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.

Comparison of the effectiveness of instrument-assisted soft tissue mobilization and extracorporeal shock wave therapy in myofascial pain syndrome.

Background/aim: To compare the effectiveness of instrument-assisted soft tissue mobilization (IASTM) and extracorporeal shock wave therapy (ESWT) used in myofascial pain syndrome (MPS) and to determine whether they are superior to conservative treatment (CT). Materials and methods: A total of 42 female patients (aged 18-60 years) diagnosed with MPS were enrolled and randomly assigned to either the CT (n = 14), CT+IASTM (n = 14), or CT+ESWT group (n = 14). All of the groups received treatment for 3 weeks (CT: 5 sessions per week, 15 sessions in total, ESWT and IASTM: 2 sessions per week, 6 sessions in total). Neck stretching exercises were given to all of the patients as a home program. The pain intensity of the patients was determined using the visual analog scale (VAS). The pressure pain threshold (PPT) was measured with an algometer. Cervical joint range of motion (ROM) was measured with a cervical ROM (CROM) device. Pain, cervical disability, quality of life, and sleep disturbances were evaluated with the Neck Outcome Score (NOOS). Depression and anxiety parameters were evaluated with the Hospital Anxiety and Depression Scale (HADS). Evaluations were made before treatment and 3 days after the last treatment session. Results: The CT+IASTM group was more successful than the other groups in terms of pain intensity, PPT, and improvements in the ROM parameters (p < 0.05). No significant difference was found between the NOOS and HADS scores of the groups when the posttreatment changes were compared to pretreatment (p > 0.05). Conclusions: All 3 of these treatments can be used to alleviate the negative effects of MPS. IASTM treatment can be preferred primarily in the creation of combined treatment programs for patients with ROM limitations and low PPTs.

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 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.

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 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.

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.

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.

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.

Manipulative Therapies: What Works.

Manipulative therapies include osteopathic manipulative treatment and many other forms of manual therapies used to manage a variety of conditions in adults and children. Spinal manipulative therapy may provide short-term improvement in patients with acute or chronic low back pain, comparable with other standard treatments. When compared with oral analgesics, cervical manipulation and/or mobilization appears to provide better short-term pain relief and improved function in patients with neck pain. Manipulative therapies may be as effective as amitriptyline for treating migraine headaches and can reduce the frequency and intensity of pain. Although manipulative therapy is sometimes recommended to treat conditions in children (e.g., musculoskeletal problems, otitis media, respiratory conditions, infantile colic, allergies), there is supporting evidence only for reducing the length of hospital stay for preterm infants. Mild adverse events, such as muscle stiffness and soreness, occur in up to 50% of adults who undergo manipulative therapy. Although serious adverse events such as lumbar disk herniation, cauda equina syndrome, and vertebrobasilar injury are rare, they can cause significant disability or death. Given the limited proven benefits of manipulative therapies and small risk of serious adverse events, additional high-quality, adequately powered studies are needed before definitive recommendations can be made for treating many conditions.

Combined Effects of Self-Myofascial Release and Dynamic Stretching on Range of Motion, Jump, Sprint, and Agility Performance.

