The Efficacy of Manual Therapy Approaches on Pain, Maximum Mouth Opening and Disability in Temporomandibular Disorders: A Systematic Review of Randomised Controlled Trials.

Temporomandibular disorder (TMD) is a common condition disabling people and bringing up costs. The aim of this study was to investigate the effects of manual therapy on pain intensity, maximum mouth opening (MMO) and disability. Searches were conducted in six databases for randomised controlled trials (RCTs). Selection of trials, data extraction and methodological quality assessment were conducted by two reviewers with discrepancies resolved by a third reviewer. Estimates were presented as mean differences (MDs) or standardized mean differences (SMDs) with 95% confidence intervals (CIs). Quality of the evidence was assessed using the GRADE approach. Twenty trials met the eligibility criteria and were included. For pain intensity, high and moderate quality evidence demonstrated the additional effects of manual therapy at short- (95% CI -2.12 to -0.82 points) and long-term (95% CI -2.17 to -0.40 points) on the 0-10 points scale. For MMO, moderate to high quality evidence was found in favour of manual therapy alone (95% CI 0.01 to 7.30 mm) and its additional effects (95% CI 1.58 to 3.58 mm) at short- and long-term (95% CI 1.22 to 8.40 mm). Moderate quality evidence demonstrated an additional effect of manual therapy for disability (95% CI = -0.87 to -0.14). Evidence supports manual therapy as effective for TMD.

Can a Single Trial of a Thoracolumbar Myofascial Release Technique Reduce Pain and Disability in Chronic Low Back Pain? A Randomized Balanced Crossover Study.

Although manual therapy for pain relief has been used as an adjunct in treatments for chronic low back pain (CLBP), there is still the belief that a single session of myofascial release would be effective. This study was a crossover clinical trial aimed to investigate whether a single session of a specific myofascial release technique reduces pain and disability in subjects with CLBP. 41 participants over 18 years old were randomly enrolled into 3 situations in a balanced and crossover manner: experimental, placebo, and control. The subjects underwent a single session of myofascial release on thoracolumbar fascia and the results were compared with the control and placebo groups. The outcomes, pain and functionality, were evaluated using the numerical pain rating scale (NPRS), pressure pain threshold (PPT), and Oswestry Disability Index (ODI). There were no effects between-tests, within-tests, nor for interaction of all the outcomes, i.e., NPRS (η 2 = 0.32, F = 0.48, p = 0.61), PPT (η2 = 0.73, F = 2.80, p = 0.06), ODI (η2 = 0.02, F = 0.02, p = 0.97). A single trial of a thoracolumbar myofascial release technique was not enough to reduce pain intensity and disability in subjects with CLBP.

A pilot study of the effects of suboccipital fascial release on heart rate variability in workers in the clothing industry: Randomized clinical trial.

INTRODUCTION: The routine of work inside the clothing industry has been associated with high levels stress perceived by the worker. The parameters of heart rate variability (HRV) are objective markers of the organic response to stress. OBJECTIVE: This trial evaluates if suboccipital fascial release (SFR) technique was able to influence HRV parameters in workers in the clothing industry. METHODS: Randomized clinical trial. Forty women who worked in clothing industry were randomized into two groups, untreated group (UG, n = 15) and treated group (TG, n = 25). Heart rate (HR) and HRV parameters were measured using a heart rate monitor. Statistical analysis of data distribution and within group and between groups analysis were performed with α adjusted to 0.05. RESULTS: Within group analysis in the TG showed significant changes in the following parameters: sympathovagal balance (low frequency/high frequency - LF/HF) (p ≤ 0.01), mean RR intervals (p ≤ 0.01), mean heart rate (Mean HR) (p ≤ 0.01), minimum heart rate (Min. HR) (p = 0.02) and maximum heart rate (Max. HR) (p ≤ 0.01). Between group analysis, on the other hand, showed significant variations in Very Low Frequency (VLF) (p = 0.04) and Max. HR (p = 0.03) in favor of the TG. No significant changes were observed in the UG during the same period. CONCLUSION: The comparison between groups showed that SFR may influence HRV parameters more than rest in workers in the clothing industry and possibly may contribute to the improvement of the stress experienced by them.

A pilot study of the effects of suboccipital fascial release on cortisol levels in workers in the clothing industry - randomized clinical trial.

INTRODUCTION: Repetitive and time sensitive demands of clothing workers has been associated with higher salivary cortisol levels that may reflect the stress experienced by the worker. OBJECTIVE: This trial evaluates if suboccipital fascial release (SFR) is associated with reduced salivary cortisol levels. METHODS: Randomized controlled trial with 40 workers, divided into: untreated group (UG, n = 15) and treated group (TG, n = 25). Both were removed from the work environment. The TG received the above technique and the UG remained lying at rest, both for five minutes. Salivary cortisol levels were measured by a commercial enzyme-linked immunosorbent assay (ELISA) kit. Statistical analysis of data distribution, intragroup and intergroups, were performed with α adjusted to 0.05. RESULTS: Pre / post intragroup analyses showed significant differences in cortisol levels in both groups, as well as intergroup analyses with lower values in favor of TG (p = 0.014). CONCLUSION: The reduction in salivary cortisol levels in TG suggests that SFR may be more effective than rest in reducing stress. Future studies with increased experimental rigor are necessary to confirm this conclusion. CLINICAL TRIAL REGISTRATION NUMBER: REBEC - RBR - 56yk9m.

