Ultrasound-Guided Percutaneous Needle Electrolysis in Dancers with Chronic Soleus Injury: A Randomized Clinical Trial.

Damage to intramuscular tendons is very common in sports injuries, specifically in soleus muscle injuries. This study sought to compare the effects of applying ultrasound- (US-) guided percutaneous needle electrolysis (PNE) in combination with an eccentric exercise program on pain and functionality in dancers with chronic soleus injury, located in the central tendon. Thirty dancers with injured central tendon of the soleus muscle were randomly allocated to a PNE group (n = 10), an eccentric exercise group (n = 10), or a combined group (n = 10). Pain, ankle dorsiflexion range of motion (DROM), endurance, the heel raise test, the DFOS questionnaire, and the minimal clinically important difference (MCID) were analyzed at baseline and after treatment (four weeks). Over half (52%) of the dancers had a chronic soleus muscle injury. Variables for pain, DROM, the heel rise test, ADL, technique, DFOS total, and DFOS-subjective variables showed significant differences (P < 0.05) in pretreatment and posttreatment in all groups, whereas no significant differences were observed between intervention groups. However, the combined group showed a higher percentage of changes compared to the other groups, and these dancers had greater perceived changes (MCID = 4.70 ± 1.42). The conclusion of the study was that dancers with chronic soleus injury, located in the central tendon, treated with a combination of US-guided PNE and an eccentric exercise program displayed improved outcomes compared to the application of PNE therapy or eccentric exercise alone. The US-guided PNE, combined with an eccentric exercise program, is a useful therapeutic tool for the treatment of chronic soleus injury, located in the central tendon. The trial is registered with NCT04042012.

Percutaneous Application of Galvanic Current in Rodents Reverses Signs of Myofascial Trigger Points.

An increase in the spontaneous release of acetylcholine (ACh) at the motor endplate is directly related to the generation of myofascial trigger points (MTrPs). In this study, percutaneous electric fields were applied to an animal model of MTrPs with high levels of spontaneous ACh release. All experiments were performed on Swiss mice and Sprague Dawley rats. For evaluating the spontaneous neurotransmission, intracellular recordings were performed, and the frequency of miniature endplate potentials was evaluated. Electromyographic recordings were also conducted to evaluate the endplate noise. Finally, the number and strength of local twitch responses (LTR) were evaluated using ultrasound recordings. The protocols used for the electric currents were 0.4 mA for five seconds and four repetitions (protocol 1), 1.5 mA for five seconds and three repetitions (protocol 2), and 3 mA for three seconds and three repetitions (protocol 3). After a subcutaneous injection of neostigmine (NTG), a great increase was observed in the frequency of mEPPs, together with an elevated endplate noise. Protocols 2 and 3 were the most effective. Protocol 3 could completely reverse the action of NTG at both three hours and 24 hours, respectively. The application of percutaneous currents produced both an increase in the number (144%) and in the speed (230% faster) of LTR compared with dry needling. In conclusion, higher doses of electrical current are more effective for decreasing MTrPs findings in an animal model.

Percutaneous Needle Electrolysis Reverses Neurographic Signs of Nerve Entrapment by Induced Fibrosis in Mice.

Nerve entrapments such as carpal tunnel syndrome are the most common mononeuropathies. The lesional mechanism includes a scarring reaction that causes a vascular compromise. The most effective treatment is surgery, which consists of removing the scarred area, thus reverting the vascular impairment. In the present study, a more conservative therapeutic approach has been undertaken to release the nerve by means of galvanic current (GC) applied with a needle: percutaneous needle electrolysis (PNE). For this purpose, a mouse model of sciatic nerve entrapment has been created using albumin coagulated by glutaraldehyde (albumin 35% and glutaraldehyde 2% volume applied, 10 µl). After two weeks, a fibrous reaction was obtained which entrapped the nerve to the extent of causing atrophy of the leg musculature (14.7%, P < 0.05 compared to the control leg). Ultrasound imaging confirmed that the model's image was compatible with that of nerve entrapment in patients. To quantify the degree of entrapment, nerve conduction recordings were made. The amplitude (peak-to-peak) of the compound muscle action potential (CMAPs) decreased by 32.2% (P < 0.05), and the proximal latency increases by 17.7% (P < 0.05, in both cases). In order to release the sciatic nerve, PNE was applied (1.5 mA for 3 seconds and 3 repetitions; 1.5/3/3) by means of a solid needle in the immediacy of perineural fibrosis before and 5 minutes after the application of GC, and the proximal latency shows a decrease of 16% (P < 0.05). The recovery of CMAPs amplitude was about 48.7% (P < 0.05). Three weeks later, the CMAPs amplitude was almost completely recovered (94.64%). Therefore, with the application of GC by means of a solid needle, the sciatic nerve was definitively released from its fibrous entrapment.