Richman, ED, Tyo, BM, and Nicks, CR. Combined effects of self-myofascial release and dynamic stretching on range of motion, jump, sprint, and agility performance. J Strength Cond Res 33(7): 1795-1803, 2019-Massage has been used as both a pre- and post-exercise modality with purported benefits to flexibility and athletic performance. This study was designed to determine the effect of a 6-minute protocol of self massage known as self-myofascial release (SMR) using a foam rolling device in conjunction with a general warm-up and sport-specific dynamic stretching (DS) session on flexibility and explosive athletic performance in a sample of 14 female collegiate athletes. After familiarization, participants completed 2 testing sessions that began with 5 minutes of jogging at a self-selected pace, followed by either a 6-minute foam rolling session (SMR) or 6 minutes of light walking (LW) and a subsequent 6-minute period of sport-specific DS. Sit-and-reach (SR) was measured after a general warm-up, the SMR, or LW session, and following DS, after which participants performed 3 trials each of squat jump (SJ), countermovement jump (CMJ), and drop jump (DJ). Two additional tests, the agility T-Test (TT) and a 10-yd short sprint (SP), were then performed. The change in SR after SMR was significantly greater than the change seen in SR after LW, although the total changes seen in each condition were not statistically different after the addition of DS. Squat jump and CMJ improved by 1.72 ± 2.47 cm and 2.63 ± 3.74 cm (p = 0.070, p = 0.070), with no significant change to DJ, SP, and TT. Self-myofascial release in the form of foam rolling after a general warm-up and preceding a DS session seems to improve SJ and CMJ with no detriment to flexibility, DJ, sprint, and agility performance in comparison with LW and DS.

Effects of Foam Rolling as a Recovery Tool in Professional Soccer Players.

Rey, E, Padrón-Cabo, A, Costa, PB, and Barcala-Furelos, R. Effects of foam rolling as a recovery tool in professional soccer players. J Strength Cond Res 33(8): 2194-2201, 2019-Foam rolling (FR) is a common strategy used after training and competition by players. However, no previous studies have assessed the effectiveness of FR as a recovery tool in sports populations. The aim of this study was to examine the effectiveness of FR (20 minutes of FR exercises on quadriceps, hamstrings, adductors, gluteals, and gastrocnemius) and passive recovery (20 minutes sit on a bench) interventions performed immediately after a training session on Total Quality Recovery (TQR), perceived muscle soreness, jump performance, agility, sprint, and flexibility 24 hours after the training. During 2 experimental sessions, 18 professional soccer players (age 26.6 ± 3.3 years; height: 180.2 ± 4.5 cm; body mass: 75.8 ± 4.7 kg) participated in a randomized fully controlled trial design. The first session was designed to collect the pretest values of each variable. After baseline measurements, the players performed a standardized soccer training. At the end of training unit, all the players were randomly assigned to the FR recovery group and the passive recovery group. A second experimental session was conducted to obtain the posttest values. Results from the between-group analyses showed that FR had a large effect on the recovery in agility (effect sizes [ES] = 1.06), TQR (ES = 1.08), and perceived muscle soreness (ES = 1.02) in comparison with the passive recovery group at 24 hours after training. Thus, it is recommended that soccer coaches and physical trainers working with high-level players use a structured recovery session lasting from 15 to 20 minutes based on FR exercises that could be implemented at the end of a training session to enhance recovery between training loads.

Non-pharmacological treatment of chronic neck-shoulder myofascial pain in patients with forward head posture.

OBJECTIVE: Introduction: Today, chronic pain remains a pressing medical and socio-economic problem, despite the rapid development of medical technologies, the presence of a vast arsenal of drug and non-drug treatments. Estimates for chronic pain prevalence ranged from 8% to 60%. At the same time, about 40% of patients report insufficient effectiveness in the treatment of chronic pain syndrome. The aim of the study was to compare the effectiveness of MTrPS management by biomechanical correction of the musculoskeletal system combined with therapeutic exercises, DN and TrPs-pressure release with the effectiveness of MTrPS management by therapeutic exercises combined with DN and TrPs-pressure release in patients with chronic neck-shoulder myofascial pain and FHP. PATIENTS AND METHODS: Materials and methods: 87 patients (mean age - 39±4,9 years) with chronic neck-shoulder myofascial pain and FHP were randomly assigned to 2 treatment groups. Group 1 received a biomechanical correction, DN, TrPs-pressure release. Group 2 - therapeutic exercises, DN, TrPs-pressure release. Study protocol included CVA-measurement, assessment of pain intensity with VAS, assessment of QoL using MOS SF-36. RESULTS: Results: increase of CVA (59,07°±1,41 in the 1st group, and 51,2°±2,01 in the 2nd group (p=0,036)), decrease of pain and decrease of influence of neck pain in performance of everyday activities, the improvement of QoL immediately after treatment occurred in both groups. However, after 3 months of therapy, 1-st group revealed more improvement than the 2-nd. CONCLUSION: Conclusion: Comparison of the effectiveness of MTrPS management by biomechanical correction of the musculoskeletal system combined with therapeutic exercises, DN and TrPs-pressure release with the effectiveness of MTrPS management by therapeutic exercises combined with DN and TrPs-pressure release in patients with chronic neck-shoulder myofascial pain and FHP demonstrated no significant differences between the therapeutic approaches in the short term. In the medium term, the inclusion of biomechanical correction in the treatment protocol demonstrated higher efficiency compared with the combination of therapeutic exercises, DN and TrPs-pressure release.

