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Resumen Objetivo: El objetivo de esta revisión sistemática con metaanálisis es sintetizar la evidencia científica disponible sobre los efectos de la terapia manual aplicada de forma aislada en comparación a otras intervenciones en el dolor, la capacidad funcional, la impresión global de mejoría y severidad de síntomas autopercibida en personas con fibromialgia. Metodología: Se realizó una revisión sistemática y metaanálisis con búsqueda electrónica en MEDLINE, WoS, SCOPUS, PEDro, CENTRAL y LILACS. Resultados: Once estudios cumplieron con los criterios de selección y seis fueron incluidos en una síntesis cuantitativa. El dolor al terminar el tratamiento tuvo una diferencia de medias de -0.42 (IC al 95% -1.14, 0.30, p = 0.25), el estado funcional al terminar el tratamiento tuvo una diferencia de medias de -0.15 (IC al 95% -0.69, 0.40, p = 0.60), la impresión global de salud al terminar el tratamiento tuvo una diferencia de media de -1.13 (IC al 95% -1.68, -0.57 p = <0.00) y posterior a doce meses una diferencia de media de -0.48 (IC al 95% -0.78, -0.19 p = <0.00), la impresión global de severidad después de la intervención tuvo una diferencia de medias de -0.62 (IC al 95% -1.22, -0.03, p = 0.04) y posterior a doce meses una diferencia de medias de -0.43 (IC al 95% -1.18, 0.32, p = 0.26). Conclusiones: La terapia manual aislada es una intervención que podría mejorar significativamente la autopercepción del estado global de mejoría y severidad de síntomas a corto plazo en comparación a agentes físicos placebo. Sin embargo, no es mejor que otras intervenciones para disminuir el dolor y mejorar la capacidad funcional.
Abstract Objective: The aim of this systematic review with meta-analysis is to synthesize the available scientific evidence on the effects of manual therapy applied in isolation in comparison to other interventions on pain, functional capacity, global impression of improvement, and self-perceived severity of symptoms in people with fibromyalgia. Methodology: A systematic review with meta-analysis was conducted with electronic search of MEDLINE, WoS, SCOPUS, PEDro, CENTRAL, and LILACS. Results: Eleven studies met the selection criteria and six were included in a quantitative synthesis. Pain at the end of treatment had a mean difference of -0.42 (95% CI -1.14, 0.30, p = 0.25), functional status at the end of treatment had a mean difference of -0.15 (95% CI - 0.69, 0.40, p = 0.60), the global impression of health at the end of treatment had a mean difference of -1.13 (95% CI -1.68, -0.57 p = <0.00) and a mean difference of -0.48 after twelve months (95% CI -0.78, -0.19 p = <0.00), the global impression of severity after the intervention had a mean difference of -0.62 (95% CI -1.22, -0.03, p = 0.04 ) and a mean difference of -0.43 after twelve months (95% CI -1.18, 0.32, p = 0.26). Conclusions: Isolated manual therapy is an intervention that could significantly improve the self-perception of the global state of improvement and severity of symptoms in the short term compared to sham physical agents. However, it is not better than other interventions to reduce pain and improve functional capacity.
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The role of adenosine receptors in fascial manipulation-induced analgesia has not yet been investigated. The purpose of this study was to evaluate the involvement of the adenosine A1 receptor (A1R) in the antihyperalgesic effect of plantar fascia manipulation (PFM), specifically in mice with peripheral inflammation. Mice injected with Complete Freund's Adjuvant (CFA) underwent behavioral, i.e. mechanical hyperalgesia and edema. The mice underwent PFM for either 3, 9 or 15 min. Response frequency to mechanical stimuli was then assessed at 24 and 96 h after plantar CFA injection. The adenosinergic receptors were assessed by systemic (intraperitoneal, i.p.), central (intrathecal, i.t.), and peripheral (intraplantar, i.pl.) administration of caffeine. The participation of the A1R was investigated using the 1,3-dipropyl-8-cyclopentylxanthine (DPCPX), a selective A1R subtype antagonist. PFM inhibited mechanical hyperalgesia induced by CFA injection and did not reduce paw edema. Furthermore, the antihyperalgesic effect of PFM was prevented by pretreatment of the animals with caffeine given by i.p., i.pl., and i.t. routes. In addition, i.pl. and i.t. administrations of DPCPX blocked the antihyperalgesia caused by PFM. These observations indicate that adenosine receptors mediate the antihyperalgesic effect of PFM. Caffeine's inhibition of PFM-induced antihyperalgesia suggests that a more precise understanding of how fascia-manipulation and caffeine interact is warranted.
