Effectiveness of manual therapy versus surgery in pain processing due to carpal tunnel syndrome: A randomized clinical trial.

BACKGROUND: People with carpal tunnel syndrome (CTS) exhibit widespread pressure pain and thermal pain hypersensitivity as a manifestation of central sensitization. The aim of our study was to compare the effectiveness of manual therapy versus surgery for improving pain and nociceptive gain processing in people with CTS. METHODS: The trial was conducted at a local regional Hospital in Madrid, Spain from August 2014 to February 2015. In this randomized parallel-group, blinded, clinical trial, 100 women with CTS were randomly allocated to either manual therapy (n = 50), who received three sessions (once/week) of manual therapies including desensitization manoeuvres of the central nervous system, or surgical intervention (n = 50) group. Outcomes including pressure pain thresholds (PPT), thermal pain thresholds (HPT or CPT), and pain intensity which were assessed at baseline, and 3, 6, 9 and 12 months after the intervention by an assessor unaware of group assignment. Analysis was by intention to treat with mixed ANCOVAs adjusted for baseline scores. RESULTS: At 12 months, 95 women completed the follow-up. Patients receiving manual therapy exhibited higher increases in PPT over the carpal tunnel at 3, 6 and 9 months (all, p < 0.01) and higher decrease of pain intensity at 3 month follow-up (p < 0.001) than those receiving surgery. No significant differences were observed between groups for the remaining outcomes. CONCLUSIONS: Manual therapy and surgery have similar effects on decreasing widespread pressure pain sensitivity and pain intensity in women with CTS. Neither manual therapy nor surgery resulted in changes in thermal pain sensitivity. SIGNIFICANCE: The current study found that manual therapy and surgery exhibited similar effects on decreasing widespread pressure pain sensitivity and pain intensity in women with carpal tunnel syndrome at medium- and long-term follow-ups investigating changes in nociceptive gain processing after treatment in carpal tunnel syndrome.

Effectiveness of physical therapy treatment of clearly defined subacromial pain: a systematic review of randomised controlled trials.

AIM: To summarise the current evidence regarding the effectiveness of physical therapy on pain, function and range of motion in individuals with subacromial pain syndrome (SAPS). DESIGN: Systematic review. DATA SOURCES: PubMed, Web of Science, CINAHL, Cochrane, Embase, Lilacs, Ibecs and Scielo databases. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Randomised controlled trials (RCTs) investigating physical therapy modalities for SAPS on pain, function/disability or range of motion were included. RESULTS: 64 high-quality RCTs were included. Exercise therapy provided high evidence of being as effective as surgery intervention and better than no treatment or placebo treatment to improve pain, function and range of motion in the short, mid and long terms. The combination of mobilisation and exercises provided high evidence to decrease pain and improve function in the short term. There is limited evidence for improvements on the outcomes with the isolated application of manual therapy. High level of evidence was synthesised regarding the lack of beneficial effects of physical resources such as low-level laser, ultrasound and pulsed electromagnetic field (PEMF) on pain, function or range of motion in the treatment of SAPS. There is limited evidence for microwave diathermy and transcutaneous electrical nerve stimulation. There is moderate evidence to no benefits with taping in the short term. Effects of diacutaneous fibrolysis and acupuncture are not well established yet. CONCLUSIONS: Exercise therapy should be the first-line treatment to improve pain, function and range of motion. The addition of mobilisations to exercises may accelerate reduction of pain in the short term. Low-level laser therapy, PEMF and taping should not be recommended.

Topographical pressure pain sensitivity maps of the shoulder region in individuals with subacromial pain syndrome.

