Effectiveness of various methods of manual scar therapy.

BACKGROUND: The skin is a protective barrier of the body against external factors, and its damage leads to a loss of integrity. Normal wound healing results in a correct, flat, bright, and flexible scar. Initial skin damage and patient specific factors in wound healing contribute that many of these scars may progress into widespread or pathologic hypertrophic and keloid scars. The changes in cosmetic appearance, continuing pain, and loss of movement due to contracture or adhesion and persistent pruritis can significantly affect an individual's quality of life and psychological recovery post injury. Many different treatment methods can reduce the trauma and surgical scars. Manual scar treatment includes various techniques of therapy. The most effectiveness is a combined therapy, which has a multidirectional impact. Clinical observations show an effectiveness of manual scar therapy. MATERIAL AND METHODS: The aim of this work was to evaluate effectiveness of the scar manual therapy combined with complementary methods on the postoperative scars. Treatment protocol included two therapies during 30 min per week for 8 weeks. Therapy included manual scar manipulation, massage, cupping, dry needling, and taping. RESULTS: Treatment had a significant positive effect to influence pain, pigmentation, pliability, pruritus, surface area, and scar stiffness. Improvement of skin parameters (scar elasticity, thickness, regularity, color) was also noticed. CONCLUSION: To investigate the most effective manual therapy strategy, further studies are needed, evaluating comparisons of different individual and combined scar therapy modalities.

Gingival Recession Treatment with the Use of Xenogeneic Matrix: Optimization of Patient-Centered Outcomes by the Digital Soft Tissue Design

Abstract Objective: To evaluate the impact of the originally-developed approach aimed at pre-treatment graphical modelling of soft-tissue changes (digital soft tissue design) for the optimization of patient-centered outcomes after Class I and Class II single gingival recessions treatment with the use of a xenogeneic dermal matrix. Material and Methods: Patients enrolled in the study group received single gingival recession treatment via CAF+XDM method supported by pre-treatment graphical modelling of potential soft-tissue changes (digital soft tissue design), while patients enrolled in the control group received single gingival recession treatment via CAF+CTG method with no pre-treatment graphical modeling of gingival level changes. Patient-centered outcomes were measured by visual analogue scale, OHIP-14, and Mahajan's scales. Results: Realization of pre-treatment graphical modelling of soft-tissue changes supported the achievement of better patient-centered outcomes, such as root coverage (p<0.05), surgical phase (p<0.05), post-surgical phase (p<0.05), cost-effectiveness (p<0.05) and diagnostics and patient-orientation (p<0.05) based on patient's personal perception grades. Conclusion: Patient-centered results were found to be more successful within the group using the xenogeneic type of graft accompanied with the implementation of pre-treatment graphical modeling of soft tissue changes, which helped to balance patients' pre-operative expectations and post-operative satisfaction with the received results, reduce post-operative morbidity and improve oral health-related quality of life (AU).

Effects of Diacutaneous Fibrolysis on Mechanosensitivity, Disability, and Nerve Conduction Studies in Mild to Moderate Carpal Tunnel Syndrome: Secondary Analysis of a Randomized Controlled Trial.

OBJECTIVE: People diagnosed with carpal tunnel syndrome (CTS) have fibrosis between the soft, connective, and neural tissues that could worsen the compression of the median nerve. The diacutaneous fibrolysis (DF) technique may release tissue adhesions and increase the mobility of connective tissues. The purpose of this study was to compare the outcomes of DF in people with mild to moderate CTS on mechanosensitivity, disability, and nerve conduction studies. METHODS: This was a secondary analysis of a double-blinded, randomized, placebo-controlled trial. Patients were recruited between April and September 2016 from the Department of Neurophysiology at the Hospital Miguel Servet, Zaragoza, Spain. Thirty-nine people (52 wrists) diagnosed with mild to moderate CTS were included. Participants were randomly assigned to either the DF group (n = 26) or the sham group (n = 26). Both groups received 5 therapy sessions, 2 sessions per week. Mechanosensitivity with the Upper Limb Neurodynamic Test 1, symptom severity and functional status with the Boston Carpal Tunnel Questionnaire, and median nerve sensory conduction velocity with nerve conduction studies were the outcomes measured. Assessments were recorded at baseline and after the intervention. RESULTS: The DF group showed significant improvements in the following: mechanosensitivity, with 28.46 degrees of elbow extension range of motion (95% CI = 19.2-37.7); an increase of 1.0 point (95% CI = 0.7-1.4) for the Boston Carpal Tunnel Questionnaire symptom severity and functional status score; and sensory conduction velocity of median nerve, which improved to 5.8 m/s (95% CI = 2.5-9.2). CONCLUSION: Participants with mild to moderate CTS experienced improvements in symptom severity, functional status, mechanosensitivity, and nerve conduction studies after 5 sessions of DF. IMPACT: This study provides evidence of an approach based on soft and connective tissues around the median nerve in patients with CTS.

