The Effects of Soft-Tissue Techniques and Exercise in the Treatment of Patellar Tendinopathy-Systematic Review and Meta-Analysis.

BACKGROUND: Patellar tendinopathy is a degenerative clinical disorder that causes load-related pain in the lower pole of the patella or patellar tendon. It predominantly affects young male athletes engaged in sports involving repetitive tendon loading, particularly explosive jumping. The combination of manual techniques with therapeutic exercise is hypothesized to provide greater benefits than exercise alone. OBJECTIVE: The aim of this study is to analyze the scientific evidence regarding the effects of soft-tissue techniques combined with therapeutic exercise versus therapeutic exercise alone on pain intensity and function in individuals with patellar tendinopathy. METHODS: A systematic review with meta-analysis was conducted following the PRISMA guidelines. PubMed, Lilacs, IBECS, CENTRAL, WOS, SciELO, Academic Search, CINAHL, SportDiscus, PEDro, and Google Scholar databases were consulted. Randomized controlled trials and quasi-randomized trials focusing on the effects of soft-tissue techniques combined with therapeutic exercise (experimental group) versus therapeutic exercise alone (control group) on pain and function in individuals aged 16 years and older with patellar tendinopathy were selected. The Cochrane tool for risk-of-bias assessment and the PEDro scale for methodological quality were used. RESULTS AND DISCUSSION: A total of six studies (n = 309; age range = 16-40 years), considered to have a low risk of bias and moderate-to-high methodological quality, were included. The results showed improvements in function in the experimental group (mean of 60% on the Visa-P scale) and pain in the experimental group (mean decrease of 2 points in the VAS scale). There were improvements in 50% of the studies when comparing variables between the experimental and control groups. CONCLUSIONS: The combination of manual techniques, such as dry needling, percutaneous electrolysis, transverse friction massage, and stretching, along with a squat on a 25° inclined plane, appears to be effective in the treatment of patellar tendinopathy. Static stretching of the quadriceps before and after the squat five times per week, along with dry needling or percutaneous electrolysis sessions twice a week for 8 weeks, is recommended. However, future studies analyzing groups with passive techniques versus therapeutic exercise are needed to standardize the treatment and establish the optimal dose.

A Novel Device for Assessment and Treatment of Upper Cervical Spine: Test-Retest Reliability Study.

INTRODUCTION: Neck pain is one of the most frequent reasons for consultation in primary care. Clinicians evaluate different variables, including movement and cervical strength, to determine the prognosis of patients. Usually, the tools employed for this purpose are expensive and bulky, or more than one is needed. This study aims to describe a novel device designed to assess the cervical spine and describe its test-retest reliability. METHODS: The Spinetrack device was designed to measure the strength of deep cervical flexor muscles and the chin-in and chin-out movement of the upper cervical spine. A test-retest reliability study was developed. The flexion, extension and strength needed to move the Spinetrack device were registered. Two measurements were developed, with one week between each assessment. RESULTS: Twenty healthy subjects were evaluated. The strength of the deep cervical flexor muscles in the first measurement was 21.18 ± 3.15 Newtons, the displacement movement during chin-in movement was 12.79 mm ± 3.46 and the displacement during chin-out movement was 35.99 mm ± 4.44. The test-retest reliability of strength was ICC 0.97 (95% CI (0.91-0.99)). CONCLUSION: The Spinetrack device has shown excellent test-retest reliability values for the measurement of the strength of the cervical flexor muscles and for the chin-in and chin-out movements.

Association between Age, Sex and Cervical Spine Sagittal Plane Motion: A Descriptive and Correlational Study in Healthy Volunteers.

Active motion examination of patients with cervical spine-related pathologies is necessary to establish baseline function, set physical therapy goals, and choose interventions. This study investigated the sagittal plane active range of motion (ROM) of the global (GCS) and upper cervical spine (UCS) in relation to age and sex in healthy volunteers. One hundred twenty-two volunteers aged 18 to 75 years participated. Volunteers were excluded if they displayed any characteristic that could affect cervical spine ROM. GCS and UCS flexion and extension were each measured three times using a CROM device. Linear regression models (LRMs) were developed to explore the relationships between age and sex and GCS and UCS ROM. The LRM for age showed a decrease in GCS flexion (-2.01°), GCS extension (-3.33°), and UCS extension (-1.87°) for every decade of increasing age. The LRM for sex showed that men displayed less ROM than women in GCS extension (-6.52°) and UCS extension (-2.43°). These results suggest an age-related loss of sagittal plane GCS ROM and UCS extension ROM, and sex-related differences in GCS and UCS extension with women having greater motion than men.