BACKGROUND: Topographical pain maps (TPM) are useful tools to assess deep tissue sensitivity in musculoskeletal pain conditions. There is evidence suggesting bilateral sensitivity in subacromial pain syndrome (SAPS), although it is not widely accepted. No previous study has investigated TPM of the shoulder in SAPS. OBJECTIVE: To investigate whether differences for TPM of the shoulder are evident among patients with unilateral SAPS and controls. METHODS: Pressure pain thresholds (PPTs) were assessed 3 times at each point and there was a 20 s rest period between each one. The TPM were calculated using 29 pre-determined points on both shoulders in all groups by inverse distance weighted interpolation of PPT data. Multivariate Analysis of Covariance was applied to detect differences in PPTs between groups, sides, points (gender as covariate). RESULTS: The results revealed significant differences between points and genders (both, P < 0.001), but not between groups (P = 0.243) and sides (P = 0.812). Heterogeneous distribution of mechanical pain sensitivity was found in both groups as the PPTs were lower on the root spine of the scapula and the posterior border of the acromion (points 5-8, P < 0.05), glenohumeral joint (points 17-20, P < 0.01) and the anterior deltoid muscle (points 21-25, P < 0.001) compared to the average of the other sites on the shoulder. Women exhibited bilateral lower PPTs in all points than men in both groups (all, P < 0.01). CONCLUSIONS: This study revealed no differences for mechanical pain sensitivity in patients with SAPS experiencing lower levels of pain compared with matched controls, but showed heterogeneous distribution of PPTs in the shoulder.

Manual therapy for the management of pain and limited range of motion in subjects with signs and symptoms of temporomandibular disorder: a systematic review of randomised controlled trials.

There is a lack of knowledge about the effectiveness of manual therapy (MT) on subjects with temporomandibular disorders (TMD). The aim of this systematic review is to synthetise evidence regarding the isolated effect of MT in improving maximum mouth opening (MMO) and pain in subjects with signs and symptoms of TMD. MEDLINE(®) , Cochrane, Web of Science, SciELO and EMBASE(™) electronic databases were consulted, searching for randomised controlled trials applying MT for TMD compared to other intervention, no intervention or placebo. Two authors independently extracted data, PEDro scale was used to assess risk of bias, and GRADE (Grading of Recommendations Assessment, Development and Evaluation) was applied to synthetise overall quality of the body of evidence. Treatment effect size was calculated for pain, MMO and pressure pain threshold (PPT). Eight trials were included, seven of high methodological quality. Myofascial release and massage techniques applied on the masticatory muscles are more effective than control (low to moderate evidence) but as effective as toxin botulinum injections (moderate evidence). Upper cervical spine thrust manipulation or mobilisation techniques are more effective than control (low to high evidence), while thoracic manipulations are not. There is moderate-to-high evidence that MT techniques protocols are effective. The methodological heterogeneity across trials protocols frequently contributed to decrease quality of evidence. In conclusion, there is widely varying evidence that MT improves pain, MMO and PPT in subjects with TMD signs and symptoms, depending on the technique. Further studies should consider using standardised evaluations and better study designs to strengthen clinical relevance.

Efectos Inmediatos de la Técnica de Manipulación de Ashmore C5/C6 en la Actividad Muscular, en pacientes con Cervicalgia Mecánica / Immediate Effects of the Ashmore Manipulation Technique C5/C6, in Muscle Activity in patients with Mechanical Neck Pain

Introducción: La manipulación vertebral se relaciona con el aumento de la fuerza muscular, aunque no existen suficientes evidencias relativas a su aplicación en el raquis cervical. Objetivo: Determinar los efectos inmediatos de la técnica de manipulación de C5/C6 (Ashmore) en la actividad electromiográfica en reposo y en las contracciones del músculo deltoides medio bilateralmente. Material y Métodos: Estudio experimental, aleatorizado, cegado y controlado. Treinta (n=30) pacientes con Cervicalgia Mecánica (CM) se distribuyeron aleatoriamente en dos grupos, experimental (GE; n=15) y control (GC; n=15). Los pacientes fueron evaluados mediante el cuestionario Neck Disability Index (NDI), el test de la arteria vertebral y electromiografía (EMG) antes de la intervención. Después de las intervenciones en los grupos de estudio, realizamos otra vez la prueba EMG. Resultados: Los análisis comparativos intergrupos post-intervención presentaron diferencias estadísticamente significativas para las variables Root Mean Square (RMS) en isometría de 30 segundos bilateral, para el músculo deltoides medio. Conclusiones: La manipulación vertebral C5-C6 disminuye la actividad electromiográfica en la contracción isométrica, pero no produce cambios electromiográficos en reposo ni en contracción isotónica (AU)