Comparison of the Graston Technique® With Instrument-Assisted Soft Tissue Mobilization for Increasing Dorsiflexion Range of Motion.

CONTEXT: Limited dorsiflexion (DF) range of motion (ROM) is commonly observed in both the athletic and general populations and is a predisposing factor for lower extremity injury. Graston Technique® (GT) is a form of instrument-assisted soft tissue mobilization (IASTM), used commonly to increase ROM. Evidence of the long-term effects of GT on ROM is lacking, particularly comparing the full GT protocol versus IASTM alone. OBJECTIVE: To evaluate the effectiveness of 6 sessions of the GT or IASTM compared with a control (CON) group for increasing closed-chain DF ROM. DESIGN: Cohort design with randomization. SETTING: Athletic training clinic. PATIENTS OR OTHER PARTICIPANTS: A total of 23 physically active participants (37 limbs) with <34° of DF. Participants' limbs were randomly allocated to the GT, IASTM, or CON group. INTERVENTION: Participants' closed-chain DF ROM (standing and kneeling) were assessed at baseline and 24-48 hours following their sixth treatment. Participants in the CON group were measured at baseline and 3 weeks later. The intervention groups received 6 treatments during a 3-week period, whereas the CON group received no treatment. The GT group received a warm-up, instrument application, stretching, and strengthening of the triceps surae. The IASTM group received a warm-up and instrument application. MAIN OUTCOME MEASURES: Closed-chain DF was assessed with a digital inclinometer in standing and kneeling. RESULTS: A significant difference between groups was found in the standing position (P = .03) but not in kneeling (P = .15). Post hoc testing showed significant improvements in DF in standing following the GT compared with the control (P = .02). CONCLUSIONS: The GT significantly increases ankle DF following 6 treatments in participants with DF ROM deficits; however, no differences were found between GT and IASTM. The GT may be an effective intervention for clinicians to consider when treating patients with DF deficits.

Vacuum myofascial therapy device for non-specific neck pain. A single blind randomized clinical trial.

OBJECTIVES: This study aimed to investigate the efficacy of a vacuum myofascial therapy device (VT) for improving pressure pain thresholds (PPTs), range of motion (ROM), neck pain-related disability, pain, and quality of life in patients with non-specific neck pain. METHODS: A randomized controlled trial in which thirty-eight participants with non-specific neck pain (NP) were randomly assigned to either an experimental (VT) or a comparison physical therapy program (PTP) group. The VT group (n = 19) received five sessions of treatment with a vacuum myofascial therapy device while the PTP group (n = 19) received five sessions of massage, ultrasound therapy (US), and transcutaneous electric nerve stimulation (TENS) over two weeks. The outcome measures were the numerical pain rating scale (NPRS), range of motion, quality of life (SF-12), neck disability Index (NDI), and PPTs at the end of treatment and at one-month follow-up. RESULTS: Although both groups experienced improvements in pain, neck disability, range of motion, and pressure pain, these only were statistically significant in the VT group. At one-month follow-up, the VT group still showed improvements in pain, neck disability, and range of motion. DISCUSSION: Vacuum myofascial therapy applied with a device offers similar results to other vacuum-based techniques such as cupping therapy. Moreover, in this device the parameters are digitally controlled, which allows for the precise reproduction of treatment.

The Acute Effects of Foam Rolling and Dynamic Stretching on Athletic Performance: A Critically Appraised Topic.

