Is Tecar Therapy Effective on Biceps Femoris and Quadriceps Rehabilitation? A Cadaveric Study.

BACKGROUND: Capacitive-resistive electric transfer therapy is an interesting rehabilitation treatment to use in musculoskeletal injuries. The purpose is to analyze the temperature change and current flow in superficial and deep biceps femoris and quadriceps tissues when applying different protocols of capacitive-resistive electric transfer therapy. METHODS: Five cryopreserved cadavers (10 legs) were included in this study. Four interventions (high/low power) were performed for 5 minutes. Dynamic movements were performed to the biceps femoris and quadriceps. Superficial, middle, and deep temperature were recorded at 1-minute intervals and 5 minutes after the treatment using invasive temperature meters placed with ultrasound guidance. RESULTS: Low-power applications have generated a very low thermal effect and an important current flow. The high-power capacitive application achieves a greater increase in superficial temperature compared with low power (P < .001). The high-power resistive application recorded a greater increase in superficial, middle, and deep temperatures with a greater current flow compared with the other applications (P < .001). CONCLUSION: This study could serve as basic science data to justify the acceleration of the processes of muscle recovery, improving cell proliferation without increasing the temperature in acute muscle injuries and increasing the temperature and viscoelasticity of the tissues in chronic processes with this therapy.

The effectiveness of manual therapy on pain, physical function, and nerve conduction studies in carpal tunnel syndrome patients: a systematic review and meta-analysis.

AIM OF THE STUDY: Systematic review and meta-analysis to assess the effectiveness of manual therapy in improving carpal tunnel syndrome (CTS) symptoms, physical function, and nerve conduction studies. METHOD: MEDLINE, Web of Science, SCOPUS, Cochrane Library, TRIP database, and PEDro databases were searched from the inception to September 2021. PICO search strategy was used to identify randomized controlled trials applying manual therapy on patients with CTS. Eligible studies and data extraction were conducted independently by two reviewers. Methodology quality and risk of bias were assessed by PEDro scale. Outcomes assessed were pain intensity, physical function, and nerve conduction studies. RESULTS: Eighty-one potential studies were identified and six studies involving 401 patients were finally included. Pain intensity immediately after treatment showed a pooled standard mean difference (SMD) of - 2.13 with 95% confidence interval (CI) (- 2.39, - 1.86). Physical function with Boston Carpal Tunnel Syndrome Questionnaire (BCTS-Q) showed a pooled SMD of - 1.67 with 95% CI (- 1.92, - 1.43) on symptoms severity, and a SMD of - 0.89 with 95% CI (- 1.08, - 0.70) on functional status. Nerve conduction studies showed a SMD of - 0.19 with 95% CI (- 0.40, - 0.02) on motor conduction and a SMD of - 1.15 with 95% CI (- 1.36, - 0.93) on sensory conduction. CONCLUSIONS: This study highlights the effectiveness of manual therapy techniques based on soft tissue and neurodynamic mobilizations, in isolation, on pain, physical function, and nerve conduction studies in patients with CTS.

Effects of a Massage Protocol in Tensiomyographic and Myotonometric Proprieties.

BACKGROUND: Pre-competition massage is usually used to improve athletic performance and reduce risk of injury. Despite its usual use, the effects of pre-competition massage on neuromuscular function have barely been studied. The aim of this study is to evaluate the effects of the pre-competition massage over the gastrocnemius neuromuscular function. METHOD: The study is a quasi-experimental clinical trial thirty healthy athletes were enrolled in the study. Subjects received an intervention in one leg (experimental), consisting of a massage, and no intervention in the opposite leg (control). From all values of neuromuscular function, the following were analyzed: contraction time (Tc) and maximal displacement (Dm) by tensiomyography, and stiffness and tone by myotonometry. RESULTS: Main effects of pre-competition massage on neuromuscular function include a significant (p < 0.05) increase in Tc and Dm variables, as well as a reduction in stiffness and tone. CONCLUSION: Data shows an increase in Tc and maximal radial displacement (Dm) variables, as well as a reduction in stiffness and tone. More quality studies are needed to draw clear conclusions about the effects of pre-competition massage.