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Modelos Animales de Enfermedad , Adyuvante de Freund , Hiperalgesia , Inflamación , Receptor de Adenosina A1 , Xantinas , Animales , Receptor de Adenosina A1/metabolismo , Receptor de Adenosina A1/efectos de los fármacos , Ratones , Masculino , Hiperalgesia/tratamiento farmacológico , Hiperalgesia/metabolismo , Inflamación/metabolismo , Inflamación/tratamiento farmacológico , Xantinas/farmacología , Fascia/efectos de los fármacos , Cafeína/farmacología , Cafeína/administración & dosificación , Analgesia/métodos , Médula Espinal/metabolismo , Médula Espinal/efectos de los fármacos , Antagonistas del Receptor de Adenosina A1/farmacologíaRESUMEN
ABSTRACT BACKGROUND AND OBJECTIVES: The purpose of this study was to evaluate the effectiveness of Transcutaneous Electrical Nerve Stimulation (TENS) combined with manual therapy in women diagnosed with muscular Temporomandibular Dysfunction (TMD) with or without Reduced Disc Displacement (RDD). The objective was to evaluate the action of manual therapy in conjunction with TENS as a therapeutic tool for treating TMD, analyzing the electromyographic tasks in MVC and in rest, and measuring pain scores with the Visual Analog Scale (VAS). METHODS: This study has a blinded randomized clinical trial design. In this context, after screening, 11 women with a diagnosis of muscular TMD with or without RDD, aged between 18 and 39 years, were investigated. The 11 women were randomly divided into two intervention groups, one receiving manual therapy alone and the other receiving manual therapy together with TENS. The participants were assessed using the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) and MBGR protocols for inclusion and exclusion, using the VAS to analyze pain, and Surface Electromyography (EMG) to analyze MVC and rest muscle activation. RESULTS: Lower MVC and rest values were observed after the intervention in both intervention groups. Manual therapy alone was as effective as manual therapy combined with TENS. There was no difference between the manual therapy group (MG) and manual therapy+TENS group (TG) in the VAS scores, however when comparing pre- and post-intervention, lower values were observed in the scores of both groups. CONCLUSION: Both groups showed a reduction in pain, but the combination of TENS and manual therapy showed a slight improvement in the stability of the masticatory muscles compared to manual therapy alone. With or without TENS, muscle relaxation and analgesia were achieved.
RESUMO JUSTIFICATIVA E OBJETIVOS: Esta pesquisa teve o propósito de avaliar a eficácia da Estimulação Elétrica Nervosa Transcutânea (TENS) combinada com terapia manual em mulheres diagnosticadas com Disfunção Temporomandibular (DTM) muscular com ou sem Deslocamento de Disco com Redução (DDR). O objetivo foi avaliar a ação da terapia manual em conjunto com a TENS como ferramenta terapêutica para tratamentos da DTM, analisando as tarefas eletromiográficas na Contração Voluntária Máxima (CVM) e no repouso, e aferindo os escores da dor com a Escala Analógica Visual (EAV). MÉTODOS: Este estudo possui um desenho de ensaio clínico randomizado cego. No contexto, após a triagem foram investigadas 11 mulheres com diagnóstico de DTM muscular com ou sem DDR, com idades entre 18 e 39 anos. As 11 mulheres foram divididas randomicamente em dois grupos de intervenção, um deles recebendo somente terapia manual e outro grupo recebendo a terapia manual juntamente com a TENS. As participantes foram avaliadas pelos protocolos Critérios de Diagnóstico para Desordens Temporomandibulares (DC/TMD) e MBGR para inclusão e exclusão, por meio da EAV para análise da dor, e da Eletromiografia de Superfície (EMG) para a análise da CVM e do repouso, verificando a ativação muscular. RESULTADOS: Foram observados menores valores da CVM e de repouso após a intervenção em ambos os grupos de intervenção. A aplicação só de terapia manual é tão eficaz quanto o uso de terapia manual em conjunto com a TENS. Não houve diferença entre o grupo com terapia manual (GM) e o grupo com terapia manual+TENS (GT) nos escores da EAV, entretanto quando comparados pré e pós-intervenção, foram observados menores valores nos escores dos dois grupos. CONCLUSÃO: Ambos os grupos apresentaram redução da dor, mas a combinação de TENS e terapia manual mostrou ligeira melhora na estabilidade da musculatura mastigatória em comparação com a terapia manual isolada. Com ou sem TENS, o relaxamento muscular e a analgesia foram alcançados.
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OBJECTIVE: To explore the potential effectiveness of myofascial release compared to passive muscle stretching and to a control group in modulating pain intensity and health status in adults diagnosed with fibromyalgia (FM). MATERIALS AND METHODS: A preliminary randomized controlled clinical trial was conducted, consisting of eight weekly sessions. The participants were divided into three groups: myofascial release group (RG = 13), a muscle stretching group (SG = 13), and a control group (CG = 12), which received advice from a rheumatologist. The outcomes measured were the visual analogue pain scale (VAS), the fibromyalgia impact questionnaire (FIQ) (representing health status), and the number of painful areas. Univariate analyzes of covariance (ANCOVA) were performed at baseline, after 4 weeks (during treatment), after 8 weeks (post-treatment), and after 12 weeks (follow-up). The International Physical Activity Questionnaire (IPAQ), the Beck Depression Inventory (BDI) and the Pain Catastrophizing Scale (PCS) were included as covariates. Clinical trial registration number: NCT: 03408496. RESULTS: After eight weeks, the RG showed lower VAS scores compared to the CG (mean difference 95% CI: -5.10 to -1.26) and the SG (mean difference 95% CI: -4.9 to -0.23) with no difference between the SG and the CG. The total FIQ score for the RG was lower than the CG after 4 weeks (95% CI: -49.92 to -5.61), and 8 weeks (mean difference 95% CI: -52.72 to -15.73), although there was no difference between the RG and SG, as well as between the SG and CG, at both time points. The number of painful body areas was similar in all groups at the four time points. CONCLUSION: Preliminary results suggest that the RG possibly showed greater improvements in pain intensity and health status compared to the CG, and possibly greater improvements in pain intensity compared to the SG.
