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Mak S, Allen J, Begashaw M, Miake-Lye I, Beroes-Severin J, De Vries G, Lawson E, Shekelle PG. Use of Massage Therapy for Pain, 2018-2023: A Systematic Review. JAMA Netw Open 2024; 7:e2422259. [PMID: 39008297 PMCID: PMC11250267 DOI: 10.1001/jamanetworkopen.2024.22259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 05/15/2024] [Indexed: 07/16/2024] Open
Abstract
Importance Massage therapy is a popular treatment that has been advocated for dozens of painful adult health conditions and has a large evidence base. Objective To map systematic reviews, conclusions, and certainty or quality of evidence for outcomes of massage therapy for painful adult health conditions. Evidence Review In this systematic review, a computerized search was conducted of PubMed, the Allied and Complementary Medicine Database, the Cumulated Index to Nursing and Allied Health Literature, the Cochrane Database of Systematic Reviews, and Web of Science from 2018 to 2023. Included studies were systematic reviews of massage therapy for pain in adult health conditions that formally rated the certainty, quality, or strength of evidence for conclusions. Studies of sports massage therapy, osteopathy, dry cupping or dry needling, and internal massage therapy (eg, for pelvic floor pain) were ineligible, as were self-administered massage therapy techniques, such as foam rolling. Reviews were categorized as those with at least 1 conclusion rated as high-certainty evidence, at least 1 conclusion rated as moderate-certainty evidence, and all conclusions rated as low- or very low-certainty evidence; a full list of conclusions and certainty of evidence was collected. Findings A total of 129 systematic reviews of massage therapy for painful adult health conditions were found; of these, 41 reviews used a formal method to rate certainty or quality of evidence of their conclusions and 17 reviews were mapped, covering 13 health conditions. Across these reviews, no conclusions were rated as high certainty of evidence. There were 7 conclusions that were rated as moderate-certainty evidence; all remaining conclusions were rated as low- or very low-certainty evidence. All conclusions rated as moderate certainty were that massage therapy had a beneficial associations with pain. Conclusions and Relevance This study found that despite a large number of randomized clinical trials, systematic reviews of massage therapy for painful adult health conditions rated a minority of conclusions as moderate-certainty evidence and that conclusions with moderate- or high-certainty evidence that massage therapy was superior to other active therapies were rare.
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Affiliation(s)
- Selene Mak
- Veterans Health Administration, Greater Los Angeles Healthcare System, Los Angeles, California
| | - Jennifer Allen
- Veterans Health Administration, Greater Los Angeles Healthcare System, Los Angeles, California
| | - Meron Begashaw
- Veterans Health Administration, Greater Los Angeles Healthcare System, Los Angeles, California
| | - Isomi Miake-Lye
- Veterans Health Administration, Greater Los Angeles Healthcare System, Los Angeles, California
- UCLA Fielding School of Public Health, University of California, Los Angeles
| | - Jessica Beroes-Severin
- Veterans Health Administration, Greater Los Angeles Healthcare System, Los Angeles, California
| | - Gerardo De Vries
- Veterans Health Administration, Greater Los Angeles Healthcare System, Los Angeles, California
| | | | - Paul G. Shekelle
- Veterans Health Administration, Greater Los Angeles Healthcare System, Los Angeles, California
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Antohe BA, Alshana O, Uysal HŞ, Rață M, Iacob GS, Panaet EA. Effects of Myofascial Release Techniques on Joint Range of Motion of Athletes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Sports (Basel) 2024; 12:132. [PMID: 38787001 PMCID: PMC11125680 DOI: 10.3390/sports12050132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 05/01/2024] [Accepted: 05/07/2024] [Indexed: 05/25/2024] Open
Abstract
Although myofascial release techniques (MRTs) are commonly used to improve athletes' range of motion (ROM), the effectiveness of MRTs may vary depending on the specific method performed. This systematic review and meta-analysis aimed to evaluate the effects of MRTs on the ROM performance of athletes. (2) Methods: The electronic databases of Cochrane Library, PubMed, Scopus, and Web of Science were searched to identify relevant articles published up to June 2023. This study utilized the PRISMA guidelines, and four databases were searched. The methodological quality of the studies was assessed using the PEDro scale, and the certainty of evidence was reported using the GRADE scale. The overall effect size was calculated using the robust variance estimator, and subgroup analyses were conducted using the Hotelling Zhang test. (3) Ten studies met the inclusion criteria. The overall effect size results indicated that the myofascial release intervention had a moderate effect on ROM performance in athletes when compared to the active or passive control groups. (4) Conclusions: Alternative MRTs, such as myofascial trigger point therapy, can further improve the ROM performance of athletes. Gender, duration of intervention, and joint type may have a moderating effect on the effectiveness of MRTs.
