrust joint manipulation (TTJM) has contributed to evidence supporting its use. Yet, TTJM is not without risk, where transient side effects (SE) and severe adverse events (AE) have been documented. With evidence supporting the importance of prethrust examination in reducing AE in other spinal regions this study investigated TTJM knowledge and pre-TTJM examination. Method: An e-survey, informed by existing evidence and expertise was designed and piloted. Eligibility criteria: UK-trained physiotherapists who use TTJM. Recruitment via professional networks and social media from December 2016 to February 2017. Data analysis included descriptive analyses (means, standard deviation and frequencies/central tendencies), and content analysis (themes and frequencies) for free text data. Results: From 306 responses, the sample comprised 146 (53%) males, mean (SD) age 36.37(8.68) years, with 12.88(8.67) years in practice, 11.07(8.14) years specialization, working in National Health Service/private practice (81%) and performing 0-5 TTJM/week (86%). EXAMINATION 40% (n = 83) utilized pre-TTJM examination with 45% (n = 139) adapting the examination for different regions. Technique selection and effect: preferred technique was prone rotational TTJM (67%). Perception of the primary underlying effect was neurophysiological (54%), biomechanical (45%) or placebo (1%). Knowledge: Levels of agreement were found for contraindications (85%), precautions (75%), and red flags (86%) with more variability for risks including AE and SE (61%). DISCUSSION UK physiotherapists demonstrated good knowledge and agreement of contraindications, precautions, and red flags to TTJM. With <50% respondents utilizing pre-TTJM examination, variable knowledge of TTJM risks, and therapeutic effects of TTJM further research is required.
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Affiliation(s)
- Nicola R. Heneghan
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Sally E. Davies
- Physiotherapy Department, Bupa Bristol Health Centre, Bristol, UK
| | - Emilio J. Puentedura
- Department of Physical Therapy, School of Allied Health Sciences, Las Vegas, NV, USA
| | - Alison Rushton
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Birmingham, UK
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Effects of an anteroposterior mobilization of the glenohumeral joint in overhead athletes with chronic shoulder pain: A randomized controlled trial. Musculoskelet Sci Pract 2018; 38:91-98. [PMID: 30359870 DOI: 10.1016/j.msksp.2018.09.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 09/13/2018] [Accepted: 09/19/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Passive oscillatory mobilizations are often employed by physiotherapists to reduce shoulder pain and increase function. However, there is little data about the neurophysiological effects of these mobilizations. OBJECTIVES To investigate the initial effects of an anteroposterior (AP) shoulder joint mobilization on measures of pain and function in overhead athletes with chronic shoulder pain. DESIGN Double-blind, controlled, within-subject, repeated-measures design. METHOD Thirty-one overhead athletes with chronic shoulder pain participated. The effects of a 9-min, AP mobilization of the glenohumeral joint were compared with manual contact and no-contact interventions. Self-reported pain, pressure pain threshold (PPT), range of movement (ROM), muscle strength, and disability were measured immediately before and after each intervention. RESULTS/FINDINGS No significant differences were found among the treatment conditions in any of the variables investigated. A significantly greater mean decrease in self-reported shoulder pain was observed following treatment condition [0.63 (0.12, 1.14); p = 0.01]. PPT at the affected shoulder increased significantly following both the treatment [0.23 (-0.43, 0.02); p = 0.02] and manual contact [0.28 (-0.51, 0.04); p = 0.01] conditions. Shoulder AP joint mobilization also increased PPT at a distal, non-painful site [0.42 (-0.85, 0.01); p = 0.04]. No changes were observed in shoulder ROM or muscle strength. CONCLUSIONS This study found no superior effects in various pain or function-related outcome measures of a passive oscillatory anteroposterior mobilization applied to the glenohumeral joint compared to manual contact and no-contact interventions in overhead athletes with chronic shoulder pain. Some ability to modulate shoulder pain and local and widespread pain sensitivity was observed in the short term after the passive oscillatory anteroposterior mobilization.