Introduction: The effects of spinal manipulation are not yet entirely clear. Previous studies have found both increased and decreased electromyographic (EMG) activity of muscles related to the level being manipulated, although few of them have considered the cervical region or symptomatic individuals. Objetives: To determine the immediate effects of the C5/C6 (Ashmore) manipulation technique on bilateral EMG activity of the middle deltoid muscle at rest and in contractions. Patients, Materials and Methods: A randomized, controlled, single blind, experimental study was conducted. A total of 30 individuals presenting with mechanical neck pain were assigned randomly to two groups: 15 formed the experimental group (EG), and 15 the control group (CG). All participants completed a data questionnaire and the NDI (Neck Disability Index), and underwent a vertebral artery and EMG evaluation before their participation. After C5/C6 manipulation in the intervention group and no manipulation in the control group, the EMG evaluation was repeated. Results: All the variables were normally distributed, indicative of the total sample's initial homogeneity. Comparative post-intervention inter-group analyses showed statistically significant differences in the root mean square (RMS) values of the 30-s isometric bilateral EMG measurements of the middle deltoid muscle's activity. Conclusions: C5-C6 spinal manipulation reduced EMG activity in the longer isometric contractions, but no changes were observed neither in the resting EMG values nor in the isotonic contractions performed(AU)

Evaluación y análisis del morfotipo raquídeo del futbolista juvenil y amateur / Evaluation and analysis of spine morpho-type of the amateur and juvenile football player

Se realiza un análisis del morfotipo raquídeo de jóvenes futbolistas (n = 100) pertenecientes a las categorías juvenil y amateur (16-25 años) de dos escuelas de fútbol de Salamanca, comparando los resultados con los correspondientes a un grupo de "no deportistas", compuesto por universitarios (n = 37) de similar edad que no practican deporte reglado. Mediante una valoración fisioterápica, se obtienen las flechas sagitales cervical y lumbar y se evalúa el grado de flexibilidad y elasticidad miotendinosa de la cadena muscular cinética recta posterior (CRP) a través de las siguientes pruebas: test de Ott; test de Schöber; test de flexión en bipedestación o "distancia dedos-suelo" (DDS); y test de flexión en sedestación o "sit and reach". Los datos son anotados en un ficha proforma individual para su posterior análisis. Los resultados obtenidos determinan un morfotipo raquídeo característico del futbolista juvenil y amateur en el que aparece una tendencia a la hiperlordosis lumbar (5,5 ± 1,1 cm); una mayor flexibilidad analítica del raquis lumbar (5,8 ± 0,7 cm) y una mayor elasticidad global de la CRP (1,8 ± 9,3 cm en el test DDS y 3,7 ± 9,4 cm para el test "sit and reach"), respecto a los individuos "no deportistas" (4,8 ± 0,9 cm; 5,1 ± 1,0 cm; ­3,7 ± 10,0 cm; y 0,0 ± 9,4 cm respectivamente). Asimismo, el análisis comparativo de los resultados obtenidos en los test DDS y test "sit and reach" (numéricamente superiores en todos los casos para el test en sedestación), pone de manifiesto la importante influencia de la extensibilidad de los elementos capsuloligamentosos y de la elasticidad de las estructuras miofasciales sobre la valoración de la elasticidad global de la CRP

It is carried out an analysis of spine morpho-type of young players (n = 100) from juvenile and amateur categories (from 16 to 25 years) belonging to two football schools in Salamanca. The results are compared with those from a group of "non-players" madep up of university students (n = 37) of similar age who practice no ruled sport. By means of a physiotherapic valuation, the sagital arrows of cervical and lumbar bow are obtained and it is evaluated the degree of flexibility and elasticity of myo-tendon structure of the posterior kinetic muscular chain (CRP) through the following tests: Ott's test, Schöber's test, biped flexión test or "toes-ground distance"(DDS) and "sit and reach" test. Data are written down in an individual register to their later analysis. The results determine a characteristic spine morpho-type of the juvenile and amateur football player where appears a tendency towards lumbar hyperlordosis (5,5 ± 1,1 cm); a higher analytic flexibility of lumbar spine (5,8 ± 0,7 cm) and a higher global elasticity of the CRP (1,8 ± 9,3 cm at DDS test and 3,7 ± 9,4 cm at the"sit and reach"test) comparing them with non-players-individuals (4,8 ± 0,9 cm; 5,1 ± 1,0 cm; ­3,7 ± 10,0 cm; and 0,0 ± 9,4 cm respectively). In the same way, the comparative analysis of the results obtained at DDS test and "sit and reach" test (numerically higher in all cases for the "sit and reach" test) shows the important influence of the capsule-ligaments elements' spreadability and the myo-fascial structures' elasticity implied at the valuation of the global elasticity of the CRP