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Affiliation(s)
- Bogdan Alexandru Antohe
- Departament of Physical Therapy and Ocupational Therapy, “Vasile Alecsandri” University of Bacău, 600011 Bacău, Romania; (B.A.A.); (E.A.P.)
| | - Osama Alshana
- Department of Physiotherapy, University College of Applied Sciences, Gaza Strip P6160675, Palestine;
| | - Hüseyin Şahin Uysal
- Faculty of Sport Sciences, Burdur Mehmet Akif Ersoy University, 15030 Burdur, Turkey
| | - Marinela Rață
- Departament of Physical Therapy and Ocupational Therapy, “Vasile Alecsandri” University of Bacău, 600011 Bacău, Romania; (B.A.A.); (E.A.P.)
| | - George Sebastian Iacob
- Department of Physical Education and Sports Science, Faculty of Physical Education and Sport, “Alexandru Ioan Cuza” University of Iași, 700506 Iași, Romania;
| | - Elena Adelina Panaet
- Departament of Physical Therapy and Ocupational Therapy, “Vasile Alecsandri” University of Bacău, 600011 Bacău, Romania; (B.A.A.); (E.A.P.)
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Lu Z, Zou H, Zhao P, Wang J, Wang R. Myofascial Release for the Treatment of Tension-Type, Cervicogenic Headache or Migraine: A Systematic Review and Meta-Analysis. Pain Res Manag 2024; 2024:2042069. [PMID: 38585645 PMCID: PMC10999287 DOI: 10.1155/2024/2042069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/07/2024] [Accepted: 03/12/2024] [Indexed: 04/09/2024]
Abstract
Objective To assess the effectiveness of myofascial release (MFR) techniques on the intensity of headache pain and associated disability in patients with tension-type headache (TTH), cervicogenic headache (CGH), or migraine. Design A systematic review and meta-analysis. Methods Eight databases were searched on September 15, 2023, including PubMed, Scopus, Web of Science, CINAHL, Cochrane Library, Embase, CNKI, and Wanfang Database. The risk of bias was evaluated utilizing the Cochrane Risk of Bias 2 (RoB 2) tool. Results Pooled results showed that MFR intervention significantly reduces pain intensity [SMD = -2.01, 95% CI (-2.98, -1.03), I2 = 90%, P < 0.001] and improves disability [SMD = -1.3, 95% CI (-1.82, -0.79), I2 = 74%, P < 0.001]. Subgroup analysis based on the type of headache revealed significant reductions in pain intensity for CGH [SMD = -2.01, 95% CI (-2.73, -1.29), I2 = 63%, P < 0.001], TTH [SMD = -0.86, 95% CI (-1.52, -0.20), I2 = 50%, P=0.01] and migraine [SMD = -6.52, 95% CI (-8.15, -4.89), P < 0.001] and in disability for CGH [SMD = -1.45, 95% CI (-2.07, -0.83), I2 = 0%, P < 0.001]; TTH [SMD = -0.98, 95% CI (-1.32, -0.65), I2 = 0%, P < 0.001] but not migraine [SMD = -2.44, 95% CI (-6.04, 1.16), I2 = 97%, P=0.18]. Conclusion The meta-analysis results indicate that MFR intervention can significantly alleviate pain and disability in TTH and CGH. For migraine, however, the results were inconsistent, and there was only moderate quality evidence of disability improvement for TTH and CGH. In contrast, the quality of other evidence was low or very low.