The Effect of Diacutaneous Fibrolysis on Local and Widespread Hyperalgesia and Muscle Length in Patients With Patellofemoral Pain Syndrome: Secondary Analysis of a Pretest-Posttest Clinical Trial.

CONTEXT: Localized and widespread hyperalgesia has been observed in patients with patellofemoral pain. Diacutaneous fibrolysis (DF) has shown to be effective in reducing pain in several musculoskeletal conditions including patellofemoral pain syndrome, but no studies have evaluated the effects of this technique in reducing localized and widespread hyperalgesia. OBJECTIVE: To assess the effect of DF on the pressure pain threshold and muscle length tests in patients with patellofemoral pain syndrome. DESIGN: A single-group, pretest-posttest clinical trial. SETTING: University of Zaragoza. PARTICIPANTS: Forty-six subjects with patellofemoral pain (20 males and 26 females: age 27.8 [6.9] y). INTERVENTION: Three sessions of DF. MAIN OUTCOME MEASURES: Pressure pain threshold using a handheld pressure algometer (4 sites around the knee, on tibialis anterior muscle, and one remote site on the upper contralateral limb); muscle length test of the iliotibial band, rectus femoris, and hamstring muscles; and patient-perceived treatment effect score. RESULTS: The application of 3 sessions of DF significantly increased the pressure pain threshold in all sites at posttreatment evaluation (P < .001) and at a 1-week follow-up (P < .001). A significant increase in muscle length was also observed at the posttreatment evaluation (P < .001) and 1-week follow-up (P < .001). Ninety-seven percent of the patients reported subjective improvement at posttreatment and at 1-week follow-up. CONCLUSION: This study found that local and widespread hyperalgesia was significantly reduced after 3 sessions of diacutaneous fibrolysis and at the 1-week follow-up. A significant improvement on muscle length tests was also observed, with high clinical satisfaction among patients.

Effects of Diacutaneous Fibrolysis on Mechanosensitivity, Disability, and Nerve Conduction Studies in Mild to Moderate Carpal Tunnel Syndrome: Secondary Analysis of a Randomized Controlled Trial.

OBJECTIVE: People diagnosed with carpal tunnel syndrome (CTS) have fibrosis between the soft, connective, and neural tissues that could worsen the compression of the median nerve. The diacutaneous fibrolysis (DF) technique may release tissue adhesions and increase the mobility of connective tissues. The purpose of this study was to compare the outcomes of DF in people with mild to moderate CTS on mechanosensitivity, disability, and nerve conduction studies. METHODS: This was a secondary analysis of a double-blinded, randomized, placebo-controlled trial. Patients were recruited between April and September 2016 from the Department of Neurophysiology at the Hospital Miguel Servet, Zaragoza, Spain. Thirty-nine people (52 wrists) diagnosed with mild to moderate CTS were included. Participants were randomly assigned to either the DF group (n = 26) or the sham group (n = 26). Both groups received 5 therapy sessions, 2 sessions per week. Mechanosensitivity with the Upper Limb Neurodynamic Test 1, symptom severity and functional status with the Boston Carpal Tunnel Questionnaire, and median nerve sensory conduction velocity with nerve conduction studies were the outcomes measured. Assessments were recorded at baseline and after the intervention. RESULTS: The DF group showed significant improvements in the following: mechanosensitivity, with 28.46 degrees of elbow extension range of motion (95% CI = 19.2-37.7); an increase of 1.0 point (95% CI = 0.7-1.4) for the Boston Carpal Tunnel Questionnaire symptom severity and functional status score; and sensory conduction velocity of median nerve, which improved to 5.8 m/s (95% CI = 2.5-9.2). CONCLUSION: Participants with mild to moderate CTS experienced improvements in symptom severity, functional status, mechanosensitivity, and nerve conduction studies after 5 sessions of DF. IMPACT: This study provides evidence of an approach based on soft and connective tissues around the median nerve in patients with CTS.