Estudio de coste-efectividad de la electrólisis percutánea intratisular (EPI ®) en las epicondilalgias / The clinical and cost-effectiveness of percutaneous electrolysis intratissue (EPI®) in lateral epicondylalgia

Introducción: La electrólisis percutánea intratisular (EPI®) es una técnica mínimamente invasiva que consiste en la aplicación de una corriente galvánica de alta intensidad que produce en el tejido blando un proceso inflamatorio local permitiendo la fagocitosis y la reparación del tejido afectado. El objetivo fue analizar el coste-efectividad de la EPI® en las epicondilalgias crónicas. Material y método Estudio de coste-efectividad de un programa de fisioterapia basado en la aplicación semanal de EPI® de forma aislada asociada con carácter domiciliario a ejercicios excéntricos y estiramientos diarios. El coste por proceso se analizó comparándolo con los casos quirúrgicos y el gasto asociado (fisioterapia, cirugía, estancia, baja laboral) y se basó sobre criterios de reducción de la intensidad del dolor. Resultados Se incluyó a 36 sujetos, 52,8% hombres (47,2% mujeres), con una media de 38 años. El 80,5% de los sujetos alcanzaron la curación tras 4 sesiones de EPI®. El coste por proceso del programa inicial y de seguimiento basado en EPI® es 16 veces inferior que el coste estimado a los casos quirúrgicos. Conclusiones El programa combinado de EPI® más ejercicios excéntricos y estiramientos constituye un tratamiento con una relación coste-efectividad muy aceptable (AU)

Introduction: Percutaneous electrolysis intratissue (EPI® ) is a minimally invasive technique that involves the application of a high intensity galvanic current that produces a local inflammatory process in the soft tissue, allowing phagocytosis and the reparation of the affected tissue. This study aimed to evaluate the cost-effectiveness of EPI®in chronic lateral epicondylalgia. Material and method: This was a cost-effectiveness study of a physiotherapy program based on the weekly application of EPI®technique alone associated with daily at home eccentric exercises and stretching. Cost per patient was analyzed in comparison to surgical cases and associated cost (physiotherapy, surgery, sick leave) and was based on pain intensity reduction criteria. Results: A total of 36 subjects were included in the study, 52.8% men (47.2% women) with meanage of 38 years. Of these, 80.5% of subjects reached complete response after four sessions ofEPI®. The cost per process in the initial program and follow-up based on EPI®is 16 times less than the estimated cost in the group surgery. Conclusions: The combined program of EPI® plus eccentric exercises and stretching is a very acceptable cost-effectiveness treatment (AU)

Efectividad de la electrólisis percutánea intratisular (EPI®) en las tendinopatías crónicas del tendón rotuliano / Effectiveness of electrolysis percutaneous intratisular (EPI®) in chronic insertional patellar tendinopathy

Objetivo: El objetivo del estudio es evaluar la efectividad de la electrólisis percutánea intratisular (EPI®) en la tendinopatía rotuliana crónica. Material y método: Estudio observacional en 32 pacientes (59,4% hombres), con una media de edad de 35 años (DE: 8) diagnosticados de tendinopatía rotuliana con más de 6 meses de evolución desde el inicio de los síntomas. Se evaluó la estructura del tendón a través de ecografía y la función con la escala VISA-P. Los sujetos fueron incluidos en el grupo 1 (VISA<50 puntos) y en el grupo 2 (VISA>50 puntos). Se aplicó la EPI® de forma aislada en cada sesión asociada con carácter domiciliario a trabajo excéntrico y estiramientos. En la evaluación inicial, todos presentaban cambios compatibles con un proceso degenerativo, el 50% presentaban hipervascularización (100% con VISA<50). Trece pacientes obtuvieron una puntuación VISA<50 y 19 VISA>50. Resultados: En el Grupo 1, el 80% de los pacientes alcanzaron el alta en fisioterapia a las 6 semanas desde el inicio de tratamiento con EPI®, con una media de 6 sesiones de EPI®. En el Grupo 2 (VISA>50) todos lograron el alta tras 4 sesiones de EPI®. Conclusiones: La EPI® constituye un tratamiento efectivo para la tendinopatía rotuliana crónica (AU)