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Affiliation(s)
- Zhoupeng Lu
- Sports Rehabilitation Research Center, China Institute of Sport Science, Beijing, China
- College of Sports Medicine and Physical Therapy, Beijing Sport University, Beijing, China
| | - Hui Zou
- Sports Rehabilitation Research Center, China Institute of Sport Science, Beijing, China
- College of Sports Medicine and Physical Therapy, Beijing Sport University, Beijing, China
| | - Peng Zhao
- Sports Rehabilitation Research Center, China Institute of Sport Science, Beijing, China
| | - Jialin Wang
- Sports Rehabilitation Research Center, China Institute of Sport Science, Beijing, China
| | - Ruirui Wang
- Sports Rehabilitation Research Center, China Institute of Sport Science, Beijing, China
- College of Sports Medicine and Physical Therapy, Beijing Sport University, Beijing, China
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Harper B, Dudek A, Williamson J, Siyufy A, Smith JA. Combining Static and Dynamic Myofascial Dry Cupping Therapy to Improve Local and Regional Symptoms in Individuals with Low Back Pain: A Case Series. Int J Sports Phys Ther 2024; 19:227-237. [PMID: 38313662 PMCID: PMC10837828 DOI: 10.26603/001c.91653] [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: 09/14/2023] [Accepted: 12/16/2023] [Indexed: 02/06/2024] Open
Abstract
Introduction Chronic low back pain is a common musculoskeletal healthcare presentation with an expense of over $100 billion annually. The clinical effect of myofascial cupping on pain and function is not clear, especially when different cupping techniques are combined. The purpose of this case series was to explore changes in pain and function following local static and distal dynamic myofascial dry cupping treatments in patients with chronic low back pain. Case Descriptions Three adults from the general population received three ten-minute treatment sessions, 48 hours between each session, of static dry cupping to the low back followed by dynamic myofascial cupping of the quadriceps and hamstring musculature. Outcome measures were taken at two different time points within one-week per participant. Subjective measures included the numeric pain rating scale and the Oswestry Disability Index, objective measures included passive straight leg raise measurements, and pressure pain threshold. Results and Discussion Local static combined with distal dynamic myofascial cupping reduced pain, pain sensitivity and perceived disability, and improved hamstring muscle extensibility in all three participants. These encouraging results support the initiation of a larger controlled trial aimed at investigating the efficacy of combined dry cupping interventions to treat musculoskeletal dysfunction and pain. Level of Evidence 4 (case series).
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Affiliation(s)
| | - Alana Dudek
- Physical Therapy Chapman University
- Physical Therapy South College
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Rodgers LJ, Bialosky JE, Minick SA, Coronado RA. An overview of systematic reviews examining the quantitative sensory testing-derived hypoalgesic effects of manual therapy for musculoskeletal pain. J Man Manip Ther 2024; 32:67-84. [PMID: 37908101 PMCID: PMC10795637 DOI: 10.1080/10669817.2023.2267954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/03/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Changes in quantitative sensory testing (QST) after manual therapy can provide insight into pain relief mechanisms. Prior systematic reviews have evaluated manual-therapy-induced QST change. This overview of systematic reviews aims to consolidate this body of literature and critically review evidence on the hypoalgesic effects of manual therapy in clinical populations. METHODS A comprehensive search was conducted on PubMed, CINAHL, PsycInfo, and Embase. Peer-reviewed systematic reviews with or without meta-analysis were eligible if the reviews examined the effect of manual therapy compared to non-manual therapy interventions on QST outcomes in clinical populations. Methodological quality was assessed with the AMSTAR 2 tool. Meta-analysis results and qualitative (non-meta-analysis) interpretations were summarized by type of manual therapy. Overlap of studies was examined with the corrected covered area (CCA) index. RESULTS Thirty systematic reviews, including 11 meta-analyses, met inclusion. There was a slight overlap in studies (CCA of 1.72% for all reviews and 1.69% for meta-analyses). Methodological quality was predominantly low to critically low. Eight (27%) reviews examined studies with a range of manual therapy types, 13 (43%) reviews focused on joint-biased manual therapy, 7 (23%) reviews focused on muscle-biased manual therapy, and 2 (7%) reviews focused on nerve-biased manual therapy. Twenty-nine (97%) reviews reported on pressure pain threshold (PPT). Meta-analytic results demonstrated conflicting evidence that manual therapy results in greater hypoalgesic effects compared to other interventions or controls. CONCLUSION Our overview of QST effects, which has relevance to mechanisms underlying hypoalgesia, shows conflicting evidence from mostly low to critically low systematic reviews.