"Short- and mid-term effects of adding upper cervical manual therapy to a conventional physical therapy program in patients with chronic mechanical neck pain. Randomized controlled clinical trial."

OBJECTIVE: To evaluate the effect of adding an Upper Cervical Translatoric Mobilization (UCTM) or an Inhibitory Suboccipital Technique (IST) to a physiotherapy treatment in the symptomatology and function of mechanical chronic neck pain patients. DESIGN: Randomized controlled trial. SETTING: Primary Care Center in Cornellà, Spain. SUBJECTS: 78 patients (64 women), with mean age (SD) of 59.96 (13.30) years with mechanical chronic neck pain were divided in three groups: control, IST and UCTM groups. INTERVENTIONS: All groups received 15 physiotherapy sessions for three weeks. The UCTM and IST groups added 5 minutes of the assigned technique during six sessions. MAIN MEASURES: Neck disability index (NDI) and numeric pain rating scale (NPRS) for neck pain were measured baseline, three-weeks and 15-weeks follow-up. RESULTS: NDI (SD) at baseline, three-weeks and 15-weeks were 11.62 (7.08), 9.65 (6.25), 7.58 (5.64) for the control group, 14.38 (6.92), 8.50 (6.11), 7.12 (4.98) for the IST group and 13.19(7.23), 5.35(6.10), 4.35(2.76) for the UCTM group. NPRS (SD) at baseline, three-weeks and 15-weeks were 58.69 (19.46), 45.19 (23.43), 44.58 (24.08) for the control group; 64.08 (19.26), 42.19 (19.69), 34 (21.14) for the IST group; and 67.65 (20.65), 36.23 (20.10), 39.85 (25.44) for the UCTM group. CONCLUSIONS: Compared with no treatment, both forms of mobilization were associated with reduced disability at three weeks, and UCTM remained better than control at 15 weeks; there were no significant differences between the two mobilization groups. TRIAL REGISTRATION: This study was registered in Clinicaltrials.gov (NCT02832232).

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.

Effects of non-pharmacological conservative treatment on pain, range of motion and physical function in patients with mild to moderate hip osteoarthritis. A systematic review.

OBJECTIVE: The purpose of this review was to identify the effects of non-pharmacological conservative treatment on pain, range of motion and physical function in patients with mild to moderate hip osteoarthritis. DESIGN: A systematic review based on Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. SETTING: We searched MEDLINE, PEDro, Scopus and the Cochrane Library databases for randomized controlled trials related to non-pharmacological conservative treatments for hip osteoarthritis with the following keywords: "hip osteoarthritis," "therapeutics," "physical therapy modalities," and "combined physical therapy". The PEDro scale was used for methodological quality assessment and the Oxford Centre of Evidence-Based Medicine scale was used to assess the level of evidence. Outcomes measures related to pain, hip range of motion and physical function were extracted from these studies. RESULTS: Twelve studies met the inclusion criteria. Most of the studies showed high level of evidence and only two showed low level of evidence. High quality of evidence showed that manual therapy and exercise therapy are effective in improving pain, hip range of motion and physical function. However, high quality studies based on combined therapies showed controversy in their effects on pain, hip range of motion and physical function. CONCLUSIONS: Exercise therapy and manual therapy and its combination with patient education provides benefits in pain and improvement in physical function. The effects of combined therapies remain unclear. Further investigation is necessary to improve the knowledge about the effects of non-pharmacological conservative treatments on pain, hip range of motion and physical function.

The Effect of Diacutaneous Fibrolysis on Patellar Position Measured Using Ultrasound Scanning in Patients With Patellofemoral Pain Syndrome.