Objective: This study aimed to evaluate the effectiveness of the electrolysis percutaneous intratisular (EPI®) in chronic patellar tendinopathy. Material and method: Observational study in 32 subjects, 59.4% men, with a mean age of 35 years (SD: 8) with diagnosis of patellar tendinopathy with more than six months of evolution from the onset of symptoms. We evaluated the structure of the tendon through musculoskeletal ultrasound and function through the VISAP scale. The subjects were classified into: Group 1 (VISA <50 points) and Group 2 (VISA> 50 points). EPI® was applied in isolation in each session associated with eccentric character home to work and stretching. On the first assessment, all the patients had changes consistent with a degenerative process, 50% showed hypervascularity (100% VISA <50). Thirty patients achieved a VISA score <50 and 19 VISA> 50. Results: In Group 1 (VISA <50), 80% of subjects achieved a cure at 6 weeks after beginning treatment with EPI®, with an average of 6 sessions of EPI®. In Group 2 (VISA> 50) all the subjects achieved a cure after four sessions of EPI®. Conclusions: The EPI ® is an effective treatment for chronic patellar tendinopathy (AU)

Fiabilidad interobservador del test de movilidad pasiva accesoria intervertebral lumbar y su correlación con la galvanopalpación en sujetos sanos / Inter-observer reliability of the passive accessory intervertebral motion test and its correlation with the galvanic palpation in healthy subjects

Introducción El diagnóstico de fisioterapia de las disfunciones vertebrales es fundamental para clasificar las alteraciones musculoesqueléticas. La evaluación pasiva de la cantidad y la calidad del movimiento en los diferentes segmentos vertebrales guía la toma de decisiones en relación con el tratamiento de fisioterapia. Los objetivos del presente estudio son determinar la fiabilidad interobservador del test de movilidad pasiva accesoria posteroanterior intervertebral unilateral lumbar como test indicado para identificar sujetos con disfunción articular y analizar la corriente galvánica como herramienta diagnóstica en la identificación de disfunción articular en la columna lumbar con dicho test ortopédico. Material y método Dos fisioterapeutas expertos en fisioterapia manual realizaron el test en una muestra de 30 sujetos asintomáticos en los niveles L1-L5 (lado derecho e izquierdo), realizándose un total de 300 pruebas. Se determinó que un nivel lumbar estaba en disfunción basándose en una sensación final anormal, la calidad de la resistencia anormal y la posible aparición de dolor asociado al movimiento. Para determinar la utilidad diagnóstica de la corriente galvánica, otros dos fisioterapeutas realizaron galvanopalpación consecutivamente al test de movilidad en las articulaciones interapofisarias lumbares de los mismos sujetos asintomáticos. Resultados En el test de movilidad, el porcentaje de acuerdo fue del 86,3%. El índice kappa (k) mostró un acuerdo moderado (k=0,5). El test fue más fiable en los niveles lumbares L3-L4 y L4-L5. En la galvanopalpación el porcentaje de acuerdo fue del 83%. El k mostró un acuerdo moderado en la identificación de disfunción articular (k=0,41). La sensibilidad fue alta en el nivel lumbar L3-L4 y L4-L5 y baja en L1-L2; la especificidad fue elevada (82,7–96,3%) en toda la columna lumbar. Conclusiones La fiabilidad interobservador del test de movilidad es moderada (k=0,5). La galvanopalpación identifica disfunciones articulares, pero en la columna lumbar alta la sensibilidad es baja (AU)

Introduction The physical therapy diagnosis of a vertebral dysfunction is essential in order to classify musculoskeletal diseases. Passive assessment of quantity and quality of movement on the different vertebral segments guides the decision-making process relative to manual therapy treatment. The aims of this present study have been to determine the interobserver reliability of passive accessory intervertebral postero-anterior unilateral lumbar motion test as a test to identify subjects with joint dysfunction, and to analyze galvanic current as a diagnostic tool to identify joint dysfunction in the lumbar spine with the motion test. Material and methods Two physiotherapists, experts in manual therapy, carried out the test in 30 asymptomatic subjects at L1 to L5 levels (right and left sides), performing a total of 300 tests. To determine the diagnostic value of galvanic current, two other physiotherapists performed galvanic palpation consecutively to the motion test in lumbar zygapophysial joints in the same asymptomatic subjects. Results Percentage agreement was 86.3% for the motion test. The Kappa index showed substantial agreement (according to Landis and Koch, 1977) (k=0.5). PA accessory motion test was more reliable to identify symptomatic spinal L4-L5 and L5-S1 level. Regarding galvanic palpation, the agreement percentage was 83%. Kappa coefficient (k) showed moderate agreement for identification of joint dysfunction (k=0.41). Sensitivity was high in the lumbar level L3-L4 and L4-L5 and was low in L1-L2 level; specificity was high (82.7–96.3%) throughout the lumbar spine. Conclusions Interobserver reliability of the passive motion test is moderate (k=0.5). Galvanic palpation identifies joint dysfunction, however sensitivity is low in the upper lumbar spine (AU)