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Affiliation(s)
- Logan J. Rodgers
- Department of Physical Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Joel E. Bialosky
- Department of Physical Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
- Brooks-UF-PHHP Research Collaboration, Gainesville, FL, USA
| | - Sophie A. Minick
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Rogelio A. Coronado
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Physical Medicine and Rehabilitation, Osher Center for Integrative Health, Vanderbilt University Medical Center, Nashville, TN, USA
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van Amstel R, Noten K, Malone S, Vaes P. Fascia Tissue Manipulations in Chronic Low Back Pain: A Pragmatic Comparative Randomized Clinical Trial of the 4xT Method ® and Exercise Therapy. Life (Basel) 2023; 14:7. [PMID: 38276256 PMCID: PMC10820544 DOI: 10.3390/life14010007] [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: 11/14/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND The 4xT method is a protocolized practice in treating musculoskeletal disorders. The 4xT method consists of four components: Test (functional diagnostic test), Trigger (fascia tissue manipulations), Tape (elastic taping), and Train (exercise). There is a lack of clinical studies evaluating the treatment effects of the use of the 4xT method. METHODS A randomized controlled trial was conducted to compare the effectiveness of the 4xT method and exercise therapy-only in patients with chronic nonspecific low back pain. Based on a priori sample size calculation, fifty-one individuals with chronic nonspecific low back pain were randomly assigned to either the 4xT or exercise group. Both groups underwent a six-week rehabilitation program with two treatments per week. The primary outcomes were trunk flexion and extension mobility, trunk flexion, and extension mobility-dependent pain, and quality of life evaluated during a 6-week therapy period and after a 6-week therapy-off period. RESULTS Interaction effects were noted in all outcomes. The 4xT group showed significant improvements over time for trunk flexion and extension mobility, trunk flexion and extension mobility-dependent pain, and quality of life (p < 0.05), with no significant relapse post-therapy (except for extension mobility). The exercise group exhibited significant within-time changes in the quality of life, as measured with the VAS (p < 0.05), but not for EQ-5D-3L. CONCLUSIONS The results of this study demonstrate that the 4xT method stands out as a promising and impactful treatment option for chronic nonspecific low back pain individuals, as it demonstrated significant reductions in mobility-dependent pain, increased trunk mobility, and improved quality of life compared to exercise-only treatments.
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Affiliation(s)
- Robbert van Amstel
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, 1081 Amsterdam, The Netherlands
- Fysio Science Department, Fysio Physics Groups, 3401 IJsselstein, The Netherlands
| | - Karl Noten
- Fysio Science Department, Fysio Physics Groups, 3401 IJsselstein, The Netherlands
| | - Shaun Malone
- Department of Rehabilitation Sciences and Physiotherapy (MOVANT), University of Antwerp, Wilrijk, 2000 Antwerpen, Belgium
| | - Peter Vaes
- Faculty of Rehabilitation Science and Physical Therapy, Vrije Universiteit Brussel, 1050 Brussels, Belgium;
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Ożóg P, Weber-Rajek M, Radzimińska A. Effects of Isolated Myofascial Release Therapy in Patients with Chronic Low Back Pain-A Systematic Review. J Clin Med 2023; 12:6143. [PMID: 37834787 PMCID: PMC10573556 DOI: 10.3390/jcm12196143] [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: 08/09/2023] [Revised: 09/08/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
Dysfunctions of the lumbosacral area and related pain syndromes, such as chronic low back pain (CLBP), are among the most common musculoskeletal problems in modern society. The purpose of this study was to evaluate the effectiveness of isolated myofascial release techniques (MFR) in the treatment of CLBP in adults. PubMed, Web of Science, Scopus, and Cochrane Library databases were searched for studies published from 1 January 2013 to 1 March 2023. We included English-language randomized controlled trials evaluating the effect of isolated MFR performed by a specialist on adults with CLBP. Only studies with a comparison group without treatment or with sham MFR were included. A total of 373 studies were detected, of which 6 studies were finally included in this review. There was a total of 397 CLBP patients aged 18-60 in all study groups. The studies evaluated the effects of a series of MFR treatments as well as a single intervention. After applying a series of treatments, a statistically significant reduction in pain intensity, improvement in the range of motion, reduction in the level of functional disability and fear-avoidance beliefs, as well as a decrease in the activity of paraspinal muscles at maximum trunk flexion were demonstrated. A single, 40-min complex intervention involving tissues at various depths significantly reduced the level of pain, improved the range of motion, and reduced the resting activity of paraspinal muscles in the standing position, but did not affect postural stability. The use of a single 5 min MFR technique did not affect pain intensity and sensitivity and functional disability. The findings suggest that the use of a series of isolated MFR improves the condition of patients with CLBP by reducing the intensity of pain, improving functional efficiency, and reducing the activity of the paraspinal muscles in the position of maximum forward bend. The use of a single intervention containing a set of techniques covering superficial and deep tissue also reduces the intensity of pain, improves mobility, and reduces the resting activity of the paraspinal muscles in a standing position. Given the small number of eligible studies with limitations, conclusions should be interpreted with caution and avoid overgeneralizing the benefits of isolated MFR based on limited or mixed evidence.
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Affiliation(s)
- Piotr Ożóg
- Department of Physiotherapy, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, 87-100 Torun, Poland; (M.W.-R.); (A.R.)
