Neural management plus advice to stay active on clinical measures and sciatic neurodynamic for patients with chronic sciatica: Study protocol for a controlled randomised clinical trial.

Advice to stay active is the primary management strategy for sciatica. Other conservative treatments such as neural management techniques may also contribute to sciatica recovery, but currently, the effects have not been robustly assessed. Thus, the aim of this study is to compare the effects of adding neural management to advice to stay active versus advice to stay active alone in improving pain intensity and functional limitation. Secondarily, to compare the effects of the experimental intervention in the sciatic neurodynamic, pain modulation, and psychosocial factors. A parallel-group, controlled, examiner-blinded superiority clinical trial randomised at a 1:1 allocation will be conducted in 210 participants with chronic sciatica. Patients will be recruited from outpatient physiotherapy clinics and community advertisements. The experimental group will receive neural mobilisation techniques and soft tissue mobilisation techniques for 30 minutes per session, 10 weekly sessions, plus advice to stay active on their activities of daily living, information on physical activity, imaging tests, and sciatica for 5 biweekly sessions lasting 25-30 minutes. The control group will receive advice to stay active only. The re-evaluation will be performed out after 5 weeks, 10 weeks, and 26 weeks after randomisation and primary endpoints will be pain intensity and functional limitation at 10 weeks. Secondary outcomes will include neuropathic symptoms, sciatic neurodynamic, pain modulation, and psychosocial factors. Adverse events and patient satisfaction will be assessed. Ethical approval has been granted from an Institutional Human Research Ethics Committee. Trial registration: Trial was prospectively registered in the Brazilian Registry of Clinical Trials (number: RBR-3db643c).

Osteocondroma de rodilla en un triatleta aficionado / Knee osteochondroma in an amateur triathlete

Introducción: El estudio describe correlaciones clínicas radiológicas después de la observación de la imagen de un Osteocondroma con localización rara en la región posterior de la rodilla, en un triatleta aficionado. Objetivos: Presentar el caso clínico atípico de dolor en la rodilla, y demostrar la aplicabilidad de los exámenes complementarios en la práctica clínica osteopática. Resultados: El triatleta aficionado sufrió la influencia del entrenamiento y de factores intrínsecos de la biomecánica, acarreando lesiones por sobrecarga, visualizadas en los exámenes de imagen y correlacionadas en el análisis de la marcha y las pruebas físicas. Conclusiones: El análisis de la marcha y el razonamiento clínico y radiológico deberían aplicarse para la interpretación del origen de los síntomas y en la decisión de la Terapia Manipulativa Osteopática (AU)

Introduction: The study describes clinical radiological correlations after observation of the image of an Osteochondroma with uncommon localization in the posterior region of the knee in an amateur triathlete. Objectives: Present the atypical clinical case of pain in the knee, and demonstrate the applicability of the supplementary exams in clinical osteopathic practice. Results: The amateur triathlete suffered the influence of training and intrinsic biomechanical factors, involving injuries due to strain, displayed in the imaging tests and correlated in walking tests and physical examinations. Conclusions: Walking tests and clinical and radiological analysis should be applied in order to interpret the origin of the symptoms and the Osteopathic Manipulative Therapy decision (AU)