Integration of focal vibration and intra-articular oxygen-ozone therapy in rehabilitation of painful knee osteoarthritis.

OBJECTIVE: To examine the pain-reducing effects of intra-articular oxygen-ozone (O2O3) injections and mechanical focal vibration (mFV) versus O2O3 injections alone in patients with knee osteoarthritis. METHODS: Patients with chronic pain (>6 weeks) due to knee osteoarthritis (II-III on the Kellgren-Lawrence scale) were consecutively enrolled and divided into two groups: O2O3 (n = 25) and O2O3-mFV (n = 24). The visual analog scale (VAS), Knee Injury and Osteoarthritis Outcome Score (KOOS), and Medical Research Council (MRC) Manual Muscle Testing scale were administered at baseline (before treatment), after 3 weeks of treatment, and 1 month after the end of treatment. Patients received three once-weekly intra-articular injections of O2O3 into the knee (20 mL O3, 20 µg/mL). The O2O3-mFV group also underwent nine sessions of mFV (three sessions per week). RESULTS: The VAS score, KOOS, and MRC score were significantly better in the O2O3-mFV than O2O3 group. The within-group analysis showed that all scores improved over time compared with baseline and were maintained even 1 month after treatment. No adverse events occurred. CONCLUSION: An integrated rehabilitation protocol involving O2O3 injections and mFV for 3 weeks reduces pain, increases autonomy in daily life activities, and strengthens the quadriceps femoris.

Osteopathy modulates brain-heart interaction in chronic pain patients: an ASL study.

In this study we used a combination of measures including regional cerebral blood flow (rCBF) and heart rate variability (HRV) to investigate brain-heart correlates of longitudinal baseline changes of chronic low back pain (cLBP) after osteopathic manipulative treatment (OMT). Thirty-two right-handed patients were randomised and divided into 4 weekly session of OMT (N = 16) or Sham (N = 16). Participants aged 42.3 ± 7.3 (M/F: 20/12) with cLBP (duration: 14.6 ± 8.0 m). At the end of the study, patients receiving OMT showed decreased baseline rCBF within several regions belonging to the pain matrix (left posterior insula, left anterior cingulate cortex, left thalamus), sensory regions (left superior parietal lobe), middle frontal lobe and left cuneus. Conversely, rCBF was increased in right anterior insula, bilateral striatum, left posterior cingulate cortex, right prefrontal cortex, left cerebellum and right ventroposterior lateral thalamus in the OMT group as compared with Sham. OMT showed a statistically significant negative correlation between baseline High Frequency HRV changes and rCBF changes at T2 in the left posterior insula and bilateral lentiform nucleus. The same brain regions showed a positive correlation between rCBF changes and Low Frequency HRV baseline changes at T2. These findings suggest that OMT can play a significant role in regulating brain-heart interaction mechanisms.

Ozone Therapy and Aquatic Rehabilitation Exercises to Overcome the Lumbar Pain Caused by Facet Joint Syndrome - Case Report.

PURPOSE: Facet joint syndrome (FJS) is an arthritis-like condition of the spine that can be a significant source of low back pain (LBP). Ozone therapy (OT) could be an additional treatment method. We evaluated the therapeutic results of percutaneous injection of ozone to ablate acute LBP caused by FJS. METHODS: A 73-year-old Caucasian woman was treated by OT: one ozone injection (20 µg/mL) per week for 3 weeks under ultrasound guidance. After a break of 1 week, she performed exercises for aquatic rehabilitation (twice a week for 4 weeks). RESULTS: The outcome measure was pain relief for ≥6 months according to the Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), and Brief Pain Inventory (BPI) test. From baseline to 1 month after OT, a reduction in pain was documented and the result was maintained at 6-month follow-up. CONCLUSION: OT followed by aquatic exercises could be efficacious against the LBP caused by FJS.

Effect of manual approaches with osteopathic modality on brain correlates of interoception: an fMRI study.

The present randomised placebo controlled trial explored the extent to which osteopathic manipulative treatment (OMT) affects brain activity, particularly the insula, during both an "interoceptive awareness" and "exteroceptive awareness" task in a sample of 32 right-handed adults with chronic Low Back Pain (CLBP) randomly assigned to either the OMT or sham group. Patients received 4 weekly sessions and fMRI was performed at enrolment (T0), immediately after the first session (T1) and at 1 month (T2). The results revealed that the OMT produced a distinct and specific reduction in BOLD response in specific brain areas related to interoception, i.e., bilateral insula, ACC, left striatum and rMFG. The observed trend across the three time points appears uncharacteristic. At T1, a marginal increase of the BOLD response was observed in all the above-mentioned areas except the rMFG, which showed a decrease in BOLD response. At T2, the response was the opposite: areas related to interoception (bilateral insula and ACC) as well as the rMFG and left striatum demonstrated significant decreased in BOLD response. The findings of this study provide an insight into the effects of manual therapies on brain activity and have implications for future research in the field.

