Abdominal and Diaphragmatic Mobility in Adults With Chronic Gastritis: A Cross-Sectional Study.

Objective: The purpose of this study was to assess abdominal and diaphragmatic mobility in adults with chronic gastritis compared with healthy individuals and to analyze the impact of chronic gastritis on musculoskeletal signs and symptoms of the cervical and thoracic spine. Methods: This was a cross-sectional study conducted by the physiotherapy department at the Universidade Federal de Pernambuco in Brazil. Fifty-seven individuals participated, 28 with chronic gastritis (gastritis group [GG]) and 29 healthy individuals (control group [CG]). We assessed the following: restricted abdominal mobility in the transverse, coronal, and sagittal planes; diaphragmatic mobility; restricted cervical vertebral segmental mobility; restricted thoracic vertebral segmental mobility; and pain on palpation, asymmetry, and density and texture of the soft tissues on the cervical and thoracic spine. The measure of diaphragmatic mobility was assessed with ultrasound imaging. The Fisher exact and χ2 tests were applied to compare the groups (GG and CG) in relation to the restricted mobility of the abdominal tissues near the stomach on all planes and diaphragm, and the independent samples t test to compare the mobility measurements of the diaphragm. A significance level of 5% was considered for all tests. Results: Restricted abdominal mobility in all directions (P < .05) was greater in GG when compared with CG except for the counterclockwise direction (P = .09). In GG, 93% of the individuals presented restricted diaphragmatic mobility, with a mean mobility of 3.1 ± 1.9 cm, and in the CG, 36.8% with a mean of 6.9 + 1.7 cm (P < .001). The GG presented a higher occurrence of restricted rotation and lateral glide mobility of the cervical vertebrae, pain to palpation, and density and texture dysfunction of the adjacent tissues when compared with CG (P < .05). In the thoracic region, there was no difference between GG and CG regarding musculoskeletal signs and symptoms. Conclusion: Individuals with chronic gastritis presented greater abdominal restriction and lower diaphragmatic mobility, in addition to a higher occurrence of musculoskeletal dysfunction in the cervical spine when compared with healthy individuals.

Home exercises for neck pain: A Delphi survey.

PURPOSE: The current context of the COVID-19 pandemic has demonstrated the need for home exercise strategies for the relief of neck pain, which, in recent times, has increased. However, there is a gap regarding home exercises that are aimed at reducing neck pain. Therefore, the aim of this study was to develop, validate and culturally adapt a home exercise protocol for neck pain. METHODS: This was an observational study conducted in three stages: (1) Developing an online search of databases for articles on neck pain exercises. (2) Validating a panel of 12 physical therapists, using the Delphi technique, and (3) Cultural adaptation, through face-to-face assessment with individuals aged 18-30 years with neck pain (n = 15). This resulted in the production of a final version of the protocol. Consensus on the protocol items (using the five-point Likert scale) was considered when the percent agreement was equal to or greater than 75%. Individuals were also asked about pain intensity during the last week before and after performing the protocol. RESULTS: A protocol was developed with the principles of neck and scapular stabilization and upper limb movements, for a period of 4 weeks. Nine physical therapists completed two rounds online, and all items in the second version of the protocol presented an agreement of over 75%. The protocol was culturally adapted by the target population, in which 73% of individuals presented pain reduction with a minimally clinically important difference. CONCLUSION: A 4-week home exercise protocol was created based on the best evidence in the literature, was validated by physical therapists and adapted for the population with neck pain. It proved to be an understandable, useful, practical and convenient tool in the treatment of this disorder and demonstrated an improvement in neck pain. CLINICALTRIALS: GOV: (NCT04187001).

Effect of Dry Cupping Therapy on Pain and Functional Disability in Persistent Non-Specific Low Back Pain: A Randomized Controlled Clinical Trial.

Background: Cupping therapy is used to treat musculoskeletal conditions, including low back pain. Objectives: The study assessed the effects of dry cupping on pain and functional disability from persistent nonspecific low back pain. Methods: This was a randomized controlled trial, where participants were allocated to a cupping therapy (n = 19) or sham (n = 18) group, for five 10-minute sessions of cupping therapy, twice a week, to stimulate the acupoints related to low back pain (GV4, BL23, BL24, BL25, and BL30, BL40 and BL58) and emotional aspects (HT3 and ST36). All participants were assessed at baseline, post-treatment and follow up (a finalization period of four weeks) using a visual analogue scale (VAS) and the Oswestry Disability Index (ODI). Groups were compared using the analysis of covariance (ANCOVA) and the effect size was calculated using Cohen̓s d. Results: The cupping therapy group presented a lower mean VAS when compared to the sham, at post-treatment (mean difference: -2.36; standard error [SE]: 0.58; p < 0.001; "large" effect size: -0.94) and follow up (mean difference: -1.71; SE: 0.81; p < 0.042; 'large' effect size: -0.83). The cupping therapy group presented a lower mean ODI when compared to the sham post-treatment (mean difference: -4.68; SE: 1.85; p: 0.017; 'large' effect size: -0.87), although in follow-up, there was no difference between the groups (mean difference: 4.16; SE: 2.97; p: 0.17; "medium" effect size: -0.70). Conclusion: Dry cupping was more effective in improving pain and functional disability in people with persistent nonspecific low back pain when compared to the sham.

Efficacy of Manual Therapy on Pain, Impact of Disease, and Quality of Life in the Treatment of Fibromyalgia: A Systematic Review.

BACKGROUND: Myofascial mobilization has been used as an intervention for patients with fibromyalgia (FM) for acting on ascending nociceptive pathways possibly involved in the central sensitization process, modulating the pain experience. However, there is still a gap in its efficacy compared with another hands-on approach because manual therapy has nonspecific effects, such as placebo. OBJECTIVES: This systematic review aims to review the scientific literature for an overview of the efficacy of manual therapy in pain, disease impact, and quality of life in patients with FM compared with control or other treatments through randomized clinical trials. STUDY DESIGN: This study involved systematic review of published randomized controlled trials (RCTs). SETTING: This study examined all RCTs evaluating the effect of manual therapy on pain, impact of disease, and quality of life for patients with FM. METHODS: Systematic review. The research was performed in 9 databases: MEDLINE/PubMed, CINAHL, Web of Science, Scopus, ScienceDirect, Lilacs, SciELO, PEDro, and Cochrane. Searches were carried out from the end of the project until September 2019, with no language and year restrictions. Randomized controlled clinical trials that used the following outcome measures were included: Visual Analog Scale, Fibromyalgia Impact Questionnaire, and SF-36 Quality of Life Questionnaire. The risk of bias and quality of studies was assessed using the PEDro scale; the Cochrane risk-of-bias tool; and Grading of Recommendations Assessment, Development, and Evaluation System. RESULTS: Seven studies were included (368 patients). The quantitative analysis was performed on 4 studies because of the lack of data in the others. Myofascial release was the most used modality. The level of evidence ranged from very low to moderate, mainly because of the inconsistency and inaccuracy of results. LIMITATIONS: The present systematic review presented limitations because of the heterogeneity of the included studies and only a short-term analysis of the intervention results. It was observed that other information, such as pressure, repetition, and/or sustaining manual therapy techniques, could be better described in future protocols, aiming at a better comparison between the techniques and their subsequent reproducibility. CONCLUSIONS: Current evidence of manual therapy in patients with FM, based on a very low to moderate quality of evidence, was inconclusive and insufficient to support and recommend the use of manual therapy in this population. To date, only general osteopathic treatment has achieved clinically relevant pain improvement when compared with control.