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Devantéry K, Morin M, Grimard J, Gaudreault N. Effects of a Myofascial Technique on the Stiffness and Thickness of the Thoracolumbar Fascia and Lumbar Erector Spinae Muscles in Adults with Chronic Low Back Pain: A Randomized before-and-after Experimental Study. Bioengineering (Basel) 2023; 10:bioengineering10030332. [PMID: 36978723 PMCID: PMC10045407 DOI: 10.3390/bioengineering10030332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/17/2023] [Accepted: 03/01/2023] [Indexed: 03/08/2023] Open
Abstract
The thoracolumbar fascia (TLF) may be a pain generator, given its rich innervation. Structural and biomechanical changes have also been documented in adults with chronic non-specific low back pain (LBP). Myofascial techniques (MFTs) are commonly used in manual therapy and are hypothesized to reduce tissue stiffness and pain. However, evidence for these effects is limited. The objective of this study was to evaluate the immediate effects of a standardized MFT compared to a simulated MFT on: (1) the stiffness of the TLF and erector spinae muscles (shear-wave sonoelastography), (2) the thickness of the TLF (B-mode ultrasound), and (3) pain intensity (numerical rating scale). Forty-nine participants with chronic non-specific LBP were included in a randomized before-and-after experimental study. Outcome measures were collected before (T0) and immediately after the intervention (T1). Pain intensity was also assessed on day two (T2) and seven (T7). The MFT group showed a significant decrease in left erector spinae muscle stiffness and left TLF thickness compared to the simulated group. In addition, there was a significant reduction in pain intensity in the MFT group compared to the simulated group at T1 and T2. The results of this study suggest that MFT results in immediate tissue changes and transient pain reduction in patients with LBP.
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Immediate Effects of Myofascial Release Treatment on Lumbar Microcirculation: A Randomized, Placebo-Controlled Trial. J Clin Med 2023; 12:jcm12041248. [PMID: 36835784 PMCID: PMC9959802 DOI: 10.3390/jcm12041248] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 01/30/2023] [Accepted: 02/02/2023] [Indexed: 02/09/2023] Open
Abstract
(1) Background: Inflammatory processes in the thoracolumbar fascia (TLF) lead to thickening, compaction, and fibrosis and are thought to contribute to the development of nonspecific low back pain (nLBP). The blood flow (BF) of fascial tissue may play a critical role in this process, as it may promote hypoxia-induced inflammation. The primary objective of the study was to examine the immediate effects of a set of myofascial release (MFR) techniques on the BF of lumbar myofascial tissue. The secondary objectives were to evaluate the influence of TLF morphology (TLFM), physical activity (PA), and body mass index (BMI) on these parameters and their correlations with each other. (2) Methods: This study was a single-blind, randomized, placebo-controlled trial. Thirty pain-free subjects (40.5 ± 14.1 years) were randomly assigned to two groups treated with MFR or a placebo intervention. Correlations between PA, BMI, and TLFM were calculated at baseline. The effects of MFR and TLFM on BF (measured with white light and laser Doppler spectroscopy) were determined. (3) Results: The MFR group had a significant increase in BF after treatment (31.6%) and at follow-up (48.7%) compared with the placebo group. BF was significantly different between disorganized and organized TLFM (p < 0.0001). There were strong correlations between PA (r = -0.648), PA (d = 0.681), BMI (r = -0.798), and TLFM. (4) Conclusions: Impaired blood flow could lead to hypoxia-induced inflammation, possibly resulting in pain and impaired proprioceptive function, thereby likely contributing to the development of nLBP. Fascial restrictions of blood vessels and free nerve endings, which are likely associated with TLFM, could be positively affected by the intervention in this study.
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10
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van Amstel RN, Jaspers RT, Pool-Goudzwaard AL. Skin Displacement as fascia tissue manipulation at the lower back affects instantaneously the flexion-and extension spine, pelvis, and hip range of motion. Front Physiol 2022; 13:1067816. [PMID: 36505071 PMCID: PMC9727291 DOI: 10.3389/fphys.2022.1067816] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 10/31/2022] [Indexed: 11/24/2022] Open
Abstract
Low back pain (LBP), associated with spine, pelvis, and hip mobility impairments can be caused by tight muscle contractions, to protect sensitized lumbar fasciae. Fascia tissue manipulations are used to treat lumbar fascia in LBP. The effect of fascia tissue manipulations through lumbodorsal skin displacement (SKD) on mobility is inconclusive likely depending on the location and displacement direction of the manipulation. This study aimed to assess whether lumbodorsal SKD affects the flexion -and extension range of motion (ROM), in healthy subjects. Furthermore, we aimed to test the effect of SKD at different locations and directions. Finally, to assess intertester and intratester reliability of SKD. Effects of SKD were tested in a motion capture, single-blinded, longitudinal, experimental study. Sixty-three subjects were randomly assigned to SKD- or sham group. SKD group was subjected to either mediolateral directed SKD during flexion or extension movement, versus a sham. The thoracic, lumbar, and hip angles and finger floor distance were measured to assess the change in ROM. Statistics indicated that the effect size in instantaneously change of flexion -and extension ROM by SKD was large (Effect size: flexion η2 p = 0.12-0.90; extension η2 p = 0.29-0.42). No significant effect was present in the sham condition. Flexion ROM decreased whereas the extension ROM increased, depending on SKD location- and displacement direction (p < 0.05). The ICC indicates a good intertester and intratester reliability (resp. ICC3,k = 0.81-0.93; ICC3,1 = 0.70-0.84). Lumbodorsal SKD affects the flexion- and extension spine, pelvis, and hip range of motion. The effects of SKD are direction- and location dependent as well as movement (flexion/extension) specific. Lumbodorsal SKD during flexion and extension may be useful to determine whether or not a patient would benefit from fascia tissue manipulations. Further research is required to obtain insight into the mechanisms via which the SKD affects ROM and muscle activation, in healthy, asymptomatic-LBP, and LBP subjects.
