Effect of ischemic compressions versus extracorporeal shockwave therapy on myofascial trigger points: A protocol of a randomized controlled trial.

INTRODUCTION: The myofascial trigger points (MTrPs) are hyperirritable nodules present in a tight muscle band. Among the symptoms, pain is one of the most common, but the individuals may have other sensory, motor, and autonomic changes. Athletes can have MTrPs more intensely due to the high physical and emotional demand. There are a variety of treatments, but not all have strong or moderate evidence of their effectiveness. Thus, the aim of this study is to compare the effects of ischemic compression (IC) and extracorporeal shockwave therapy (ESWT) on pressure pain threshold immediately after the intervention and after 48h. METHODS: This randomized clinical trial was registered in the Brazilian Registry of Clinical Trial (RBR-6wryhb9) and was approved by the Research Ethics Committee (CAAE 46682921.9.0000.5406). Forty participants will be randomized to receive IC or ESWT treatment once in each MTrPs. The protocol will consist of evaluations before (T0), immediate after (T1), and after forty-eight hours (T2) of the intervention. The primary outcome will be pressure pain threshold and the secondary outcomes will be jump height, muscle strength, dorsiflexion range of motion (ROM), the correlation between MTrPs and temperature and participant's satisfaction. CONCLUSIONS: The IC and ESWT have been shown to be efficient in decreasing pain, however, the studies that compare the efficiency of these two treatments are limited in the literature, mainly in the muscles of the lower limbs, which are of great importance and are commonly injured. This study will provide evidence of the IC and ESWT in the triceps surae muscles, assisting in a better treatment for the individual with MTrPs.

Evaluation of peripheral neuropathy in lower limbs of patients with rheumatoid arthritis and its relation to fall risk.

BACKGROUND: Rheumatoid Arthritis (RA) is a chronic disabling systemic disease characterized by joint inflammation, and extra-articular manifestations, including peripheral neuropathy, a condition that can be associated with changes in muscle strength, proprioception and postural balance contributing for the risk of falls. The objective of this study is to analyze the incidence of peripheral neuropathy in patients with RA and its association with the occurrence of falls. METHODS: Patients were assessed by an electroneuromyography (ENMG) exam and by a questionnaire on accidental falls occurrence in the previous 12 months. They were also assessed on balance by the Short Physical Performance Battery (SPPB), functionality by the Health Assessment Questionnaire (HAQ), disease activity by the Disease Activity Score (DAS-28), neuropathic pain by the Questionnaire for the Diagnosis of Neuropathic Pain (DN4), and cutaneous sensitivity of the feet by the monofilament testing of Semmes-Weinstein. Monthly calls on falls were made in the subsequent six months. Data analysis was performed using the Shapiro-Wilk test for normality and Spearman, Chi-square, and T-student correlation tests, with a significant P level ≤ 0.05. RESULTS: A sample of 33 patients were evaluated. The incidence of peripheral neuropathy was 48.5%, of which 68.7% were axonal and 31.3% myelinic. The sensorimotor type was present in 64.7%, motor in 17.6%, and sensorial in 11.7% of the cases. Neuropathy was associated to balance (P = 0.026), neuropathic pain (P = 0.016), deep tendon reflexes absence (P = 0,049), altered skin sensitivity of the feet (P = 0.029) and fear of falling (P = 0.001). No association was found between peripheral neuropathy and age, gender, disease activity, or functionality. No significant association was found between peripheral neuropathy and occurrence of falls, in a 12-month retrospective and 6-month prospective evaluation. CONCLUSION: Peripheral neuropathy has a high incidence in patients with RA, and is related to neuropathic pain, altered postural balance, but not to the occurrence of falls.

Hand strength in patients with RA correlates strongly with function but not with activity of disease.

BACKGROUND: Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by chronic inflammation of the joints, especially of the hands. The evaluation of handgrip strength (HS) and pinch strength can be useful to detect reduction in hand function in RA patients. The aim of the study was to compare HS and pinch strength between RA patients (RA Group - RAG) and a non-RA control group (CG) and to relate HS and pinch strength to functional capacity, duration and disease activity in the RAG. METHODS: A cross-sectional case control study. The RAG was assessed for disease activity by the Disease Activity Score (DAS-28); for functional capacity by the Health Assessment Questionnaire (HAQ), the Cochin Hand Functional Scale (CHFS) questionnaire, and the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire; and for HS and pinch strength (2-point tip-to-tip, lateral or key, and 3-point) using Jamar® and pinch gauge dynamometers, respectively. Associations were analyzed by Pearson and Spearman tests, and groups were compared by the independent samples t test, with a significance level of P <  0.05. RESULTS: The convenience sample included 121 rheumatoid patients and a control group matched by age, sex, and body mass index. The RAG showed lower strength values compared with the CG in all measurements (P <  0.01, 95% CI) and these values were associated with worse performance in the functional questionnaires and greater disease activity and duration. There was a strong correlation among the functional assessment instruments. CONCLUSIONS: The decrease in grip and pinch strength, easily measured by portable dynamometers, is a strong indicator of functional disability in RA patients.