Clinical Scenario: Dynamic stretching and foam rolling are commonly used by athletes to reduce injury and enhance recovery, thereby improving athletic performance. In contrast to dynamic stretching, little research has been conducted on the acute effects of foam rolling as part of the preexercise warm-up routine. Previously, when researchers implemented foam rolling with static stretching as a warm-up, some found that foam rolling slightly improved flexibility and performance outcomes. More recent research has shown that dynamic stretching is favorable to static stretching when used as a warm-up strategy. Therefore, adding foam rolling to dynamic stretching is hypothesized to create more significant improvements in flexibility and performance compared with adding foam rolling to static stretching. Focused Clinical Question: In active individuals, does foam rolling in addition to dynamic stretching lead to enhanced performance compared with dynamic stretching alone? Summary of Key Findings: Four randomized controlled trials were included. Two studies concluded that the addition of foam rolling to dynamic stretching increased vertical jump height more than dynamic stretching alone, while 2 studies found no difference between these treatment groups. Two studies concluded that the addition of foam rolling increased agility performance compared with dynamic stretching alone, while one study found no difference between treatment groups and one study did not measure agility. All 4 studies reviewed concluded that foam rolling did not improve flexibility more than dynamic stretching alone. Clinical Bottom Line: Foam rolling in conjunction with dynamic stretching may further improve an athlete's agility and power output; however, little improvement has been observed with foam rolling in regard to athlete flexibility when compared with completing dynamic stretching programs alone. Strength of Recommendation: Inconsistent findings from 4 randomized controlled trials suggest there is Grade C evidence to support the inclusion of foam rolling in a dynamic warm-up.

Plantar Myofascial Mobilization: Plantar Area, Functional Mobility, and Balance in Elderly Women: A Randomized Clinical Trial.

OBJECTIVE: The purpose of this study was to evaluate the effects of plantar myofascial mobilization (PMM) on the plantar area, balance, and functional mobility of elderly women. METHODS: In this randomized, single-blind, placebo-controlled clinical trial, elderly women with maintained independent orthostatism were recruited from the community and randomly separated into a PMM group (MG = 15), a placebo group (PG = 13), or a control group (control group = 14). Vigorous PMM and soft PMM were performed in the MG and PG, respectively, for 5 days with a rest day between each. The measures of plantar area, single leg stance test with open eye and closed eye, and timed up-and-go test were performed pre-PMM, immediately post-PMM, and on the last day of the protocol. The control group only underwent evaluation before and on the last day of the protocol. The sample size was calculated, and, for quantitative variables, a mixed analysis of variance was used for repeated measurements (split plot), followed by the Bonferroni post hoc test. The results were analyzed in 2 ways: 3 groups at 2 moments (pre, last day), and 2 groups at 3 moments (pre, post, last day). RESULTS: Forty-two elderly women with mean age of 69.03 ± 3.32 years were included in the study. The vigorous MMP showed a statistically significant increase in the plantar area of the right foot (3 groups: P = .49) and single leg stance test with open eye time (2 groups: P = .002; 3 groups: P = .001), and a decrease in the timed up-and-go time (2 groups: P = .04; 3 groups: P = .0001). CONCLUSION: The vigorous PMM showed increases of the plantar area and promoted beneficial effects on functional mobility and body balance.

Effects of a Single Myofascial Induction Session on Neural Mechanosensitivity in Breast Cancer Survivors: A Secondary Analysis of a Crossover Study.

OBJECTIVES: The purpose of this study was to investigate the short-term effects of myofascial induction on mechanosensitivity of upper limb nerves. METHODS: In this secondary analysis of a randomized, single-blind, placebo-controlled crossover study, 21 breast cancer survivors with stage I-IIIA cancer were randomly allocated to an experimental group (30 minutes of myofascial induction session) or placebo control group (unplugged pulsed 30 minutes of shortwave therapy), with a 4-week washout period between sessions that occurred in a physical therapy laboratory in the Health Science Faculty (University of Granada, Spain). Range of motion (universal goniometry), structural differentiation, symptoms (yes/no), and pressure pain thresholds (electronic algometry) were assessed during neurodynamic tests and attitude toward massage scale as covariate. RESULTS: An analysis of covariance revealed significant time × group interactions for range of motion in affected upper limb nerves (median, P < .001; radial, P = .036; ulnar, P = .002), but not for nonaffected upper limb nerves (median, P = .083; radial, P = .072; ulnar, P = .796). A χ2 or Fisher exact test, as appropriate, also revealed a significant difference (P = .044) in sensitivity for the affected upper limb ulnar nerve in the experimental group, whereas the rest of the assessed nerves (affected and nonaffected upper limb nerves) showed no significant changes in either the experimental or control groups (P > .05). An analysis of covariance revealed no significant interactions on pressure pain thresholds over the nerves for affected (all P > .05) and nonaffected (all P > .05) upper limb nerves. CONCLUSION: A single myofascial induction session may partially improve mechanosensitivity of median, radial, and ulnar nerves and yield positive effects on symptom mechanosensitivity, especially regarding the ulnar nerve in breast cancer survivors.