INTRODUCTION: Les exigences aiguës imposées aux travailleurs de l'industrie du vêtement ont été associées à de fortes concentrations de cortisol salivaire pouvant traduire le stress vécu par ces travailleurs. OBJECTIF: Cet essai vise à savoir si le relâchement des fascias des muscles sous-occipitaux est associé à une réduction des concentrations de cortisol salivaire. MÉTHODOLOGIE: Essai comparatif avec répartition aléatoire mené auprès de 40 travailleurs répartis en deux groupes: groupe non traité (GNT, n = 15) et groupe traité (GT, n = 25). Les sujets des deux groupes ont été retirés de leur milieu de travail. La technique ci-haut mentionnée a été utilisée sur les sujets du GT alors que les sujets du GNT sont restés au repos: pour les deux groupes, l'intervention a duré cinq minutes. Les concentrations de cortisol salivaire ont été mesurées à l'aide d'une trousse pour dosage d'immunoabsorption par enzyme liée (ELISA) offerte dans le commerce. L'analyse statistique de la distribution des données intra-groupes et inter-groupes a été effectuée avec α ajusté à 0.05. RÉSULTATS: L'analyse des données prétraitement et post-traitement à l'intérieur des groupes a révélé des différences appréciables de concentration de cortisol dans les deux groupes, les analyses entre les groupes montrant des concentrations plus faibles dans le GT (p = 0.014). CONCLUSION: La réduction des concentrations de cortisol salivaire dans le GT semble indiquer que le relâchement des fascias de muscles sous-occipitaux peut être plus efficace que le repos pour réduire le stress. Il faut mener d'autres études expérimentales plus rigoureuses pour confirmer cette conclusion. NUMÉRO D'ENREGISTREMENT DE L'ESSAI CLINIQUE: REBEC ­ RBR ­ 56yk9m.

Prevalência de lesões no futebol em atletas jovens: estudo comparativo entre diferentes categorias / Prevalence of football injuries in youth players: comparative study in different categories

A popularidade do futebol somada à elevada taxa de incidência de lesões têm sido objeto de crescenteinteresse epidemiológico. Vários autores investigaram a freqüência de lesões em jovens jogadores de futebol.Entretanto, os resultados desses estudos são de difícil comparação por causa das diferentes faixas etáriasinvestigadas e os vários métodos aplicados. O objetivo do presente estudo foi comparar a prevalência ecaracterísticas de lesões da categoria infantil e juvenil. Foi realizada uma análise retrospectiva da ocorrênciade lesões esportivas através do levantamento de fichas médicas de dois clubes brasileiros durante a temporadade futebol no ano de 2003 em Minas Gerais. Na categoria infantil 42,2% das lesões não necessitaram deafastamento das atividades esportivas, taxa aparentemente maior à encontrada na categoria juvenil (26,9%).Além disso, o número de lesões que resultaram em afastamento por mais de um mês foi aparentementemaior na categoria juvenil (10,4%) em relação à categoria infantil (1,7%). Observamos que a prevalência ecaracterísticas das lesões nos atletas das categorias pesquisadas diferem aparentemente, sendo que quantomais velho o atleta, mais as taxas de lesões se aproximam das taxas de equipes adultas. Apesar da maior taxade prevalência, a categoria infantil apresenta uma porcentagem maior de lesões que não necessitaram deafastamento das atividades esportivas.

The popularity of the soccer, added to the high incidence of injuries, has been crescent object of interestof the health care teams. Several authors have investigated the frequency of lesions in young soccerplayers. However, the results of these studies are difficult to compare because of differences in theinvestigated age group and in the applied methods. The aim of the present study was to compare theincidence and the characteristics of injuries of the under 16 and under 18 categories. We performed aretrospective analysis of sporting injuries of athletes' medical records of two Brazilian teams during thesoccer season in the year of 2003 in Minas Gerais. In the under 16 category 42.2% of the lesions didn'tneed removal. This rate was greater than that found in the under 18 category (26.9%). In addition, thenumber of injuries that resulted in removal for more than one month was substantially greater in theunder 18 category (10.4%) in relation to the under 16 category (1.7%). We observed that the prevalenceand characteristics of the injuries in athletes of different categories differ substantially from adultathletes. However, as athletes get older the rate of injuries approach the rate observed in adult teams.In spite of the largest prevalence rate, the under 16 category presents a greater injury percentage ofinjuries that did not need removal from sport activities.