The Addition of Diacutaneous Fibrolysis to a Pharmacological Intervention in Patients with Tension-Type Headache: A Randomized Controlled Trial.

Background: Tension-type headache (TTH) is the most common headache worldwide. Pharmacological interventions are the most investigated therapies in patients with TTH. The addition of physical therapy treatments such as diacutaneous fibrolysis (DF) may have promising results. The aim of this study was to investigate the addition of three sessions of DF to a pharmacological intervention in patients with TTH. Methods: A single-blinded randomized controlled trial was carried out. Participants were randomly assigned to the standard care group or to the DF group. Both groups received a pharmacological intervention. Three sessions of DF in the thoracic and cervicocranial region were added in the DF group. The impact caused by headache (HIT-6), headache intensity, and cervical range of motion were measured by blinded assessors at baseline, after the intervention, and at 1 month follow-up. Results: Eighty-two patients with TTH were included (41 standard care group; 41 DF group). Statistically significant differences were found between both groups in all the variables after the intervention and at 1 month follow-up (p < 0.001). No adverse effects or side-effects were reported during the study. Conclusions: The addition of three sessions of DF to a pharmacological therapy provided improvements in the impact caused by headache, headache intensity, and cervical range of motion after the intervention and at 1 month follow-up compared to a pharmacological therapy in isolation. Further research is needed to investigate long-term effects.

Correlation between Physical Performance and Stabilometric Parameters in Older Adults.

Background and Objectives: Falls are a common and serious threat to the health and independence of older adults. The decrease in functional capacity during aging means an increased risk of falls. To date, it is not known whether there is a relationship between balance and functional tests. The aim of the study was to evaluate the correlation between eyes-open and eyes-closed static balance with different functional tests. Materials and Methods: A correlation study was designed with 52 healthy subjects over 65 years of age. Results: Regarding the open eyes stabilometric parameters, significant correlations observed between the surface and the functional tests were weak in all cases. The correlations observed between length and the functional tests performed were moderate, except for that of the Timed Up and Go test (TUG) which was weak. No significant correlation between TUG and surface was found. Regarding the closed eyes stabilometric parameters, statistically significant moderate correlations were found between the surface and the Short Physical Performance Battery (SPPB) and the Five Times Sit to Stand test (5XSST). In the case of the length with eyes closed, a statistically significant moderate correlation (rho = 0.40-0.69) was found with the SPPB and 5XSST variables, and weak correlations with the 4 m Walk Speed test (4WS) and TUG variables. Conclusions: There is a mild to moderate correlation between some functional tests and stabilometric parameters in adults over 65 years old.

Immediate effects of diacutaneous fibrolysis in athletes with hamstring shortening. A randomized within-participant clinical trial.