The Effect of Foam Rolling Versus IASTM on Knee Range of Motion, Fascial Displacement, and Patient Satisfaction.

CONTEXT: Soft tissue restrictions have been linked to poor flexibility and decreased range of motion (ROM). To decrease the soft tissue restrictions and ultimately increase ROM/flexibility, myofascial release techniques, such as foam rolling (FR) and instrument-assisted soft tissue mobilization (IASTM), have been used. However, the benefit regarding which technique is more beneficial remains unknown. OBJECTIVE: To examine the effects of myofascial release techniques (FR vs the instrumented portion of IASTM) on knee joint ROM, rectus femoris (RF) and biceps femoris (BF) fascial displacement, and patient satisfaction. DESIGN: Randomized controlled clinical trial. SETTING: Mid-Atlantic University. PARTICIPANTS: Twenty moderately active participants (age 21.1 [2.0] y) with variable levels of soft tissue restriction in the quadriceps and hamstrings started and completed the study. Participants were randomly assigned to 2 groups, FR or IASTM. INTERVENTIONS: All participants completed the same warm-up prior to the intervention. The FR group followed the proper FR protocol for gluteals/iliotibial band, quadriceps, and hamstrings/adductors, and the participants were monitored while the protocol was completed. The IASTM group received treatment on the gluteals/iliotibial band followed by the quadriceps, adductors, and hamstrings. Participants in both groups attended intervention sessions twice per week for 3 weeks. Prior to the start, knee ROM measurements were taken, along with fascial displacement measured via ultrasound. Upon completion of the study, posttest measurements were completed. A patient satisfaction survey was also administered at this time. MAIN OUTCOME MEASURES: Pretest to posttest knee ROM measurements, RF and BF fascial displacement, and patient satisfaction. RESULTS: Both groups improved pretest to posttest for knee-extension ROM, with a slight trend toward increased knee-extension ROM for the FR group. Both groups improved pretest to posttest for BF and RF fascial displacement, in favor of the IASTM group for BF fascial displacement. Both groups were equally satisfied. CONCLUSIONS: As both groups improved pretest to posttest, either treatment could be used.

Using RNA-Seq to Explore the Repair Mechanism of the Three Methods and Three-Acupoint Technique on DRGs in Sciatic Nerve Injured Rats.

Objective: To study the effects of the three methods and three-acupoint technique on DRG gene expression in SNI model rats and to elucidate the molecular mechanism of the three methods and three-acupoint technique on promoting recovery in peripheral nerve injury. Methods: 27 male SD rats were randomly divided into three groups: a Sham group, the SNI group, and the Tuina group. The Tuina group was treated with a tuina manipulation simulator to simulate massage on points, controlling for both quality and quantity. Point-pressing, plucking, and kneading methods were administered quantitatively at Yinmen (BL37), Chengshan (BL57), and Yanglingquan (GB34) points on the affected side once a day, beginning 7 days after modeling. Intervention was applied once a day for 10 days, then 1 day of rest, followed by 10 more days of intervention, totally equaling 20 times of intervention. The effect of the three methods and three-point technique on the recovery of injured rats was evaluated using behavior analysis. RNA sequencing (RNA-Seq) analysis of differentially expressed genes in DRGs of the three groups of rats was also performed. GO and KEGG enrichment was analyzed and verified using real-time PCR. Results: RNA-Seq combined with database information showed that the number of differentially expressed genes in DRG was the largest in the Tuina group compared with the SNI group, totaling 226. GO function is enriched in the positive regulation of cell processes, ion binding, protein binding, neuron, response to pressure, response to metal ions, neuron projection, and other biological processes. GO function is also enriched in the Wnt, IL-17, and MAPK signaling pathways in the KEGG database. PCR results were consistent with those of RNA sequencing, suggesting that the results of transcriptome sequencing were reliable. Conclusion: The three methods and three-acupoint technique can promote the recovery of SNI model rats by altering the gene sequence in DRGs.

Effects of Exercise and an Integrated Neuromuscular Inhibition Technique Program in the Management of Chronic Mechanical Neck Pain: A Randomized Controlled Trial.