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Ceballos-Laita L, Estébanez-de-Miguel E, Martín-Nieto G, Bueno-Gracia E, Fortún-Agúd M, Jiménez-Del-Barrio S. Effects of non-pharmacological conservative treatment on pain, range of motion and physical function in patients with mild to moderate hip osteoarthritis. A systematic review. Complement Ther Med 2018; 42:214-222. [PMID: 30670244 DOI: 10.1016/j.ctim.2018.11.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 11/22/2018] [Accepted: 11/26/2018] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE The purpose of this review was to identify the effects of non-pharmacological conservative treatment on pain, range of motion and physical function in patients with mild to moderate hip osteoarthritis. DESIGN A systematic review based on Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. SETTING We searched MEDLINE, PEDro, Scopus and the Cochrane Library databases for randomized controlled trials related to non-pharmacological conservative treatments for hip osteoarthritis with the following keywords: "hip osteoarthritis," "therapeutics," "physical therapy modalities," and "combined physical therapy". The PEDro scale was used for methodological quality assessment and the Oxford Centre of Evidence-Based Medicine scale was used to assess the level of evidence. Outcomes measures related to pain, hip range of motion and physical function were extracted from these studies. RESULTS Twelve studies met the inclusion criteria. Most of the studies showed high level of evidence and only two showed low level of evidence. High quality of evidence showed that manual therapy and exercise therapy are effective in improving pain, hip range of motion and physical function. However, high quality studies based on combined therapies showed controversy in their effects on pain, hip range of motion and physical function. CONCLUSIONS Exercise therapy and manual therapy and its combination with patient education provides benefits in pain and improvement in physical function. The effects of combined therapies remain unclear. Further investigation is necessary to improve the knowledge about the effects of non-pharmacological conservative treatments on pain, hip range of motion and physical function.
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Affiliation(s)
- Luis Ceballos-Laita
- Department of Surgery, Ophtalmology and Physiotherapy, University of Valladolid, c/Universidad s/n, 42004, Soria, Spain.
| | - Elena Estébanez-de-Miguel
- Department of Physiatrist and Nursey, Faculty of Health Sciencies, University of Zaragoza, c/Domingo Miral s/n, 50010, Zaragoza, Spain.
| | - Gadea Martín-Nieto
- Department of Surgery, Ophtalmology and Physiotherapy, University of Valladolid, c/Universidad s/n, 42004, Soria, Spain.
| | - Elena Bueno-Gracia
- Department of Physiatrist and Nursey, Faculty of Health Sciencies, University of Zaragoza, c/Domingo Miral s/n, 50010, Zaragoza, Spain.
| | | | - Sandra Jiménez-Del-Barrio
- Department of Surgery, Ophtalmology and Physiotherapy, University of Valladolid, c/Universidad s/n, 42004, Soria, Spain.
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Sparks CL, Liu WC, Cleland JA, Kelly JP, Dyer SJ, Szetela KM, Elliott JM. Functional Magnetic Resonance Imaging of Cerebral Hemodynamic Responses to Pain Following Thoracic Thrust Manipulation in Individuals With Neck Pain: A Randomized Trial. J Manipulative Physiol Ther 2018; 40:625-634. [PMID: 29229052 DOI: 10.1016/j.jmpt.2017.07.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 06/22/2017] [Accepted: 07/20/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The purpose of this study was to examine whether cerebral activation in response to noxious mechanical stimuli varies with thrust manipulation (TM) when compared with sham manipulation (SM) as measured by blood oxygenation level-dependent functional magnetic resonance imaging. METHODS Twenty-four volunteers (67% female) with complaints of acute or subacute mechanical (nontraumatic) neck pain satisfied eligibility requirements and agreed to participate. Participants were randomized to receive TM to the thoracic spine or SM, and then underwent functional magnetic resonance scanning while receiving noxious stimuli before and after TM or SM. An 11-point numeric pain rating scale was administered pre- and postmanipulation for neck pain and to determine perceptions of pain intensity with respect to neck pain and mechanical stimuli. Blood oxygenation level-dependent functional magnetic resonance imaging recorded the cerebral hemodynamic response to the mechanical stimuli. RESULTS Imaging revealed significant group differences, with those individuals in the manipulation group exhibiting increased areas of activation (postmanipulation) in the insular and somatosensory cortices and individuals in the sham group exhibiting greater areas of activation in the precentral gyrus, supplementary motor area, and cingulate cortices (P < .05). However, between-group differences on the numeric pain rating scale for mechanical stimuli and for self-reported neck pain were not statistically significant. CONCLUSIONS This study provides preliminary level 2b evidence suggesting cortical responses in patients with nontraumatic neck pain may vary between thoracic TM and a sham comparator.