BACKGROUND: Diacutaneous fibrolysis is a non-invasive instrumental physiotherapeutic technique, used to treat mechanical or inflammatory pain and normalize function in the musculoskeletal system. Different studies have reported positive effects on range of motion, strength or function in musculoskeletal disorders, mainly in the upper extremity. The incidence and recurrence rates of hamstring injuries are high in many sports. However, there are no studies assessing these parameters in the hamstring and gluteus maximus in athletes. Objective. To evaluate the immediate and 30 minutes post-treatment effects of a single diacutaneous fibrolysis session on hamstring length, flexibility, muscle strength, myoelectrical activity and lower limb performance in athletes with hamstring shortening. METHODS: A randomized within-participant clinical trial. Sixty-six athletes with hamstring shortening were recruited. A single session of diacutaneous fibrolysis was applied following the cetripetal protocol to the gluteus maximus, biceps femoris and semitendinosus of for the experimental lower limb, whereas the control limb was not treated. Hamstring length (Passive knee extension test), hamstring and low back flexibility (Modified back saver sit and reach test), hamstring and gluteus maximus strength and electrical activity (dynamometry and surface electromyography, respectively) and lower limb performance (Countermovement Jump) were tested before treatment (T0), after treatment (T1), and 30 minutes post-treatment (T2). RESULTS: We only found a statistically significant difference between T0-T2 for the hamstring length favouring the experimental limbs (p<0.001). There were no statistically significant changes for hamstring and lower back flexibility, strength and electrical activity outcomes between groups. In the countermovement jump, we found a decrease of 0.58 cm in the high jump and a decrease of 9.19 N in the power jump at T1. These values recovered and improved at T2. However, these changes were not statistically significant (p>0.05). CONCLUSIONS: A single session of diacutaneous fibrolysis in athletes with hamstring shortening, following the centripetal protocol for the posterior part of the thigh, produces improvements in hamstring length 30 minutes after, and in gluteus maximus strength immediately and 30 minutes after the treatment. It seems to have no effects on the overall hamstring and lower back flexibility or myoelectric activity. Importantly, the lower limb performance was not impaired after the treatment.

Effects of Diacutaneous Fibrolysis on Passive Neuromuscular Response and Mechanosensitivity in Athletes with Hamstring Shortening: A Randomized Controlled Trial.

INTRODUCTION: Diacutaneous Fibrolysis is defined as specific instrumental intervention to normalize function in the musculoskeletal system. It is considered a treatment method for the mechanical alterations of the locomotor system, and it is widely used in sports for therapeutic and preventive purposes. Despite the clinical benefits observed in different musculoskeletal conditions, the action mechanism of diacutaneous fibrolysis remains uncertain. There are no studies evaluating the neuromuscular response on the posterior muscular chain of the lower extremity in athletes, where overload, stiffness, and injury incidence are high. OBJECTIVE: To evaluate the immediate, and 30 min post treatment effects of a single diacutaneous fibrolysis session on passive neuromuscular response and mechanosensitibity on hamstring and gluteus in athletes with shortening. DESIGN: A randomized within participant clinical trial. METHODS: Sixty-six athletes with hamstring shortening were included (PKE < 160). The lower limbs were randomized between the experimental limb and control limb, regardless of dominance. A single session of diacutaneous fibrolysis was applied to the posterior gluteus maximus, biceps femoris, and semitendinosus of the experimental lower limb whereas the control limb was not treated. Viscoelastic muscle properties (myotonometry), contractile muscle properties (tensomiography), and mechanosensitivity (algometry) were tested before treatment (T0), after treatment (T1), and 30 min post treatment (T2). RESULTS: Regarding viscoelastic properties, in the intra-group analysis we found statistically significant differences in the experimental limb at T1, decreasing muscle stiffness in gluteus maximus (p < 0.042), in biceps femoris (p < 0.001) and in semitendinosus (p < 0.032). We also observed statistically significant differences in Tone decrease (p < 0.011) and relaxation increase (p < 0.001) in biceps femoris. At T2, the decrease in stiffness in all tested muscles was maintained (p < 0.05). There were statistically significant inter-groups differences in stiffness on gluteus (p < 0.048) and biceps femoris (p < 0.019) and in tone on biceps femoris (p < 0.009) compared to the control limb. For contractile properties, we only found statistically significant differences on maximal radial displacement (Dm) in gluteus, both control and experimental at T2 (p < 0.05) and in biceps femoris control (p < 0.030). No changes were found in the mechanosensitivity. CONCLUSIONS: A single session of diacutaneous fibrolysis produces changes in some parameters related to viscoelasticity properties of the biceps femoris and gluteus. There were no changes on contractile properties on semitendinosus. Only small changes on the contractile properties on the gluteus maximus and biceps femoris were found. No effect was found on the mechanosensitivity of the posterior chain muscles in athletes with hamstring shortening.

The Immediate Effect of Informational Manual Therapy for Improving Quiet Standing and Bodily Pain in University Population.