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Affiliation(s)
- Robbert N. van Amstel
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands,Fysio Science Department, Fysio Physics Group, IJsselstein, Netherlands,*Correspondence: Robbert N. van Amstel, ; Annelies L. Pool-Goudzwaard,
| | - Richard T. Jaspers
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Annelies L. Pool-Goudzwaard
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands,SOMT, University of Physiotherapy, Amersfoort, Netherlands,*Correspondence: Robbert N. van Amstel, ; Annelies L. Pool-Goudzwaard,
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11
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Bohlen L, Schwarze J, Richter J, Gietl B, Lazarov C, Kopyakova A, Brandl A, Schmidt T. Effect of osteopathic techniques on human resting muscle tone in healthy subjects using myotonometry: a factorial randomized trial. Sci Rep 2022; 12:16953. [PMID: 36217012 PMCID: PMC9551048 DOI: 10.1038/s41598-022-20452-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 09/13/2022] [Indexed: 12/29/2022] Open
Abstract
Musculoskeletal disorders (MSDs) are highly prevalent, burdensome, and putatively associated with an altered human resting muscle tone (HRMT). Osteopathic manipulative treatment (OMT) is commonly and effectively applied to treat MSDs and reputedly influences the HRMT. Arguably, OMT may modulate alterations in HRMT underlying MSDs. However, there is sparse evidence even for the effect of OMT on HRMT in healthy subjects. A 3 × 3 factorial randomised trial was performed to investigate the effect of myofascial release (MRT), muscle energy (MET), and soft tissue techniques (STT) on the HRMT of the corrugator supercilii (CS), superficial masseter (SM), and upper trapezius muscles (UT) in healthy subjects in Hamburg, Germany. Participants were randomised into three groups (1:1:1 allocation ratio) receiving treatment, according to different muscle-technique pairings, over the course of three sessions with one-week washout periods. We assessed the effect of osteopathic techniques on muscle tone (F), biomechanical (S, D), and viscoelastic properties (R, C) from baseline to follow-up (primary objective) and tested if specific muscle-technique pairs modulate the effect pre- to post-intervention (secondary objective) using the MyotonPRO (at rest). Ancillary, we investigate if these putative effects may differ between the sexes. Data were analysed using descriptive (mean, standard deviation, and quantiles) and inductive statistics (Bayesian ANOVA). 59 healthy participants were randomised into three groups and two subjects dropped out from one group (n = 20; n = 20; n = 19-2). The CS produced frequent measurement errors and was excluded from analysis. OMT significantly changed F (-0.163 [0.060]; p = 0.008), S (-3.060 [1.563]; p = 0.048), R (0.594 [0.141]; p < 0.001), and C (0.038 [0.017]; p = 0.028) but not D (0.011 [0.017]; p = 0.527). The effect was not significantly modulated by muscle-technique pairings (p > 0.05). Subgroup analysis revealed a significant sex-specific difference for F from baseline to follow-up. No adverse events were reported. OMT modified the HRMT in healthy subjects which may inform future research on MSDs. In detail, MRT, MET, and STT reduced the muscle tone (F), decreased biomechanical (S not D), and increased viscoelastic properties (R and C) of the SM and UT (CS was not measurable). However, the effect on HRMT was not modulated by muscle-technique interaction and showed sex-specific differences only for F.Trial registration German Clinical Trial Register (DRKS00020393).
