Movilidad lumbopélvica en pacientes estreñidos tras la maniobra hemodinámica abdominal modificada / No disponible

Introducción: El estreñimiento funcional es la patología más frecuente en Gastroenterología. Recientes estudios aseveran una presencia del 78% de dolores referidos al aparato locomotor de origen visceral. Objetivos: Evaluar la Maniobra Hemodinámica abdominal modificada (MHAM) en pacientes estreñidos a través del Umbral de dolor a la presión (UDP) en los niveles dorsales T10,T11 y T12, inclinometría para la flexión lumbar, el test de extensibilidad Sit and Reach y la valoración postural del paciente con el programa SAPO. Material y Métodos: Ensayo clínico aleatorizado controlado, a doble ciego en 20 pacientes (n=20); Grupo Control (GC: n=10) y Grupo Experimental (GE: n=10). Resultados: Algometría T11: en el GE la diferencia media fue de 1,05 kg (IC95%=0,501 a 1,603; p=0,001; d Cohen= 0,84). Algometría T12: en el GE la diferencia fue 1,23 kg (IC95%=0,499 a 1,969; p=0,002 significativa; d Cohen=0,89). Inclinometría T12: en el GE se produjo un incremento medio de 10,4º (IC 95%=7,59 a 13,21º; p<0,001; d Cohen=0,94).Test Sit and Reach: en el GE el aumento medio fue de 3,47cm (IC95%= 2,35 a 4,58 cm; p<0,001; d Cohen=0,77). Conclusiones: La aplicación de la Maniobra Hemodinámica Abdominal Modificada en pacientes con estreñimiento funcional genera cambios inmediatos aumentando la tolerancia al dolor en las vértebras T11 y T12, aumentando la flexión lumbar y mejorando la extensibilidad de los miembros inferiores (AU)

No dispoible

Técnicas manipulativas vertebrales como terapia osteopática en el dolor cervical / Vertebral manipulative techniques such as osteopathic therapy for neck pain

Introducción: Se considera a la cervicalgia como una de las patologías con mayor incidencia en la población. Las manipulaciones espinales utilizadas en Osteopatía, terapia manual y Quiropraxia parecen ofrecer buenos resultados restituyendo la fisiología cervical, por lo que consideramos necesario revisar la evidencia actualizada en esta área y resumir que técnicas arrojan mejores resultados a corto y largo plazo. Objetivo: Comparar el efecto de la manipulación de alta velocidad y corta amplitud (HVLA) dirigida tanto a la columna cervical como a la dorsal y de las técnicas de movilización solas y/o comparadas con otras técnicas en la recuperación de movilidad la disminución del dolor y la disminución de la discapacidad. Material y Métodos: Se realiza una búsqueda bibliográfica en PubMed (Medline), Scopus y PEDro. Encontramos 1.020 artículos relacionados, aunque se incluyeron 11 revisiones sistemáticas/metaanálisis y 18 ensayos controlados aleatorizados, de cohortes o serie de casos, por lo que han sido analizadas veintinueve publicaciones (n=29) en texto completo. Resultados: En el dolor agudo del cuello, en la primera hora después de la intervención, las técnicas de HVLA obtienen resultados superiores a los medicamentos recetados en urgencias y en el dolor crónico a corto, medio y largo plazo, son claramente superiores a la visita médica y medicamentos. También obtienen mejores resultados que las intervenciones electro/termales, que el Kinesiotaping(R), el ejercicio, el láser en disfunciones facetarías y otras terapia. Los efectos adversos, en su mayoría, son síntomas de leve duración en las primeras 24 horas, y raramente son intensos. Conclusiones: Las técnicas manipulativas producen efectos analgésicos, de aumento del rango articular, de la función, de la satisfacción del paciente y de la calidad de vida en el dolor del cuello, tanto agudo como crónico, con o sin dolores asociados, a corto, medio y largo plazo (AU)

Introduction: Neck pain is considered one of the most frequent pathologies in the population. Spinal manipulations used in osteopathy, manual therapy and chiropractics seem to offer good results in restoring cervical physiology. Therefore, we consider it necessary to review the updated evidence in this area and summarize which techniques show better results in the short and long term. Objective: To compare the effect of high speed manipulation and low amplitude (HVLA), targeting both the cervical and the dorsal spine and mobilization techniques alone and/or compared with other techniques in mobility recovery, pain reduction and disability reduction. Material and methods: A bibliographical search was conducted in PubMed (Medline), Scopus and PEDro. We found 1020 related articles, although 11 systematic reviews/metaanalysis were included and 18 randomized controlled trials, cohort trials or case series, twenty publications having been analyzed (n = 29) in full text. Results: In acute neck pain, in the first hour after intervention, HVLA techniques get superior results as compared to prescription drugs in emergencies and chronic pain in the short, medium and long term and are clearly superior to medical visits and medicines. They also perform better than electro thermal interventions, Kinesiotaping®, exercise, laser in faceting dysfunctions and other therapy. Adverse effects are mostly short duration symptoms in the first 24 hours, and are rarely severe. Conclusions: The manipulative techniques produce analgesic effects, an increase in joint range, range of function, patient satisfaction and the quality of life in neck pain, both acute and chronic, with or without associated pain, in the short, medium and long term (AU)

Immediate effects of hamstring muscle stretching on pressure pain sensitivity and active mouth opening in healthy subjects.