BACKGROUND: The Informational Manual Therapy (IMT) is a therapeutic touch. This study aims to assess the effect of IMT on quiet standing, pain and health status in university population. METHODS: An experiment was conducted on subjects utilizing a comparative paired analysis both before and after the intervention. One IMT session was performed on 57 healthy individuals aged from 18 to 65 years. The primary outcome was quiet standing assessed by the Satel 40 Hz stabilometric force platform. Secondary outcomes were bodily pain assessed by the 36-Item Short Form Survey (SF-36) and health status by EQ-5D-3L. The primary outcome was evaluated before and immediately after treatment. RESULTS: The individuals were divided into 3 age groups, 18-35 (52.6%), 35-50 (29.8%) and 51-65 (17.6%). Statistically significant differences were immediately observed after the session ended when comparing the pre-post quiet stance scores in a number of length parameters: L, Lx, Ly and stabilometry amplitude on Y-axis with eyes open and closed. Significant differences were also found when testing bodily pain (SF-36) and anxiety (5Q-5D-3L). CONCLUSION: One session of IMT produced positive effects when testing quiet standing with eyes open and eyes closed, as well as a significant reduction in pain and anxiety for those tested. Further research is suggested.

The Effectiveness of Massage Therapy for Improving Sequelae in Post-Stroke Survivors. A Systematic Review and Meta-Analysis.

OBJECTIVE: To assess the effect of therapeutic massage for improving sequelae in stroke survivors. METHODS: A systematic review of the nine medical databases from January 1961 to December 2020 was carried out. The bibliography was screened to identify randomized controlled clinical trials (RCTs). Two reviewers independently screened references, selected relevant studies, extracted data and assessed the risk of bias using the PEDro scale. The primary outcome was upper and lower limb motor function and spasticity. RESULTS: A total of 3196 studies were identified and 18 RCT were finally included (1989 individuals). A meta-analysis of RCTs in the comparison of Chinese massage (Tuina) plus conventional physiotherapy versus conventional physiotherapy was performed. The mean difference (MD) in the subacute stage on upper limb motor-function using the Fugl Meyer Assessment was 2.75; (95% confidence interval (CI) from 0.97 to 4.53, p = 0.002, I2 = 36%). The MD on upper limb spasticity using modified Ashworth scale was -0.15; (95% CI from -0.24 to -0.06, p < 0.02, I2 = 0%).The MD on lower limb spasticity was -0.59; (95% CI from -0.78 to -0.40, p < 0.001, I2 = 0%) in the endpoint. CONCLUSIONS: Therapeutic massage, especially Tuina, in addition to conventional therapy is effective for improving motor function and for reducing spasticity in stroke survivors.

Effect of diacutaneous fibrolysis on the muscular properties of gastrocnemius muscle.

Diacutaneous fibrolysis is a noninvasive technique that has been shown to be effective in the treatment of musculoskeletal disorders such as shoulder pain, lateral epicondylalgia, patellofemoral pain syndrome and carpal tunnel syndrome. However, while diacutaneous fibrolysis is applied to soft tissue, its effects on muscular properties are unknown. The purpose of the present study was to evaluate the effects of diacutaneous fibrolysis on muscle properties as measured by tensiomyography and myotonometry in asymptomatic subjects. An analytical descriptive study was performed. A single session of diacutaneous fibrolysis on the gastrocnemius muscle was applied to one limb (treated limb group) and the other limb was the control (control limb group). Subjects were assessed with tensiomyography and myotonometry before treatment (T0), after treatment (T1) and 30 minutes later (T2). The primary outcomes were tensiomyography and myotonometry variables. The treated limb group showed a statistically significant increase (p<0.05) in tensiomyography parameters. A decrease in rigidity and increase in relaxation was also observed on myotonometry at T1, with some of the effects being maintained at T2. Rigidity and relaxation at T1 were statistically significant between groups (p<0.05). A single session of diacutaneous fibrolysis to the gastrocnemius muscle of asymptomatic subjects produced immediate changes in muscle properties. These changes were maintained 30 minutes after the application of the technique.

Does Upper Cervical Manual Therapy Provide Additional Benefit in Disability and Mobility over a Physiotherapy Primary Care Program for Chronic Cervicalgia? A Randomized Controlled Trial.