The use of adaptive neuro-stimulation for rebalancing posture and muscular tone in a soccer team.

BACKGROUND: Posture and somatic structure could positively influence athletic gestures for their biomechanical implications. Working on neuromuscular activity, offers the possibility of intervention on postural control. The aim of this study was to demonstrate the possibility of interacting with the human body system through the spinal reflex pathway, starting from the stimulation of cutaneous receptors. METHODS: Twenty soccer players were recruited: all were male aged 25.5±10.6 years. Patients were divided using a single-blind criterion into two groups, each containing ten subjects. The experimental group was treated with 2 pre-set programs 4 times a week with an adaptive neuro-stimulation (ANS) able to interact with cutaneous receptors through an ENF Physio® device with a range of electrical frequency of about 15-350 Hz; the placebo-controlled group received the treatment with the device switched off. Patients performed a myometric evaluation with the MyotonPRO® system and a postural one with the Rarog software at T0 before the treatment and at T1 after the four-week treatment. RESULTS: After our intervention, we identified an improvement in muscular tone, in particular in the hamstring muscles (17.69%, right P<0.01 / left P<0.05) and a rebalancing of the principal bone points in the postural system (shoulder 71%, P<0.05, hips 65.6%, P=0.056, sagittal AP and frontal LL center of gravity, respectively 40%, P<0.05 and 52.7%, P=0.01). CONCLUSIONS: In conclusion, we could hypothesize the usefulness of an ANS to act on these parameters. ANS could be used not only for treatment of injuries but also in the field of prevention.

Preoperative Rehabilitation in Lung Cancer Patients: Yoga Approach.

Lung cancer is one of the leading causes of cancer death worldwide. Surgical removal remains the best option for most tumors of this type. Reduction of cigarette consumption in patients with lung cancer candidates for the surgery could limit the impact of tobacco on postsurgical outcomes. Breathing exercises appear to help combat cigarette cravings. Yoga exercise benefits have been studied in lung cancer survivors, rather than in the preoperative setting. In this study, we have recruited 32 active smokers affected by lung cancer and being candidates for pulmonary surgery. The patients were randomly assigned to two groups: one treated by standard breathing and the other treated by yoga breathing (YB). The groups were evaluated at times T0 (baseline) and T1 (after 7 days of treatment) to compare the effects of the two breathing treatments on pulmonary performance in a presurgery setting. Pulmonary and cardiocirculatory functions have been tested using a self-calibrating computerized spirometer and a portable pulse oximetry device. The findings demonstrate appreciable short-term improvement in lung function assessed by spirometry. We conclude that yoga breathing can be a beneficial preoperative support for thoracic surgery.

Contralateral effect of short-duration unilateral neuromuscular electrical stimulation and focal vibration in healthy subjects.

BACKGROUND: The "contralateral effect" phenomenon refers to the strength gain in the opposite, untrained homonymous muscle following unilateral training. Previous studies showed that neuromuscular electrical stimulation (NMES) of the right quadriceps facilitated maximal voluntary strength and efferent neural drive of the left knee extensors, while no previous study investigated the contralateral effect elicited by focal muscle vibration. AIM: The aim of this study was to investigate whether quadriceps NMES and focal vibration, when applied unilaterally, have the same potential to enhance the contralateral muscle strength and the associated neural drive. DESIGN: Randomized controlled experimental study. SETTING: University laboratory. POPULATION: Healthy subjects. METHODS: Subjects completed several maximal voluntary contractions (MVCs) of the left quadriceps (tested muscle) while the right quadriceps (treated muscle) received no conditioning stimulation (control condition), NMES or focal vibration. Paired supramaximal stimuli were delivered to the left quadriceps during and immediately after the MVCs to assess voluntary activation. The EMG activity of vastus lateralis, vastus medialis, and rectus femoris muscles of the left quadriceps was also concomitantly recorded. RESULTS: MVC torque and voluntary activation of the left quadriceps increased during contralateral NMES and vibration. A remarkable inter-individual variability was observed in the contralateral effect of NMES and vibration. In fact, MVC and voluntary activation increases were particularly evident in subjects "responders" to both treatments (who showed NMES-elicited increases in MVC and voluntary activation of 22.5% and 15.8%, respectively, and vibration-elicited increases of 13.1% and 10.7%, respectively). Moreover, we found that the increases in voluntary activation and EMG activity elicited by NMES were higher than those elicited by focal vibration. We also found that voluntary activation increases were higher in subjects presenting lower baseline levels of voluntary activation. CONCLUSIONS: The short-duration unilateral application of quadriceps NMES and focal vibration increased MVC torque and efferent neural drive of the contralateral homologous muscle in healthy subjects. CLINICAL REHABILITATION IMPACT: As the two physical therapy modalities can be useful to maximize motor unit recruitment contralaterally to the side of application, they could be incorporated in rehabilitation protocols when unilateral voluntary contractions are uncomfortable, painful or not feasible.

Effects of Manual Somatic Stimulation on the Autonomic Nervous System and Posture.