OBJECTIVE: The aim of this study was to evaluate the effect of adding the integrated neuromuscular inhibition technique (INIT) to therapeutic exercise (TE) in individuals with chronic mechanical neck pain (CMNP). METHODS: In this 34-week, assessor-blind randomized controlled trial, 40 participants (men and women) with CMNP with active or latent myofascial trigger points on the neck muscles were divided into 2 groups. The participants followed 4 treatments per week for 10 weeks. The intervention group followed a TE program in combination with the INIT, whereas the control group followed the same program without the INIT. Both protocols were applied by physiotherapists. Pain, disability, pressure pain threshold, active range of motion, and health-related quality of life were evaluated before, during, and after the intervention, whereas patients were followed for 6 months after completion of treatment. Repeated-measures ANOVA was applied. RESULTS: Both groups showed a significant improvement in all dependent measures after the intervention (P < .05). However, the intervention group showed greater improvement in the visual analog scale and neck disability index score, in the neck muscles pressure pain threshold, in the range of motion, and in the 36-Item Short Form Health Survey score, than the control group. In many of the above variables this improvement was seen from the second week and was maintained for 6 months after the intervention. CONCLUSION: The results of this preliminary study suggest that the addition of the INIT to a TE program had a positive effect on pain, functionality, and the quality of life in individuals with CMNP.

Effectiveness of spinal manipulation and myofascial release compared with spinal manipulation alone on health-related outcomes in individuals with non-specific low back pain: randomized controlled trial.

OBJECTIVE: To investigate the effectiveness of spinal manipulation combined with myofascial release compared with spinal manipulation alone, in individuals with chronic non-specific low back pain (CNLBP). DESIGN: Randomized controlled trial with three months follow-up. SETTING: Rehabilitation clinic. PARTICIPANTS: Seventy-two individuals (between 18 and 50 years of age; CNLBP ≥12 consecutive weeks) were enrolled and randomly allocated to one of two groups: (1) Spinal manipulation and myofascial release - SMMRG; n=36) or (2) Spinal manipulation alone (SMG; n=36). INTERVENTIONS: Combined spinal manipulation (characterized by high velocity/low amplitude thrusts) of the sacroiliac and lumbar spine and myofascial release of lumbar and sacroiliac muscles vs manipulation of the sacroiliac and lumbar spine alone, twice a week, for three weeks. MAIN OUTCOME MEASURES: Assessments were performed at baseline, three weeks post intervention and three months follow-up. Primary outcomes were pain intensity and disability. Secondary outcomes were quality of life, pressure pain-threshold and dynamic balance. RESULTS: No significant differences were found between SMMRG vs SMG in pain intensity and disability post intervention and at follow-up. We found an overall significant difference between-groups for CNLBP disability (SMG-SMMRG: mean difference of 5.0; 95% confidence interval of difference 9.9; -0.1), though this effect was not clinically important and was not sustained at follow-up. CONCLUSIONS: We demonstrated that spinal manipulation combined with myofascial release was not more effective compared to spinal manipulation alone for patients with CNLBP. CLINICAL TRIAL REGISTRATION NUMBER: NCT03113292.

Evaluation of soft-tissue response around laser microgrooved titanium percutaneous devices.

Percutaneous devices are prone to epidermal downgrowth and sinus tract formation, which can serve as a nidus for bacterial colonization and increase the risk of peri-prosthetic infection. A laser microgrooved topography has been shown to limit gingival epidermal downgrowth around dental implants. However, the efficacy of this laser microgrooved topography to limit epidermal downgrowth around nongingival percutaneous devices is yet to be investigated. In this study, devices with a porous-coated subdermal component and a percutaneous post were designed and manufactured. The proximal 2 mm section of the percutaneous post were left smooth, or were textured with either a porous coating, or with the laser microgrooved topography. The smooth and porous topographies served as controls. The devices were tested in a hairless guinea pig back model, where 18 animals were randomly assigned into three groups, with each group receiving one implant type (n = 6/group). Four weeks postimplantation, the devices with surrounding soft-tissues were harvested and processed for histological analyses. Results indicated that the laser microgrooved topography failed to prevent epidermal downgrowth (23 ± 4%) around percutaneous posts in this model. Furthermore, no significant differences (p = 0.70) in epidermal downgrowth were present between the three topographies, with all the groups exhibiting similar measures of downgrowth. Overall, these findings suggest that the laser microgrooved topography may not halt downgrowth around percutaneous devices for dermal applications.