Introduction: Neck pain is a condition with a high incidence in primary care. Patients with chronic neck pain often experience reduction in neck mobility. However, no study to date has investigated the effects of manual mobilization of the upper cervical spine in patients with chronic mechanical neck pain and restricted upper cervical rotation. Objective: To evaluate the effect of adding an upper cervical translatoric mobilization or an inhibitory suboccipital technique to a conventional physical therapy protocol in patients with chronic neck pain test on disability and cervical range of motion. Design: Randomized controlled trial. Methods: Seventy-eight patients with chronic neck pain and restricted upper cervical rotation were randomized in three groups: Upper cervical translatoric mobilization group, inhibitory suboccipital technique group, or control group. The neck disability index, active cervical mobility, and the flexion-rotation test were assessed at baseline (T0), after the treatment (T1), and at three-month follow-up (T2). Results: There were no statistically significant differences between groups in neck disability index. The upper cervical translatoric mobilization group showed a significant increase in the flexion-rotation test to the more restricted side at T1 (F = 5.992; p < 0.004) and T2 (F = 5.212; p < 0.007) compared to the control group. The inhibitory suboccipital technique group showed a significant increase in the flexion-rotation test to the less restricted side at T1 (F = 3.590; p < 0.027). All groups presented high percentages of negative flexion-rotation tests. (T1: 69.2% upper neck translator mobilization group; 38.5% suboccipital inhibition technique group, 19.2% control group; at T2: 80.8%; 46.2% and 26.9% respectively). No significant differences in the active cervical mobility were found between groups. Conclusion: Adding manual therapy to a conventional physical therapy protocol for the upper cervical spine increased the flexion-rotation test in the short- and mid-term in patients with chronic neck pain. No changes were found in the neck disability index and the global active cervical range of motion.

Validity and Reliability of the Satel 40 Hz Stabilometric Force Platform for Measuring Quiet Stance and Dynamic Standing Balance in Healthy Subjects.

BACKGROUND: A force platform must have validity and reliability for optimal use. The objective of this study was to analyze the validity and the reliability of the Satel 40 Hz stabilometric force platform. METHODS: A study of instrumental validity and reliability, involving a cross-sectional correlational and comparative analysis was performed. To determine the validity, four certified weights located on three axes were used and the ability of the stabilometric force platform to detect changes in the position of the different axes was observed. A test-retest was performed to analyze the reliability. Forty-two symptom-free volunteers participated in the study. Assessments were taken in a standing static position and in a dynamic position, with the eyes open and closed. Three measurements were taken and the intra-class correlation coefficient (ICC) was calculated. RESULTS: The validity increased as the weight increased for all the variables measured in the stabilometric parameters (p < 0.05). The reliability was shown to be good to excellent for the two visual conditions. The positional variables obtained a higher ICC. The variable with the best ICC was the Y mean in OE (ICC 0.874 and a p < 0.001). All the values showed an increase in a dynamic situation. CONCLUSION: The findings support the reliability and validity of the Satel 40 Hz stabilometric force platform. The platform could be recommended to evaluate static and dynamic standing balance in healthy adult individuals. Guidelines for treatment and the level of quality of stabilometry could be obtained from its use.

The effectiveness of extracorporeal shock wave therapy for improving upper limb spasticity and functionality in stroke patients: a systematic review and meta-analysis.

OBJECTIVE: To assess the effectiveness of Extracorporeal Shock Wave Therapy for reducing spasticity and improving functionality of the upper limb in stroke survivors. DATA SOURCES: A systematic review of MEDLINE, Cochrane Central Register of Controlled Trials, CINAHL, PEDro, REHABDATA, Scielo, Scopus, Web of Science, Tripdatabase and Epistemonikos from 1980 to April 2020 was carried out. REVIEW METHODS: The bibliography was screened to identify randomized controlled clinical trials that applied extracorporeal shock waves to upper limb spastic muscles in post-stroke individuals. Two reviewers independently screened references, selected relevant studies, extracted data and assessed risk of bias using the PEDro scale. The primary outcome was spasticity and functionality of the upper limb. RESULTS: A total of 1,103 studies were identified and 16 randomized controlled trials were finally included (764 individuals) were analyzed. A meta-analysis was performed and a beneficial effect on spasticity was found. The mean difference (MD) on the Modified Ashworth Scale for comparison extracorporeal shock wave versus sham was -0.28; with a 95% confidence interval (CI) from -0.54 to -0.03. The MD of the comparison of extracorporeal shock wave plus conventional physiotherapy versus conventional physiotherapy was -1.78; 95% CI from -2.02 to -1.53. The MD for upper limb motor-function using the Fugl Meyer Assessment was 0.94; 95% CI from 0.42 to 1.47 in the short term and 0.97; 95% CI from 0.19 to 1.74 in the medium term. CONCLUSION: The extracorporeal shock wave therapy is effective for reducing upper limb spasticity. Adding it to conventional therapy provides an additional benefit.