CONTEXT: Tightness or lack of flexibility of several muscles of the thigh has been associated with patellofemoral joint pain. A tight iliotibial band can lead to laterally located patella and an abnormal patellar tracking pattern. Diacutaneous fibrolysis (DF) is commonly used to reduce muscle tightness, but no studies have evaluated the effects of this technique in the treatment of patients with patellofemoral pain syndrome. OBJECTIVE: To assess the effect of DF on patellar position in patients with patellofemoral pain syndrome. DESIGN: A single-group, pretest-posttest clinical trial. SETTING: University of Zaragoza. PARTICIPANTS: A total of 46 subjects with patellofemoral pain (20 males, 26 females; age: 27.8 [6.9] y). INTERVENTION: Three sessions of DF. MAIN OUTCOME MEASURES: Patellar position measurement using real-time ultrasound scanning; pain intensity measured with visual analog scale and function measured with the Anterior Knee Pain Scale. RESULTS: The application of 3 sessions of DF significantly increased the patellar position at posttreatment evaluation (P < .001) and at 1-week follow-up (P < .001). There was not a significant difference on patellar position between posttreatment and follow-up measurements (P = .28). There were also a statistically significant decrease in pain and increase in function at posttreatment and at 1-week follow-up measurements (P < .001). CONCLUSION: This study found that patellar position, pain intensity, and function were significantly improved after 3 sessions of DF and at 1-week follow-up.

Effects of diacutaneous fibrolysis in patients with mild to moderate symptomatic carpal tunnel syndrome: a randomized controlled trial.

OBJECTIVE:: To compare the effects of diacutaneous fibrolysis with sham in patients with mild to moderate carpal tunnel syndrome. DESIGN:: Double-blind (patient and evaluator) randomized controlled trial. SETTING:: Miguel Servet University Hospital, Zaragoza, Spain. SUBJECTS:: A total of 52 patients (72 wrists) with carpal tunnel syndrome, 41 women and 11 men, mean age was 46.9 (8.8) years. They were divided into two groups: diacutaneous fibrolysis group and sham group. INTERVENTIONS:: Real diacutaneous fibrolysis in diacutaneous fibrolysis group and sham diacutaneous fibrolysis in sham group. Both groups received five sessions in the forearm, wrist and hand. MAIN MEASURES:: Neurophysiological parameters assessed at baseline and at the end of the treatment. Intensity of nocturnal symptoms (visual analogue scale (VAS)) and upper limb functional capacity (Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire) at baseline, at the end of the treatment and one month after treatment. RESULTS:: Diacutaneous fibrolysis group (n = 30 wrists) improved in nerve conduction distal motor latency (mean difference: -0.26, 95% confidence interval (CI): -0.49/-0.26), sensory conduction velocity (mean difference: 6.52, 95% CI: 3.52/9.51), intensity of nocturnal symptoms (mean difference: -2.24, 95% CI: -4.08/-2.04) and upper limb functional capacity (mean difference: -19, 95% CI: -26.1/-11.9) compared to the sham group (n = 30 wrists) ( P < 0.02, P < 0.01, P < 0.01 and P < 0.01, respectively). At one-month follow-up, improvements in the nocturnal symptoms and upper limb functional capacity were maintained compared to the sham group ( P < 0.01). CONCLUSION:: Diacutaneous fibrolysis provides short-term and one-month follow-up, improvements in sensory conduction velocity, motor distal latency, symptoms and functional capacity in patients with mild to moderate carpal tunnel syndrome.

Comparison of high, medium and low mobilization forces for increasing range of motion in patients with hip osteoarthritis: A randomized controlled trial.