Acupuncture Therapy in a Group Setting for Chronic Pain.

Objective: This project was designed to test the feasibility and effectiveness of acupuncture therapy given in a group setting for chronic pain. Design: Nonrandomized, repeated measures quasi-experimental trial. Setting: Care was delivered in a primary care clinic waiting area after clinic hours. Subjects: Included were primary care patients (≥18 years old) with chronic pain of the neck, back, shoulder, or osteoarthritis of any site of at least three months' duration. Methods: Subjects received eight weekly acupuncture therapy sessions in a group setting. Acupuncture therapy included a combination of palpation, acupuncture needling, Tui na, Gua sha, and auricular treatment. Baseline pain levels were established in a two- to four-week run-in; assessment of the intervention impact on pain intensity, mood, and functional status were made at the end of the treatment period (eight weeks) and 16 weeks after completion of intervention (24 weeks). Results: Of the total 113 participants recruited for the trial, 96 completed the 24-week protocol. We found a statistically and clinically significant decrease in pain severity, pain interference, and depression in our study population. There were no serious adverse events. Conclusions: Acupuncture therapy offered in the group setting was effective in reducing pain severity, pain interference, and depression in patients with chronic neck, back, or shoulder pain or osteoarthritis. Benefit persisted through the 24-week measure despite no additional treatment. This finding has potentially important implications for improving access to effective acupuncture treatment for patients with limited financial resources.

Effect of myofascial techniques for treatment of persistent arm pain after breast cancer treatment: randomized controlled trial.

OBJECTIVE: To investigate the effect of myofascial therapy in addition to a standard physical therapy program for treatment of persistent arm pain after finishing breast cancer treatment. DESIGN: Double-blinded (patient and assessor) randomized controlled trial. SETTING: University Hospitals Leuven, Belgium. PATIENTS: A total of 50 patients with persistent arm pain and myofascial dysfunctions after breast cancer treatment. INTERVENTION: Over three months, all patients received a standard physical therapy program. The intervention group received in addition 12 sessions of myofascial therapy, and the control group received 12 sessions of placebo therapy. MAIN MEASUREMENTS: Main outcome parameters were pain intensity (primary outcome) (maximum visual analogue scale (VAS) (0-100)), prevalence rate of arm pain, pressure hypersensitivity (pressure pain thresholds (kg/cm2) and pain quality (McGill Pain Questionnaire). Measures were taken before and after the intervention and at long term (6 and 12 months follow-up). RESULTS: Patients in the intervention group had a significantly greater decrease in pain intensity compared to the control group (VAS -44/100 vs. -24/100, P = 0.046) with a mean difference in change after three months between groups of 20/100 (95% confidence interval, 0.4 to 39.7). After the intervention, 44% versus 64% of patients still experienced pain in the intervention and control group, respectively ( P = 0.246). No significant differences were found for the other outcomes. CONCLUSION: Myofascial therapy is an effective physical therapy modality to decrease pain intensity at the arm in breast cancer survivors at three months, but no other benefits at that time were found. There were no long-term effects at 12 months either.

Congenital Bilateral Eyelid Eversion and Chemosis: A Case Study.