Effectiveness of diacutaneous fibrolysis for the treatment of chronic lateral epicondylalgia: a randomized clinical trial.

OBJECTIVE: To assess the end of treatment and three months after treatment effects of diacutaneous fibrolysis as adjuvant of physical therapy for chronic lateral epicondylalgia. DESIGN: Double-blind (patient and evaluator) randomized controlled trial. SETTING: Primary Care Center of the Spanish NHS. SUBJECTS: A total of 54 people with 60 elbows affected with chronic lateral epicondylalgia, 33 women, mean (SD) age was 48.43 (8.69) years. INTERVENTIONS: All three groups (Intervention, Placebo and Control) received three weeks of physical therapy treatment and in addition Intervention Group received six sessions of real diacutaneous fibrolysis and Placebo Group received six sessions of sham diacutaneous fibrolysis. MAIN MEASURES: Pain intensity, pressure pain threshold, pain free grip strength, function and subjective assessment were assessed at baseline, at the end of treatment and three months after treatment. RESULTS: Between-group results at three months after treatment showed a statistically significant improvement of the Intervention Group in pain free grip strength (mean, 7.91 km/cm2; SD, 9.23) compared to the Placebo Group (mean, 1.47 km/cm2; SD, 7.86) and to the Control Group (mean, 2.09 km/cm2; SD, 4.45) ( P values <0.01 and <0.03, respectively) and also in function (mean, 20.87; SD, 14.25) compared to the Control Group (mean, 4.17; SD, 18.02) ( P < 0.01). Subjective assessment was statistically better in the Intervention Group both at the end of treatment ( P < 0.01) and three months after treatment ( P < 0.03). CONCLUSION: Diacutaneous fibrolysis added to physical therapy provides better results in the treatment of chronic lateral epicondylalgia, with greater clinical satisfaction among patients.

Validation and reliability of the Spanish version of the Function in Sitting Test (S-FIST) to assess sitting balance in subacute post-stroke adult patients.

BACKGROUND: Function in Sitting Test (FIST) is a clinical functional assessment of sitting balance validated in adults with stroke. For a major use of this, the test is recommended to be translated in Spanish-speaking countries. OBJECTIVES: Translate to Spanish the FIST and determine its intra-rater and inter-rater reliabilities and concurrent validity as a measure of sitting balance in adult individuals with stroke. METHODS: The original version was translated into Spanish and was agreed by a team of experts. A back-translation into English was subsequently performed and sent to the original author, who approved this version named from now Spanish version of Function in Sitting Test (S-FIST). Sixty post-stroke patients' performance was recorded on a videotape. These videos were then used to carry out four measurements to assess the intra-rater and inter-rater reliabilities; two of these were performed by the same rater and the third and fourth by a second and third rater. RESULTS: The S-FIST meets the following requirements: good construct validity and high correlation with Spanish version of Trunk Impairment Scale 2.0 (S-TIS 2.0) scores (r = 0.791) Spearman's rank, high internal consistency (Cronbach's α-coefficient = 0.97), and high intra-rater and inter-rater reliabilities for the summed scores assessed by intra-class correlation coefficient were 0.999 and 0.997, respectively. CONCLUSIONS: The S-FIST is valid and reliable and can be recommended for use in the evaluation of dynamic and sitting balance and trunk control in future research and clinical practice on post-stroke patients. Guidelines for treatment and level of quality of trunk activity can be derived from its use.