Efectividad de la diatermia UHF 434MHz en el tratamiento tras movilización bajo anestesia de la artrofibrosis glenohumeral / Effectiveness of hyperthermia at 434MHz after manipulation under anesthesia in the treatment of frozen shoulder

IntroducciónLa UHF (434MHz) es una modalidad de diatermia profunda que tiene una gran profundidad de acción (6–8cm) con un importante efecto antiinflamatorio y reparador del tejido. El objetivo es analizar la efectividad de la diatermia profunda por UHF en el tratamiento tras movilización bajo anestesia (MBA) de la artrofibrosis glenohumeral.Material y métodoEstudio prospectivo y aleatorizado durante el periodo de 1 año (marzo 2007–2008) en pacientes diagnosticados de artrofibrosis en la articulación glenohumeral que requirieron MBA y un programa de fisioterapia posterior. Los pacientes fueron asignados aleatoriamente al grupo control o al grupo UHF. Se evaluó el dolor, la movilidad y las actividades de la vida diaria (AVD) mediante el test de Constant-Murley en condiciones basales, 1, 2 y 3 semanas tras la MBA y al alta.ResultadosSe incluyeron 65 pacientes que fueron aleatorizados (34 grupo UHF, 31 grupo control). Sus características clínicas previas a la MBA fueron similares. Los resultados indican que tanto el protocolo convencional como el que incluye diatermia UHF mejoran de forma estadísticamente significativa (p<0,05) los parámetros de dolor, AVD y rango de movilidad. Cuando el análisis se realiza comparando las mismas variables entre los grupos, el grupo con UHF es superior al convencional al alta, con un mayor porcentaje de recuperación total y con diferencias estadísticamente significativas (p<0,05) en los parámetros de movilidad y AVD.ConclusionesLa diatermia por UHF mejora los resultados obtenidos con los protocolos convencionales de fisioterapia tras la MBA de la articulación glenohumeral(AU)

IntroductionUHF (434MHz) is a deep modality of diathermy having great depth of action, that is 6–8cm, with important antiinflammatory and tissue repairing effect. Our study has aimed to analyze the effectiveness of hyperthermia at 434MHz in treating post-manipulation under anesthesia for arthrofibrosis of the glenohumeral capsule.Material and methodA randomized prospective trial conducted during the period of one year (March 2007–2008) in patients diagnosed with arthrofibrosis in glenohumeral joint requiring manipulation under anesthesia and a subsequent physiotherapy program. The patients were randomly assigned to the control or UHF groups. Outcome measures were the Constant-Murley Test and measurements of pain, mobility and activities of daily living (ADL). Measurements were taken at baseline and 1, 2 and 3 weeks after manipulation under anesthesia.ResultsSixty-five patients were included, randomizing 34 to the UHF group and 31 to the control group. No significant pre-treatment baseline differences were found between the two treatment groups. The results indicate that both the conventional protocol and that with associated UHF diathermy significantly (p<0.05) improve the pain, ADL and mobility range parameters. When the analysis was made comparing the same variables between the groups, the UHF group was superior to the conventional one on discharge, with higher percentage of total recovery and statistically significant differences (p<0.05) in the mobility and ADL parameters.ConclusionsWe conclude that diathermy with UHF improves the results obtained with the conventional protocols of physiotherapy after manipulation under anesthesia for fibrosis of the glenohumeral capsule(AU)

¿Qué opinan los fisioterapeutas sobre el actual plan de estudios en Fisioterapia y el futuro título de grado? / What is the opinion of Spanish physical therapists on the present and future degree program?