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Affiliation(s)
- Lucas Bohlen
- Osteopathic Research Institute, Osteopathie Schule Deutschland, Hamburg, Germany.
| | - Jonah Schwarze
- Osteopathic Research Institute, Osteopathie Schule Deutschland, Hamburg, Germany
| | - Jannik Richter
- Osteopathie Schule Deutschland, Hamburg, Germany
- Dresden International University, Dresden, Germany
| | - Bernadette Gietl
- Osteopathie Schule Deutschland, Hamburg, Germany
- Dresden International University, Dresden, Germany
| | - Christian Lazarov
- Osteopathie Schule Deutschland, Hamburg, Germany
- Dresden International University, Dresden, Germany
| | - Anna Kopyakova
- Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Andreas Brandl
- Osteopathic Research Institute, Osteopathie Schule Deutschland, Hamburg, Germany
| | - Tobias Schmidt
- Osteopathic Research Institute, Osteopathie Schule Deutschland, Hamburg, Germany
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Hamburg, Germany
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Pinloche L, Souvignet S, Germain M, Monteil K, Hautier C. The short-term effect of a myofascial protocol versus light touch applied to the cervical spine towards the prevention of balance disorders in the elderly: protocol of a randomised controlled trial. Chiropr Man Therap 2022; 30:33. [PMID: 36045446 PMCID: PMC9429471 DOI: 10.1186/s12998-022-00446-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/10/2022] [Indexed: 11/16/2022] Open
Abstract
Background Falling is a major trauma that can occur with aging, leading to very significant psychological and physical health effects with financial and societal consequences. It is therefore essential to explore therapeutic treatments that can reduce this risk. Some recognized effective treatments exist, concerning in particular the re-education of the muscles of the lower limbs. However, to our knowledge, none of them focus on the cervical spine although the latter is located at an essential physiological crossroads. Manual therapy, which has already demonstrated its impact on pain and balance parameters in the elderly, could be a painless and non-invasive tool of choice in addressing this problem. Methods Interventional study (not related to a health product), monocentric, prospective, controlled, randomized double-blind (patient and evaluator performing the measurements). The experiment will take place over three measurement periods on D0, D7 and D21. On D0 subjects will be randomized in 2 groups: experimental and placebo group. Both groups will be assessed on: Short Physical Performance Battery test score, walking speed, lower limb strength, balance, heart rate variability and cervical spine strength and mobility. Then the experimental group will receive a myofascial release protocol applied to the cervical spine and the placebo group will receive a placebo light touch protocol. The intervention will be followed by the same measurements as before. This schedule will be reproduced on D7. On D21, only one assessment will be done. Discussion This study started in 2020 but could not go beyond the inclusion phase due to the COVID pandemic. It is envisaged that recruitment could resume during 2022. Trial registration: Registered by the Comité de Protection des Personnes—Sud Méditerranée; under the title “Prévention des troubles de l’équilibre chez le senior: influence de la thérapie manuelle appliquée au rachis sur les paramètres statiques et dynamiques», n° 19.12.27.47.259 in date of February 4, 2020. Registered by ClinicalTrials.gov ID: NCT05475652; under the title « The Influence of Manual Therapy Applied to the Cervical Spine in the Prevention of Balance Disorders in the Elderly (ManEq)”.
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Wu Z, Zhu Y, Wang Y, Zhou R, Ye X, Chen Z, Li C, Li J, Ye Z, Wang Z, Liu W, Xu X. The Effects of Patient Education on Psychological Status and Clinical Outcomes in Rheumatoid Arthritis: A Systematic Review and Meta-Analysis. Front Psychiatry 2022; 13:848427. [PMID: 35370836 PMCID: PMC8968629 DOI: 10.3389/fpsyt.2022.848427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 02/10/2022] [Indexed: 12/25/2022] Open
Abstract
Background Rheumatoid arthritis (RA) is a common systemic inflammatory autoimmune disease. The disease has a serious impact on mental health and requires more effective non-pharmacological interventions. Objective This study aims to systematically evaluate the effectiveness of patient education on psychological status and clinical outcomes in rheumatoid arthritis. Methods This systematic review and meta-analysis was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Cochrane Library, EMBASE database, and Web of Science database were screened for articles published until November 2, 2021. Randomized controlled trials (RCTs) of patient education for RA were included. Outcomes measures included pain, physical function, disease activity, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), anxiety, depression, Arthritis Self-Efficacy (pain, other symptoms, total), and General health. For each outcome, standardized mean differences or mean differences and 95% confidence intervals (CIs) were calculated. Results A total of 24 RCTs (n = 2,276) were included according to the inclusion and exclusion criteria. Meta-analysis revealed a statistically significant overall effect in favor of patient education for physical function [SMD = -0.52, 95% CI (-0.96, -0.08), I 2 = 93%, P = 0.02], disease activity [SMD = -1.97, 95% CI (-3.24, -0.71), I 2 = 97%, P = 0.002], ASE (pain) [SMD = -1.24, 95% CI (-2.05, -0.43), I 2 = 95%, P = 0.003], ASE (other symptoms) [SMD = -0.25, 95% CI (-0.41, -0.09), I 2 = 25%, P = 0.002], ASE (total) [SMD = -0.67, 95% CI (-1.30, -0.05), I 2 = 90%, P = 0.03], and general health [SMD = -1.11, 95% CI (-1.36, -0.86), I 2 = 96%, P < 0.00001]. No effects were found for anxiety [SMD = 0.17, 95% CI (-0.64, 0.98), I 2 = 82%, P = 0.68], depression [SMD = -0.18, 95% CI (-0.52, 0.15), I 2 = 52%, P = 0.28], pain [SMD = -0.37, 95% CI (-0.80, 0.05), I 2 = 89%, P = 0.08], and CRP [SMD = -0.27, 95% CI (-0.57, 0.02), I 2 = 0%, P = 0.07]. Conclusions Patient education may be effective in improving clinical outcomes and psychological status in patients with rheumatoid arthritis. Considering the methodological limitations of the included RCTs, more high-quality and large-sample RCTs are needed to confirm this conclusion in the future. Systematic Review Registration http://www.crd.york.ac.uk/prospero, identifier: CRD42021250607.