This case reports the findings and management of a late preterm female infant born with congenital bilateral eyelid eversion with chemosis. The pathogenic process remains unknown but typically presents at birth, predominantly affecting the upper eyelid of both eyes. Black males, patients with trisomy 21, and collodion infants have a higher incidence of eyelid eversion. Treatment modalities range from conservative therapy including eye patching with antibiotic and lubricating ointment to invasive surgical eyelid suturing. In this case report, successful resolution of chemosis and eyelid inversion occurred with conservative management.

Effect of Platelet-rich Fibrin and Free Gingival Graft in the Treatment of Soft Tissue Defect preceding Implant Placement.

INTRODUCTION: Free gingival graft is a procedure that is used to increase keratinized tissue around teeth and edentulous sites for future dental implants. Keratinized tissue is critical for maintainability of surgical site and flap management. Platelet-rich fibrin consists of bioactive and biological components, mainly composed of growth factors. Growth factors attract stem cells to the site of release and stimulate cell proliferation. Moreover, growth factors promote angiogenesis, which accelerates wound healing. Site preparation is critical in implant dentistry, including soft tissue and hard tissue augmentation. AIM: To improve free gingival graft (FGG) healing by using platelet-rich fibrin (PRF) at the soft tissue defect area of extracted upper right first molar in order to restore keratinized tissue and prepare the site for bone grafting followed by dental implant placement. CASE REPORT: A healthy female patient, 59 years old, presented to the dental clinic at the University at Buffalo, School of Dental Medicine, seeking dental implants to restore missing teeth. The patient had an extraction for upper right first molar 4 months ago. The surgical extraction left severe soft and hard tissue defects at the site. Free gingival graft was placed at the site to increase keratinized tissue band followed by PRF to improve healing. Cyanoacrylate adhesive was used to stabilize PRF Two months later, a full-thickness flap was reflected, and tenting screws placed with bone grafting at the site. Titanium-reenforced membrane was placed over the bone graft. Three months later, tenting screws were removed and two dental implants were placed at the site. CONCLUSION: The use of PRF accelerates the healing of FGG. More tissue handling could be achieved by increasing the kera-tinized tissue during surgical procedures. CLINICAL SIGNIFICANCE: The combination of PRF and FGG could help in the healing process during soft tissue procedures.

Effectiveness of a Treatment Involving Soft Tissue Techniques and/or Neural Mobilization Techniques in the Management of Tension-Type Headache: A Randomized Controlled Trial.

OBJECTIVE: To evaluate the effects of a protocol involving soft tissue techniques and/or neural mobilization techniques in the management of patients with frequent episodic tension-type headache (FETTH) and those with chronic tension-type headache (CTTH). DESIGN: Randomized, double-blind, placebo-controlled before and after trial. SETTING: Rehabilitation area of the local hospital and a private physiotherapy center. PARTICIPANTS: Patients (N=97; 78 women, 19 men) diagnosed with FETTH or CTTH were randomly assigned to groups A, B, C, or D. INTERVENTIONS: (A) Placebo superficial massage; (B) soft tissue techniques; (C) neural mobilization techniques; (D) a combination of soft tissue and neural mobilization techniques. MAIN OUTCOMES MEASURES: The pressure pain threshold (PPT) in the temporal muscles (points 1 and 2) and supraorbital region (point 3), the frequency and maximal intensity of pain crisis, and the score in the Headache Impact Test-6 (HIT-6) were evaluated. All variables were assessed before the intervention, at the end of the intervention, and 15 and 30 days after the intervention. RESULTS: Groups B, C, and D had an increase in PPT and a reduction in frequency, maximal intensity, and HIT-6 values in all time points after the intervention as compared with baseline and group A (P<.001 for all cases). Group D had the highest PPT values and the lowest frequency and HIT-6 values after the intervention. CONCLUSIONS: The application of soft tissue and neural mobilization techniques to patients with FETTH or CTTH induces significant changes in PPT, the characteristics of pain crisis, and its effect on activities of daily living as compared with the application of these techniques as isolated interventions.