Mimicked scaffolds based on coated silk woven fabric with gelatin and chitosan for soft tissue defect in oral maxillofacial area.

Soft tissue defects in the oral maxillofacial area are critical problems for many patients and, in some cases, patients require an operation coupled with a performance scaffold substitution. In this research, mimicked anatomical scaffolds were constructed using gelatin- and chitosan-coated woven silk fibroin fabric. The morphologies, crystals, and structures were observed and then characterized using scanning electron microscopy, X-ray diffraction, and differential scanning calorimetry, respectively. Physical performance was evaluated from the swelling behavior, mechanical properties, and biodegradation, while the biological performance was tested with fibroblasts and keratinocytes, after which cell proliferation, viability, and histology were evaluated. The results revealed that a coated woven silk fibroin fabric displayed a crystal structure of silk fibroin with amorphous gelatin and chitosan layers. Also, the coated fabrics contained residual water within their structure. The physical performance of the coated woven silk fibroin fabric with gelatin showed suitable swelling behavior and mechanical properties along with acceptable biodegradation for insertion at a defect site. The biological performances including cell proliferation, viability, and histology were suitable for soft tissue reconstruction at the defect sites. Finally, the results demonstrated that mimicked anatomical scaffolds based on a gelatin layer on woven silk fibroin fabric had the functionality that was promising for soft tissue construction in oral maxillofacial defect.

The current role of Astym therapy in the treatment of musculoskeletal disorders.

Background: In general, chronic problems of soft tissues (muscles, tendons, ligaments) are due to scarring or degeneration. Astym therapy (Performance Dynamics, Inc. Muncie, Indiana) has been reported to address tendinopathy by stimulating regeneration in soft tissues (muscles, tendons, ligaments) and the resorption of unwanted scar tissue that causes pain and limits mobility.Purpose: To analyze the effectiveness of Astym therapy in the treatment of musculoskeletal problemsMethods: A narrative review of the literature on the topic was carried out. A Cochrane Library and PubMed (MEDLINE) search related to the role of Astym therapy was analyzed. The only language searched was English. Scientific meeting abstracts and other sources of evidence were not considered. The main criteria for selection were articles that were focused on the role of Astym therapy.Results: Astym therapy seems to be useful for the treatment of chronic ankle sprains, Achilles tendon tendinopathy, hamstring tendinopathy, elbow tendinopathy, and the stiff total knee arthroplasty. Astym therapy also appears to be useful to gain range of motion, muscle strength, and function in patients with cerebral palsy, and after mastectomy.Conclusions: Astym therapy seems to activate a regenerative response in degenerative tendinopathy and eliminate or reduce the scar tissue/fibrosis that causes pain and limitation of mobility. Based on the positive findings of the emerging published research further study is warranted to confirm the benefits of Astym therapy on a variety of musculoskeletal disorders.

Myofascial pain and treatment: Editorial a critical overview of the current myofascial pain literature - August 2019.

This quarter's overview of the myofascial pain literature includes quite a few basic research papers in addition to the usual high quantity of dry needling (DN) papers. Of particular interest are a study by Fischer and colleagues studying the role of mitochondrial functions in chronic trigger points (TrPs) (Fischer et al 2018), a study by Li and associates who conducted a quantitative proteomics analysis to identify biomarkers of chronic myofascial pain and therapeutic targets of dry needling in a rat model of TrPs (Li et al 2019), and a sonography study by Mitchell et al. looking into the distances from the skin to the pleura in the context of DN (Mitchell et al 2019). A total of 33 papers are included in this overview article. We welcome Dr. Jacob Thorp to our team of authors. Dr. Thorp is a US-based physical therapist. He is Professor and Founding Director of the Physical Therapy Program at Charleston Southern University in North Charleston, SC.

Soft tissue mobilization techniques in treating chronic abdominal scar tissue: A quasi-experimental single subject design.