BACKGROUND: Manual therapy has been shown to increase range of motion (ROM) in hip osteoarthritis (OA). However, the optimal intensity of force during joint mobilization is not known. OBJECTIVE: To compare the effectiveness of high, medium and low mobilization forces for increasing range of motion (ROM) in patients with hip OA and to analyze the effect size of the mobilization. DESIGN: Randomized controlled trial. METHODS: Sixty patients with unilateral hip OA were randomized to three groups: low, medium or high force mobilization group. Participants received three treatment sessions of long-axis distraction mobilization (LADM) in open packed position and distraction forces were measured at each treatment. Primary outcomes: passive hip ROM assessed before and after each session. SECONDARY OUTCOMES: pain recorded with Western Ontario and McMaster Universities (WOMAC) pain subscale before and after the three treatment sessions. RESULTS: Hip ROM increased significantly (p < 0.05) in the high-force mobilization group (flexion: 10.6°, extension: 8.0°, abduction:6.4°, adduction: 3.3°, external rotation: 5.6°, internal rotation: 7.6°). These improvements in hip ROM were statistically significant (p < 0.05) compared to the low-force group. There were no significant changes in the low-force and medium-force groups for hip ROM. No significant differences in hip pain were found between treatment groups. CONCLUSION: A high force LADM in open packed position significantly increased hip ROM in all planes of motion compared to a medium or low force mobilization in patients with hip OA. A specific intensity of force mobilization appears to be necessary for increasing ROM in hip OA.

Dimensional changes of the carpal tunnel and the median nerve during manual mobilization of the carpal bones.

INTRODUCTION: The carpal tunnel is a clinically important fibro-osseous conduit for the median nerve and associated tendons. It is mechanically dynamic, such that the dimensions of the tunnel and median nerve change with position, movement and application of externally applied force with mechanical devices. Therapeutic manual techniques that appear to move and change tunnel shape are part of clinical practice. The aim of this study was therefore to measure changes in dimensions of the carpal tunnel and median nerve with manual mobilization of the carpal bones. MATERIAL AND METHODS: An analytical descriptive study with 18 volunteer subjects and a total of 33 records was designed. Ultrasound measurements of the cross-sectional area (CSA), anteroposterior diameter (APD), transverse diameter (TD), perimeter, flattening ratio and circularity of the carpal tunnel and of the median nerve, were measured, both in the anatomical position of the wrist and during mobilization techniques of the carpal bones. RESULTS: During the mobilization technique, the tunnel (p = 0.003) CSA significantly increased. APD also increased significantly for the tunnel (<0.001) while TD decreased. The median nerve showed similar and significant (p < 0.001) changes than the tunnel. However, because several of the obtained differences where smaller than the SDD obtained in a previous study, these differences were considered as irrelevant. CONCLUSIONS: Manual mobilization of the carpal bones produced significant changes in the dimensions of the carpal tunnel.

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.

Clinical and ultrasonographic evidence of a proximal positional fault of the radius. A case report.

Positional faults are considered a possible underlying mechanism mimicking the symptoms of a joint sprain. Despite numerous clinical studies indicating the presence of positional faults, there is limited evidence of imaging studies confirming positional faults. This case report is a preliminary study that offers clinical and ultrasonographic evidence of a proximal positional fault of the radius, treated successfully with manual therapy techniques. Three weeks after a bike fall on the outstretched hand, the patient in this study presented with right wrist pain and a lack of progress with conventional conservative treatment (NSAIDs, rest and immobilization). Clinical findings indicating a proximal positional fault of the radius included pain during active pronation increased by associating a passive movement of the radius in a proximal direction and it was reduced by associating a passive movement of the radius in a distal direction. Ultrasonographic (US) images showed a reduction of radio-capitellar distance on the right side (11.4 mm) compared to the left side (13.3 mm). A positive response with a distal mobilization of the radius supported the proximal positional fault of the radius. After two manual therapy sessions, the patient had recovered normal asymptomatic function. The outcomes used to assess function and pain were active pronation range of motion, the Spanish version of the DASH questionnaire and a 0-10 numeric pain rating scale. Each measure was conducted prior and after each treatment session and one week post treatment. The patient was re-examined at 6 months follow-up, during which US images, demonstrated a normalization of the right radio-capitellar distance.