OBJECTIVE: This study analyzed the immediate effect of hamstring muscle stretching on pressure pain sensitivity over the masseter and the upper trapezius muscles and maximum active mouth opening in healthy subjects. METHODS: One hundred twenty volunteers, 70 males and 50 females, between the ages of 22 and 47, were randomly divided into 3 groups: group 1 (control group) that did not receive any intervention, group 2 where a unilateral hamstring muscle stretching was applied, and group 3 where a bilateral stretching was applied. Pressure pain thresholds (PPTs) were bilaterally assessed over the masseter and upper trapezius muscles pre- and 5 minutes posttreatment by an assessor blinded to group assignment. Maximum mouth opening was also assessed pre- and 5 minutes posttreatment. Mixed-model analyses of variance (ANOVAs) were used to examine the effects of the intervention. The primary analysis was the group x time interaction. RESULTS: The ANOVA revealed significant group x time interaction for changes in PPTs over the upper trapezius (F = 4.5; P = .01) and masseter (F = 6.3; P = .002) muscles. Pre-post effect sizes were moderate (0.5 >d > 0.7) for both stretching groups and negative (d < -0.2) for the control group. A significant group x time interaction (F = 8.15; P < .001) for maximum mouth opening was also found; both experimental groups showed greater improvement when compared to the control group (P < .001). Pre-post effect sizes were large (d > 0.7) for both stretching groups and negative (d < -0.2) for the control group. CONCLUSIONS: The application of a stretching of the hamstring musculature produced an immediate increase in PPTs over both masseter and upper trapezius muscles in healthy subjects.

Repeated Applications of Thoracic Spine Thrust Manipulation do not Lead to Tolerance in Patients Presenting with Acute Mechanical Neck Pain: A Secondary Analysis.

It has been demonstrated that patients receiving mobilization techniques do not exhibit tolerance to repeated applications. However, this phenomenon has not been investigated for thoracic manipulation. Our aim was to determine if patients receiving thoracic thrust manipulation exhibit tolerance to repeated applications in acute mechanical neck pain. Forty-five patients were randomly assigned to two groups. The control group received electro- and thermotherapy for 5 sessions, and the experimental group received the same program and also received a thoracic thrust manipulation once a week for 3 consecutive weeks. Outcome measures included neck pain and cervical mobility. Within-session change scores for pain and mobility during treatment sessions #1, 3, and 5 were examined with a one-way repeated measured ANOVA. A 2-way ANOVA with session as within-subject variable and group as between-subject variable was used to compare change scores for each visit between groups to ascertain if there were significant between-group differences in within-session changes for the experimental versus the control group. The ANOVA showed that for either group the 3 within-session change scores were not significantly different (P > 0.1). The 2-way ANOVA revealed significant differences between groups for both pain and neck mobility in within-session change scores (all, P < 0.001). Change scores in each session were superior in the experimental group as compared to those in the control group. The results suggest that patients receiving thoracic manipulation do not exhibit tolerance to repeated applications with regard to pain and mobility measures in acute mechanical neck pain. Further studies should investigate the dose-response relationship of thoracic thrust manipulation in this population.

Inclusion of thoracic spine thrust manipulation into an electro-therapy/thermal program for the management of patients with acute mechanical neck pain: a randomized clinical trial.