INTRODUCTION: Roughly 17 million abdominal surgeries are performed annually in the U.S. Up to 17% of those may be readmitted for adhesion related problems. This study evaluated the effectiveness of soft tissue mobilization (STM) techniques at improving chronic pain, mobility restrictions and functional deficits following complex abdominal surgery. METHODS: Subjects Two females aged 51 and 65. DESIGN: Single subject quasi-experimental A-B-A. INTERVENTION: Four 30-min treatment sessions of abdominal tissue mobilizations. Outcome measures Pain pressure threshold (PPT) and average scar mobility (ASM), Numeric Pain Rating Scale (NPRS), and the Oswestry Disability Index (ODI). RESULTS: Subject 1 ASM and PPT of the abdomen improved significantly and exceeded the established standard error of measurement (SEM). PPT of the scar decreased during the second baseline. This decrease exceeded the SEM for PPT but was not statistically significant. The changes in NPRS did not reach the minimal clinically important difference (MCID). Subject 2 abdominal PPT and ASM showed statistically significant improvements that exceeded their SEMs. Scar PPT showed improvement during the repeat baseline, however, this reached neither statistical significance nor the SEM. CONCLUSIONS: Scar mobility and abdominal PPT improved both statistically and clinically in both subjects after only 4 sessions of STM. Scar pain measured by NPRS and PPT did not show significant improvement. This study demonstrated that STM can be an effective way to treat chronic abdominal scars by increasing scar mobility and reducing abdominal sensitivity to pressure. It is non-invasive, and is a less costly alternative to laparoscopic adhesiolysis.

Usefulness of Soft Tissue Therapy in Patients with Shoulder Pain Syndrome.

BACKGROUND: Shoulder pain is among the most common musculoskeletal pain syndromes. This study aimed to compare the effectiveness of the worldwide renowned Kaltenborn and Evjenth manual therapy and the innovative concept of Fascial Distortion Model (FDM) in the treatment of patients suffering from shoulder pain. MATERIAL AND METHOD: The study group consisted of 100 patients treated for shoulder pain (SP), who were randomly assigned to two groups: Group A, whose therapy involved FDM (51), and Group B, treated with Kaltenborn and Evjenth method (49). Exclusion criteria comprised age < 30 years, low threshold of sensitivity to pain, participation in another rehabilitation programme, uncontrolled arterial hypertension, neurological conditions associated with sensory impairment, connective tissue conditions and presence of 'red flags'. The tools used in the study included a digital inclinometer to measure the range of joint mobility and a NeuroTrack device to assess neuromuscular conductivity. Statistical analysis used the non-parametric Mann-Whitney U test and non-parametric Wilcoxon signed rank test. The significance threshold was accepted as p ≤ 0.05. RESULTS: Both groups showed significant improvement (p<0.05) in the range of motion in the upper limb in all direc-tions (flexion, abduction and external rotation) and change in the function of the infraspinous muscle. The only significant difference between the groups was found for external rotation (p<0.05), with Group A displaying a superior range of motion. CONCLUSIONS: 1. A single session of the Kaltenborn and Evjenth method and FDM in patients suffering from shoulder pain may increase their range of motion in the shoulder as well as improve the function of the infraspinous muscle. 2. Cur-rently there is insufficient evidence to warrant stronger recommendation of one of the study therapies over the other. 3. There is a need for further prospective randomised studies involving larger groups of patients and assessing long-term effec-tiveness of the therapies.

Multicenter study of vacuum-assisted precise tissue release for the treatment of cellulite in a cohort of 112 Italian women assessed with cellulite dimples scale at rest.

Objectives and background: Tissue stabilized-guided subcision (TS-GS) treatment has emerged as a single session treatment for cellulite dimples. To date, studies on a few patients were reported. We present data concerning efficacy and safety of TS-GS for cellulite in a cohort of Italian patients.Patients and Methods: This is a retrospective study involving 122 patients requiring cellulite treatment, classified according to validate cellulite dimples scale at rest, at T0. TS-GS technique is assessed in terms of efficacy (masked evaluations of pre- and post-treatment pictures, satisfaction of patients and variations in cellulite dimples scale at rest), safety of results at 12 months follow-up (T1). U nivariate and multivariate analyses were carried out to evaluate variables associated with the size effect.Results: Masked evaluations of 112 patients completing the study resulted in the correct selection of pre- and post-treatment images in all cases and all patients were satisfied. The mean cellulite dimples scale at rest score improved ≥1 point at T1. We found a significant association between size effect, higher satisfaction (p < .01), cellulite grading at T0 (p < .01), higher BMI (p = .037); a higher BMI was correlated to an increased cellulite grading at T0 (p = .02). Only minor and temporary adverse events were reported.Conclusions: We confirm herein the clinical efficacy and safety of TS-GS for cellulite dimples treatment in a cohort of Italian patients assessed with the validated cellulite dimples scale at rest.