ObjetivoConocer la opinión de los fisioterapeutas españoles sobre el actual plan de estudios en Fisioterapia y el futuro título de grado.Material y métodoEstudio cualitativo mediante encuesta telefónica.ResultadosCincuenta fisioterapeutas de diferente procedencia geográfica y universidad de origen fueron encuestados. El 53,1% considera que la formación académica recibida no fue la adecuada, el 60% incluiría más asignaturas relacionadas con la terapia manual y el 46% aumentaría los créditos de asignaturas, como Anatomía, Biomecánica y Fisiología. El 94% de los fisioterapeutas considera que el futuro título de grado debería desarrollarse entre 4 y 5 años, y debería incluir la especialización.ConclusionesBajo grado de satisfacción del actual plan de estudios con carencias formativas en técnicas de terapia manual e insuficiente carga lectiva en asignaturas de estructura y función del cuerpo humano. El aspecto más valorado por los fisioterapeutas encuestados es la formación práctica. El futuro título de grado debería desarrollarse en cuatro años e incluir la especialidad.Todo ello haría necesaria una futura revisión del desarrollo curricular(AU)

ObjectiveTo learn the opinion of Spanish Physical Therapists on the present physical therapy curriculum and future degree program.Material and methodQualitative study by telephone survey.Results50 physical therapists from different geographic and university origins were polled. A total of 53.1% consider that they did not receive adequate academic training, 60% would include more subjects related to the manual therapy and 46% would increase the credits for subjects such as anatomy, biomechanics and physiology. A total of 94% of the physical therapists consider that the future degree program should include 4 and 5 years and should include the specialization.ConclusionsThere is a low degree of satisfaction regarding present curriculum with training deficiencies in techniques of manual therapy and insufficient content regarding the subject load for subjects on structure and function of the human body. The feature receiving the highest value by the physical therapists surveyed is practical training. The future degree studies should be carried out in a four year program and include the speciality. Thus, a future review of the curricular development is necessary(AU)

Programa “Essentials”: innovación docente en fisioterapia / “Essentials” program: teaching innovation in physical therapy

Introducción: La adaptación al Espacio Europeo deEducación Superior (EEES) implicará una profundareestructuración de la docencia universitaria en loreferente al diseño curricular, metodologías deaprendizaje y modelos de evaluación.El objetivo del presente estudio es evaluar y exponer losresultados cuantitativos y cualitativos de una nuevametodología de aprendizaje y sistema de evaluaciónbasado en el aprendizaje activo: Programa “Essentials”.Material y método: Estudio descriptivo transversalbasado en el análisis de: a) los resultados obtenidos porlos alumnos en las convocatorias de febrero, junio yseptiembre desde el curso académico 03-04 hasta el 05-06; b) la opinión del alumnado mediante una encuestaautocumplimentada de carácter anónimo.Resultados: a) Análisis cuantitativo (n = 653): el 69,5%superó los contenidos nucleares, y de éstos el 71,1%aprobó la asignatura. Los resultados obtenidos con elPrograma “Essentials” son independientes del tipo deasignatura y de la convocatoria de examen (p < 0,05).b) Análisis cualitativo (n = 51): el 94,1 % considera que la metodología didáctica propuesta facilita elaprendizaje y les ayuda a organizar y planificar elestudio; el 80,4% indica que el sistema de evaluaciónse ajusta mejor a sus condiciones individuales (lopuntúa con un 7,1 sobre 10 puntos).Conclusiones: El Programa “Essentials” facilita elproceso de aprendizaje del alumno, que se traduce enun alto porcentaje de aprobados (más del 70 %) y enuna alta satisfacción de éstos. Los resultadosacadémicos obtenidos siguiendo esta metodología nodependen ni del tipo de asignatura ni de laconvocatoria de examen(AU)

Introduction: Adaptation to the European HigherEducation Area (EHEA) is going to involve a deeprestructuring of university teaching regarding curriculumdesign, learning methodologies and assessment models(“Competences”). The aim of this present study is toevaluate and present the quantitative and qualitativeresults of a new learning methodology and assessmentsystem based on active learning: the “Essentials” Program.Material and method: A cross-sectional, descriptive studybased on the analysis of: a) results achieved by the studentsin the February, June and September exams from year03-04 to year 05-06; b) the students’ opinion obtainedfrom an anonymous self-reported questionnaire.Results: a) A quantitative analysis (n = 653): 69.5%passed the nuclear contents and 71.1 %of them passed thecourse. The results obtained with the “Essentials” Programare independent of the course type and course calendar(p < 0.05). b) Qualitative analysis (n = 51): 94.1%consider that the didactic methodology makes learningeasier and helps them arrange and plan their studies;80.4 % indicate that the assessment system is in better keeping with their individual conditions (they grade it7.1 on a 10-point scale).Conclusions: The “Essentials” Program makes thelearning process easier. This means a high percentage ofstudents who passed (over 70 %) and high satisfaction.The academic results obtained following this methodologydoes not depend on the kind of subject or the officialexamination time(AU)