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Affiliation(s)
- Zugui Wu
- The Fifth Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yue Zhu
- Baishui Health Center, Qujing, China
| | - Yi Wang
- The Fifth Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Rui Zhou
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiangling Ye
- The Fifth Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zehua Chen
- The Fifth Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Congcong Li
- The Fifth Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Junyi Li
- The Fifth Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zixuan Ye
- The Fifth Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhenbang Wang
- Qujing Hospital of Traditional Chinese Medicine, Qujing, China
| | - Wengang Liu
- The Fifth Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Second Traditional Chinese Medicine Hospital, Guangzhou, China
| | - Xuemeng Xu
- The Fifth Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Second Traditional Chinese Medicine Hospital, Guangzhou, China
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14
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Bac A, Kaczor S, Pasiut S, Ścisłowska-Czarnecka A, Jankowicz-Szymańska A, Filar-Mierzwa K. The influence of myofascial release on pain and selected indicators of flat foot in adults: a controlled randomized trial. Sci Rep 2022; 12:1414. [PMID: 35082352 PMCID: PMC8791964 DOI: 10.1038/s41598-022-05401-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 01/06/2022] [Indexed: 11/10/2022] Open
Abstract
Flat foot pain is a common complaint that requires therapeutic intervention. Currently, myofascial release techniques are often used in the therapy of musculoskeletal disorders. A group of 60 people suffering from flat feet with associated pain. Patients were assigned to four groups (15 people each): MF-myofascial release, E-the exercise program, MFE-myofascial release and the exercise program, C-no intervention. The rehabilitation program lasted 4 weeks. The NRS scale was used to examine pain intensity and FreeMed ground reaction force platform was used to examine selected static and dynamic foot indicators. Statistically significant pain reduction was obtained in all research. A static test of foot load distribution produced statistically significant changes only for selected indicators. In the dynamic test, statistically significant changes were observed for selected indicators, only in the groups subjected to therapeutic intervention. Most such changes were observed in the MF group. In the dynamic test which assessed the support phase of the foot, statistically significant changes were observed only for selected subphases. Most such changes were observed in the MFE group. Both exercise and exercise combined with myofascial release techniques, and especially myofascial release techniques alone, significantly reduce pain in a flat foot. This study shows a limited influence of both exercises and myofascial release techniques on selected static and dynamic indicators of a flat foot.
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Affiliation(s)
- Aneta Bac
- Faculty of Motor Rehabilitation, The Bronisław Czech, University of Physical Education, al. Jana Pawła II 78, 31-571, Krakow, Poland.
| | - Sabina Kaczor
- Faculty of Motor Rehabilitation, The Bronisław Czech, University of Physical Education, al. Jana Pawła II 78, 31-571, Krakow, Poland
| | - Szymon Pasiut
- Faculty of Motor Rehabilitation, The Bronisław Czech, University of Physical Education, al. Jana Pawła II 78, 31-571, Krakow, Poland
| | - Anna Ścisłowska-Czarnecka
- Faculty of Motor Rehabilitation, The Bronisław Czech, University of Physical Education, al. Jana Pawła II 78, 31-571, Krakow, Poland
| | | | - Katarzyna Filar-Mierzwa
- Faculty of Motor Rehabilitation, The Bronisław Czech, University of Physical Education, al. Jana Pawła II 78, 31-571, Krakow, Poland
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