Low back pain frequently involves a multifactorial etiology and requires medical attention. The aim of the study was to assess the associations among pain, posture, and autonomic nervous system function in patients with low back pain, using neuromuscular manual therapy versus a generic peripheral manual stimulation (back massage therapy). Twenty young patients with low back pain were enrolled into the study. The patients were randomly divided into two groups: treated with neuromuscular manual therapy performed after a specific structural evaluation and treated with back massage therapy. Both groups performed eight sessions of 30 min each, once a week for two months. There were three main time points of the assessment: during the first, the fourth, and the last eighth session. In each of these three sessions, data were collected before onset of session (baseline), 5 min from onset, at end of session, and 5 min after the end. All patients were subjected to stabilometric evaluation and were assessed on a visual analogue scale to quantify postural and pain changes. Tabletop capnography and pulse oximetry were used to monitor autonomic changes. The findings were that the improvement in posture and pain reduction were appreciably better in patients subjected to neuromuscular manual therapy than in those subjected to back massage therapy, with a comparable autonomic response in both groups. In conclusion, the study demonstrates that posture modification was significantly more advantageous in patient treated with neuromuscular manual therapy.

Somato-Visceral Effects in the Treatment of Dysmenorrhea: Neuromuscular Manual Therapy and Standard Pharmacological Treatment.

OBJECTIVES: This study aims to verify whether neuromuscular therapy (NMT) or pharmacology therapy (PT) is more effective for reducing symptoms in women affected by primary dysmenorrhea and the effects associated with each treatment. DESIGN: A controlled, randomized, single-blind clinical trial within the framework of the chair of physical medicine and rehabilitation of the University "G. d'Annunzio" of Chieti-Pescara. The study was conducted on a sample of 60 women suffering from primary dysmenorrhea. Subjects were randomly divided in two groups (A and B). Group A was treated with NMT and group B with PT. Group B was given ibuprofen or naproxen because they are considered the best painkillers for this condition. Group A was treated with 8 neuromuscular manual lumbosacral and abdominal therapy sessions twice per week for 4 weeks. Results were analyzed at the beginning (T0) and end (T1) of the study with a menstrual distress questionnaire, brief pain inventory, and visual analogue scale. Twenty patients from Group A were selected for evaluation of their maintenance of the eventual improvement that was detected in T1 at follow-up (T2). RESULTS: Both therapies had significant short-term effects in reducing the perception and duration of pain. However, NMT appears to give more improvements in the duration of pain. NMT had a long-term effect on perception of pain because patients conserved the positive effects of treatment after 4 weeks. NMT also had a long-term effect on duration of pain because patients conserved benefits of treatment, but this improvement started to decrease after 4 weeks. CONCLUSIONS: In the treatment of primary dysmenorrhea, NMT represents a valid therapeutic alternative method to PT. NMT is free from potential adverse effects of analgesics, is noninvasive, and is easy to perform.

Pes Anserine Bursitis in Symptomatic Osteoarthritis Patients: A Mesotherapy Treatment Study.

BACKGROUND: Pes anserine bursitis strongly affects quality of life in patients with osteoarthritis. Treatment includes nonsteroidal anti-inflammatory drugs (NSAIDs), physiotherapy, and injections of corticosteroid, with highly variable responses; recovery can take 10 days to 36 months. Mesotherapy is a minimally invasive technique consisting of subcutaneous injections of bioactive substances. The goal is to modulate the pharmacokinetics of the injected substance and prolong the effects at a local level. OBJECTIVE: To evaluate the effects of mesotherapy with diclofenac for anserine bursitis associated with knee osteoarthritis. METHODS: One hundred and seventeen patients with anserine bursitis associated with grade II Kellgren-Lawrence knee osteoarthritis, assessed by clinical, radiographic, and ultrasonographic examination, were evaluated and treated. They were randomly divided into two groups (A, mesotherapy; B, control). Group A completed nine sessions of mesotherapy with sodium diclofenac (25 mg/1 mL; Akis®, IBSA, Lugano, Switzerland), 1 mL for each session, three times per week. Group B received 21 oral administrations of sodium diclofenac (50 mg; Voltaren®, Novartis, Parsippany, NJ), once a day for 3 weeks. Primary outcome measures were pain intensity assessed by visual analogue scale (VAS), along with ability to perform activities of daily living, ability to participate in sports, level of pain, symptoms, and quality of life, as assessed by the Knee injury and Osteoarthritis Outcome Score. These measures were performed before and after the treatment period and at 30 and 90 days' follow up. RESULTS: In both groups pain level decreased significantly after the treatment period. Ultrasonography showed a reduction of the hypoechoic area related to anserine bursitis only in group A. CONCLUSION: Administration of conventional NSAIDs (diclofenac) by mesotherapy is effective in managing anserine bursitis in knee osteoarthritis in the short term and mid-term. These observations could be of interest for efforts to reduce the adverse effects of oral administration of anti-inflammatory drugs.