Myofascial Induction Effects on Neck-Shoulder Pain in Breast Cancer Survivors: Randomized, Single-Blind, Placebo-Controlled Crossover Design.

OBJECTIVES: To (1) investigate the immediate effects of myofascial induction (MI), with placebo electrotherapy as a control, on perceived pain, cervical/shoulder range of motion (ROM), and mood state in breast cancer survivors (BCSs) with shoulder/arm morbidity; and (2) examine the relationships between pain modifications and cervical/shoulder ROM on the side affected by breast cancer. DESIGN: Randomized, single-blind, placebo-controlled crossover study. SETTING: Physical therapy laboratory. PARTICIPANTS: BCSs (N=21) who had a diagnosis of stage I-IIIA breast cancer and had completed adjuvant therapy (except hormonal treatment). INTERVENTION: During each session, the BCSs received either an MI (fascial unwinding) intervention focused on the upper limb area following the Pilat approach or placebo pulsed shortwave therapy (control group). Each session lasted 30 minutes, and an adequate washout period of 4 weeks between sessions was established. MAIN OUTCOME MEASURES: The visual analog scale (VAS) for pain and anxiety, shoulder-cervical goniometry for ROM, the Profile of Mood States for psychological distress, and the Attitudes Towards Massage Scale were used. RESULTS: An analysis of covariance (ANCOVA) revealed significant time × group interactions for VAS affected arm (P=.031) but not for VAS cervical (P=.332), VAS nonaffected arm (P=.698), or VAS anxiety (P=.266). The ANCOVA also revealed significant interactions for affected shoulder flexion (P<.001), abduction (P<.001), external rotation (P=.004), and internal rotation (P=.001). Significant interactions for affected cervical rotation (P=.022) and affected cervical lateral flexion (P=.038) were also found. A significant negative correlation was found between changes in VAS affected arm and shoulder/arm internal rotation ROM (r=-.46; P=.03). CONCLUSIONS: A single MI session decreases pain intensity and improves neck-shoulder ROM to a greater degree than placebo electrotherapy for BCSs experiencing pain.

Myofascial techniques have no additional beneficial effects to a standard physical therapy programme for upper limb pain after breast cancer surgery: a randomized controlled trial.

OBJECTIVE: To investigate the effects of myofascial techniques, in addition to a standard physical therapy programme for upper limb pain shortly after breast cancer surgery. DESIGN: Double-blinded (patient and assessor) randomized controlled trial with two groups. SETTING: University Hospitals Leuven, Belgium Patients: A total of 147 patients with unilateral axillary clearance for breast cancer. INTERVENTION: All participants received a standard physical therapy programme starting immediately after surgery for four months. The intervention group received additionally eight sessions of myofascial therapy from two up to four months after surgery. The control group received eight sessions of a placebo intervention, including static hand placements at the upper body region. MAIN MEASUREMENTS: The primary outcome was prevalence rate of upper limb pain. Additionally, pain intensity (Visual Analogue Scale (VAS, 0-100)), pressure hypersensitivity (pressure pain thresholds (PPTs; kg/cm2)) and pain quality (McGill Pain Questionnaire) were evaluated. All measurements were performed at 2 (=baseline), 4, 9 and 12 months post-surgery. RESULTS: At 4, 9 and 12 months post-surgery, prevalence rates of pain, pain intensity and pain quality were comparable between the intervention and control group. PPT of the upper trapezius muscle was significantly higher in the intervention group at four months with a difference of -1.2 (-1.9 to -0.4) kg/cm2, P = 0.012). PPT of the supraspinatus muscle was significantly higher in the intervention group at four months (-0.7 (-1.4 to -0.1) kg/cm2, P = 0.021) and at nine months (-0.5 (-1.1 to 0.0), P = 0.040). CONCLUSION: Myofascial therapy has no added beneficial effect as standard physical therapy modality in the postoperative stage.