Identificación de las alteraciones en los hábitos de estudiantes respecto al transporte de material escolar / Identification of the alterations in the students habits regarding the transport of school material

El trabajo presente tiene como objetivo identificar las alteraciones de los hábitos en los estudiantes de enseñanza primaria y en la estructura institucional de las escuelas de la red privada en la ciudad de São Carlos, respecto al transporte de material escolar. El peso del material, el tipo de equipo usado en el transporte y la infraestructura de las escuelas fueron observados, analizados y comparados con los resultados del trabajo de Rebelatto, Caldas y Vitta1. Las comparaciones indicaron que los promedios y los pesos mínimos disminuyeron de una manera significativa en todos los grupos de edad, hecho que no aconteció con el peso máximo. Respecto a los materiales, el carrito supuso el 28 por ciento en el total del uso, siendo el favorito para los niños hasta los 10 años de edad. La mochila de fijación escapular se cambió por la bolsa de fijación dorsal por el 22,9 por ciento de los alumnos y el 35 por ciento de las niñas empezaron a llevar el material en las manos o usar el carrito con ruedas, como propusieron Rebelatto, Caldas y Vitta en 1991. El estudio también identificó alteraciones en la infraestructura de las escuelas y en las orientaciones dadas a los alumnos y a los padres (AU)

Eficacia de la fisioterapia en la enfermedad de Parkinson / Effectiveness of Physiotherapy in Parkinson's disease

La enfermedad de Parkinson se presenta como uno de los cuadros neurológicos más frecuentes en las personas mayores de 65 años. Produce numerosas alteraciones en el movimiento y la postura, evolucionando de forma lenta y progresiva y provocando diversas deficiencias en los pacientes afectados. Con este artículo se pretende comprobar la eficacia de la fisioterapia basada en la evidencia en el tratamiento de la enfermedad de Parkinson. Para ello se realiza una revisión bibliográfica de los textos publicados en los últimos siete años, tanto en bases de datos como publicaciones especializadas. Obteniendo escasas referencias y unos resultados poco significativos, concluyendo en la necesidad de un mayor control científico en los ensayos que se realicen (AU)

Tratamiento fisioterápico en las apofisitis del calcáneo en futbolistas jóvenes / Physiotherapy treatment in calcaneal apophysitis in young footballers

Introducción: El elevado número de casos de apositis del calcáneo (afección del núcleo de osificación secundario del calcáneo, Danowski 1992) que aparecen en jóvenes deportistas y la incapacidad que esta produce para la práctica deportiva, justifica la sistematización de un programa de actuación fisioterápica encaminado a tratar esta patología. Materialy método: El propósito del trabajo es valorar la eficacia de un programa de actuación fisioterápica para el tratamiento de esta patología. Se cuenta con una población de casi 200 deportistas que pertenecen a una Escuela de Fútbol, con edades comprendidas entre los 7 y los 16 años, y que entrenan 3 días a la semana (1,5 horas/día) y un partido de competición los fines de semana. El programa de tratamiento fisioterápico se diseña a partir de la utilización de medidas antinflamatorias, descontracturantes, de corrección del patrón de marcha y carrera y de corrección de los trastornos estáticos pretendiéndose eliminar los signos y síntomas que presenta dicho síndrome. Se aplica el programa a todos los casos de apofisitis del calcáneo que aparecen durante las temporadas 96-97 y 97-98. Resultados: Se registran 22 casos de apofisitis del calcáneo en una población entre los 7 y los 13 años, de los que el 68 por ciento fueron casos unilaterales. Tras la aplicación del programa de fisioterapia se obtuvieron buenos resultados en el 63,6 por ciento de los casos, en los que desaparecieron los signos y síntomas . En el 9 por ciento de los mismos aparecieron recidivas durante la misma temporada. Y en un 27 por ciento la evolución fue desconocida. Conclusión: El tratamiento fisioterápico puede calificarse de eficaz ya que mantiene al deportista realizando su actividad física normal y elimina los signos y sítomas de la afección en un corto período de tiempo y con buenos resultados (AU)