Our aim was to examine the effects of a seated thoracic spine distraction thrust manipulation included in an electrotherapy/thermal program on pain, disability, and cervical range of motion in patients with acute neck pain. This randomized controlled trial included 45 patients (20 males, 25 females) between 23 and 44 years of age presenting with acute neck pain. Patients were randomly divided into 2 groups: an experimental group which received a thoracic manipulation, and a control group which did not receive the manipulative procedure. Both groups received an electrotherapy program consisting of 6 sessions of TENS (frequency 100Hz; 20min), superficial thermo-therapy (15min) and soft tissue massage. The experimental group also received a thoracic manipulation once a week for 3 consecutive weeks. Outcome measures included neck pain (numerical pain rate scale; NPRS), level of disability (Northwick Park Neck Pain Questionnaire; NPQ) and neck mobility. These outcomes were assessed at baseline and 1 week after discharge. A 2-way repeated-measures ANOVA with group as between-subject variable and time as within-subject variable was used. Patients receiving thoracic manipulation experienced greater reductions in both neck pain, with between-group difference of 2.3 (95% CI 2-2.7) points on a 11-NPRS, and perceived disability with between-group differences 8.5 (95% CI 7.2-9.8) points. Further, patients receiving thoracic manipulation experienced greater increases in all cervical motions with between-group differences of 10.6 degrees (95% CI 8.8-12.5 degrees) for flexion; 9.9 degrees (95% CI 8.1-11.7 degrees) for extension; 9.5 degrees (95% CI 7.6-11.4 degrees) for right lateral-flexion; 8 degrees (95% CI 6.2-9.8 degrees) for left lateral-flexion; 9.6 degrees (95% CI 7.7-11.6 degrees) for right rotation; and 8.4 degrees (95% CI 6.5-10.3 degrees) for left rotation. We found that the inclusion of a thoracic manipulation into an electrotherapy/thermal program was effective in reducing neck pain and disability, and in increasing active cervical mobility in patients with acute neck pain.

Changes in neck pain and active range of motion after a single thoracic spine manipulation in subjects presenting with mechanical neck pain: a case series.

OBJECTIVE: Our aim was to report changes in neck pain at rest, active cervical range of motion, and neck pain at end-range of cervical motion after a single thoracic spine manipulation in a case series of patients with mechanical neck pain. METHODS: Seven patients with mechanical neck pain (2 men, 5 women), 20 to 33 years old, were included. All patients received a single thoracic manipulation by an experienced manipulative therapist. The outcome measures of these cases series were neck pain at rest, as measured by a numerical pain rating scale; active cervical range of motion; and neck pain at the end of each neck motion (eg, flexion or extension). These outcomes were assessed pre treatment, 5 minutes post manipulation, and 48 hours after the intervention. A repeated-measures analysis was made with parametric tests. Within-group effect sizes were calculated using Cohen d coefficients. RESULTS: A significant (P < .001) decrease, with large within-group effect sizes (d > 1), in neck pain at rest were found after the thoracic spinal manipulation. A trend toward an increase in all cervical motions (flexion, extension, right or left lateral flexion, and right or left rotation) and a trend toward a decrease in neck pain at the end of each cervical motion were also found, although differences did not reach the significance (P > .05). Nevertheless, medium to large within-group effect sizes (0.5 < d < 1) were found between preintervention data and both postintervention assessments in both active range of motion and neck pain at the end of each neck motion. CONCLUSIONS: The present results demonstrated a clinically significant reduction in pain at rest in subjects with mechanical neck pain immediately and 48 hours following a thoracic manipulation. Although increases in all tested ranges of motion were obtained, none of them reached statistical significance at either posttreatment point. The same was found for pain at the end of range of motion for all tested ranges, with the exception of pain at the end of forward flexion at 48 hours. More than one mechanism likely explains the effects of thoracic spinal manipulation. Future controlled studies comparing spinal manipulation vs spinal mobilization of the thoracic spine are required.

Immediate effects of manipulation of the talocrural joint on stabilometry and baropodometry in patients with ankle sprain.

OBJECTIVE: This study assessed the immediate effects of talocrural joint manipulation on stabilometric and baropodometric outcomes in patients with grade II ankle sprain. METHODS: Fifty-two field hockey players (35 men and 17 women) between 18 and 40 years old (mean = 22.5 years, SD = 3.6 years) were included in this study. A simple blind, intrapatient, placebo-controlled, and repeated-measures study was carried out. All the patients underwent a baropodometric study performed with a Foot Work force platform (4 times; pre-post placebo group and pre-post intervention group). The sample was subjected to two techniques of manipulative treatment: (a) talocrural joint manipulation and (b) posterior gliding manipulation over the talus. In a second instance, placebo manipulation was applied. Unilateral analysis of variance and multivariate analysis of variance were used for statistical analysis. RESULTS: The results in the intervention group revealed significant differences in the percentage of posterior load on the foot (P = .015) and the percentage of bilateral anterior load (P = .02) before and after the manipulation. The placebo group did not show any change in any of the variables except for area (P = .045). Intergroup comparison revealed statistically significant differences in the increase in percentage of posterior load on the manipulated foot, percentage of bilateral posterior load, percentage of anterior load on the manipulated foot, and percentage of bilateral anterior load (with the exception of the total load on the foot). CONCLUSIONS: The application of caudal talocrural joint manipulation, as compared with placebo manipulation, in athletic patients with grade II ankle sprain redistributed the load supports at the level of the foot.