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Affiliation(s)
- Cheryl L Sparks
- Rehabilitation Center of Expertise, OSF Healthcare, Peoria, Illinois.
| | - Wen C Liu
- Department of Radiology, Saint Francis Medical Center, OSF Healthcare, Peoria, Illinois
| | - Joshua A Cleland
- Department of Physical Therapy, Franklin Pierce University, Concord, New Hampshire
| | - Joseph P Kelly
- Department of Physical Therapy, Bradley University, Peoria, Illinois
| | - Sarah J Dyer
- OSF Rehabilitation at Saint Francis Medical Center, OSF Healthcare, Peoria, Illinois
| | - Kathryn M Szetela
- OSF Rehabilitation at Saint Francis Medical Center, OSF Healthcare, Peoria, Illinois
| | - James M Elliott
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Chimenti RL, Frey-Law LA, Sluka KA. A Mechanism-Based Approach to Physical Therapist Management of Pain. Phys Ther 2018; 98:302-314. [PMID: 29669091 PMCID: PMC6256939 DOI: 10.1093/ptj/pzy030] [Citation(s) in RCA: 146] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 02/12/2018] [Indexed: 12/11/2022]
Abstract
Pain reduction is a primary goal of physical therapy for patients who present with acute or persistent pain conditions. The purpose of this review is to describe a mechanism-based approach to physical therapy pain management. It is increasingly clear that patients need to be evaluated for changes in peripheral tissues and nociceptors, neuropathic pain signs and symptoms, reduced central inhibition and enhanced central excitability, psychosocial factors, and alterations of the movement system. In this Perspective, 5 categories of pain mechanisms (nociceptive, central, neuropathic, psychosocial, and movement system) are defined, and principles on how to evaluate signs and symptoms for each mechanism are provided. In addition, the underlying mechanisms targeted by common physical therapist treatments and how they affect each of the 5 categories are described. Several different mechanisms can simultaneously contribute to a patient's pain; alternatively, 1 or 2 primary mechanisms may cause a patient's pain. Further, within a single pain mechanism, there are likely many possible subgroups. For example, reduced central inhibition does not necessarily correlate with enhanced central excitability. To individualize care, common physical therapist interventions, such as education, exercise, manual therapy, and transcutaneous electrical nerve stimulation, can be used to target specific pain mechanisms. Although the evidence elucidating these pain mechanisms will continue to evolve, the approach outlined here provides a conceptual framework for applying new knowledge as advances are made.
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Affiliation(s)
- Ruth L Chimenti
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, Iowa
| | - Laura A Frey-Law
- Department of Physical Therapy and Rehabilitation Science, University of Iowa
| | - Kathleen A Sluka
- Department of Physical Therapy and Rehabilitation Science, 1-242 MEB, University of Iowa, Iowa City, IA 52242 (USA)
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Sit RWS, Chan KKW, Yip BHK, Zhang DD, Reeves KD, Chan YH, Chung VCH, Wong SYS. Clinical effectiveness of patella mobilisation therapy versus a waiting list control for knee osteoarthritis: a protocol for a pragmatic randomised clinical trial. BMJ Open 2018; 8:e019103. [PMID: 29540410 PMCID: PMC5857690 DOI: 10.1136/bmjopen-2017-019103] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Knee osteoarthritis (KOA) is a common, disabling and costly medical condition. The patellofemoral joint is a critical source of pain in individuals with KOA, and coexistence of patellofemoral osteoarthritis (PFOA) and tibiofemoral osteoarthritis (TFOA) is sometimes observed. The identification of subgroups with PFOA and customised interventions to correct underlying pathomechanics is beneficial for individuals with KOA. This study aims to evaluate whether a clinic-based patella mobilisation therapy (PMT) leads to significant improvement in pain, physical function and quality of life of individuals with KOA. METHODS AND ANALYSIS A total of 208 participants with coexistence of PFOA and TFOA will be recruited. A pragmatic randomised clinical trial will be conducted, and participants will be randomised into the PMT and waiting list groups. For the PMT group, three manual mobilisation sessions, along with home-based vastus medialis oblique muscle exercise, will be conducted at 2-month intervals. The waiting list group will continue to receive their usual care, and as an incentive the waiting list group will be offered PMT after the study period is over. The primary outcome is the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale, and secondary outcomes include the WOMAC function and stiffness subscales, scores for objective physical function tests (the 30 s chair stand, 40-metre fast-paced walk test, the Timed Up and Go Test), and the EuroQol-5D scores. All outcomes will be evaluated at baseline and 6 months using intention-to-treat and incorporating covariate analysis. ETHICS AND DISSEMINATION Ethics approval has been obtained (CREC no: 2014.379). Results of the trial will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER ChiCTR-IPC-15006618; Pre-results.
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Affiliation(s)
- Regina Wing Shan Sit
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Keith Kwok Wai Chan
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Benjamin Hon Kei Yip
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Daisy Dexing Zhang
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Kenneth Dean Reeves
- Department of Physical Medicine and Rehabilitation (1986-2015), The University of Kansas, Kansas City, Kansas, USA
| | - Ying Ho Chan
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Vincent Chi Ho Chung
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Samuel Yeung Shan Wong
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
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