Myofascial release in fibromyalgia may potentially have greater improvements on pain modulation and health status when compared to medical counseling.Myofascial release, when compared to stretching, may potentially offer greater improvement in pain modulation in fibromyalgia.Myofascial release was not effective in decreasing the number of painful body areas of patients with fibromyalgia.
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Sport is a science of constant reinvention that is always searching for strategies to improve performance. Objective: This study seeks to compare the effects of myofascial release with Findings-Oriented Orthopedic Manual Therapy (OMT) combined with Foam Roller (FR), versus FR by itself, on the physical performance of university athletes. A randomized controlled study was conducted with a total of twenty-nine university athletes, measuring Range of Motion (ROM), jump height and flight time, strength and dynamic flexibility using Goniometer pro, CMJ protocol in OptoGait, 1 Repetition Maximum (1RM) and Mean Propulsive Velocity (MPV) and the Sit and Reach (V) test, correspondingly. This study was registered at clinicaltrials.gov prior to the initial measurement of the participants under the code NCT05347303. Through a univariate analysis, together with an analysis of independent groups with ANOVA and an analysis of covariance, it was evidenced that OMT combined with FR generated more and better effects in all the evaluated ROM, jump height and flight time, RM and VMP tests. Finally, it was found that OMT combined with FR is better when it is desired to improve ROM, muscle power, strength and flexibility, while FR alone only improves dynamic flexibility.
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Manipulaciones Musculoesqueléticas , Terapia de Liberación Miofascial , Humanos , Universidades , Músculo Esquelético/fisiología , Atletas , Rendimiento Físico Funcional , Rango del Movimiento Articular/fisiologíaRESUMEN
The objective of this study was to determine the effect of enhancing conventional care for people with chronic painful temporomandibular disorders (TMD) with an individualised contemporary pain science education (PSE) intervention. In this randomized controlled trial, a consecutive sample of 148 participants (18-55 years of age) was randomized into 2 groups: PSE-enhanced conventional care or Conventional care alone. Conventional care involved a 6-week, 12-session manual therapy and exercise program. The PSE enhancement involved 2 sessions of modern PSE, undertaken in the first 2 treatment sessions. Primary outcomes were pain intensity, assessed with a numeric pain rating scale, and disability, assessed with the craniofacial pain and disability inventory, post-treatment. Linear mixed model analyses were used to investigate between-group differences over time. There was a statistically and clinically meaningful effect of PSE enhancement on disability (Mean Difference = 6.1, 95% CI: 3.3-8.8), but not on pain intensity, post-treatment. Secondary analyses suggested clinically meaningful benefit of PSE enhancement on pain and disability ratings at 10-week and 18-week follow-ups, raising the possibility that preceding conventional care with a PSE intervention may result in long-term benefits. PERSPECTIVE: The addition of modern Pain Science Education (PSE) intervention improved disability for people with chronic TMD receiving manual therapy and exercise, but not pain. A mean difference in pain and disability favoring the PSE group at the 10- and 18-week follow-ups, respectively, suggests that PSE addition resulted in longer-lasting effects. Trial registration: NCT03926767. Registered on April 29, 2019. https://clinicaltrials.gov/ct2/show/NCT03926767.
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Dolor Crónico , Manipulaciones Musculoesqueléticas , Trastornos de la Articulación Temporomandibular , Humanos , Manipulaciones Musculoesqueléticas/métodos , Dolor Crónico/terapia , Terapia por Ejercicio/métodos , Escolaridad , Trastornos de la Articulación Temporomandibular/terapiaRESUMEN
En la actualidad la mayoría de las personas por lo menos una vez en el año presenta una molestia en la estructura del cuello, considerado como cervicalgia o dolor cervical, el mismo que está ocasionando un impacto considerable en la vida de las personas dentro del ámbito familiar, laboral y en la comunidad, provocando efectos negativos en la calidad de vida y en casos severos puede llegar a ocasionar discapacidad y limitación funcional de los movimientos. Por lo que este estudio presentó como objetivo determinar la efectividad de la aplicación de la técnica manual craneosacral en mujeres que laboran en la Universidad Católica de Santiago de Guayaquil. La metodología que se utilizó fue un enfoque cuantitativo- descriptivo con un diseño experimental del tipo pre experimental, con un corte longitudinal, se utilizó como muestra a 31 mujeres que laboran en diversas áreas de la Universidad Católica Santiago de Guayaquil, a su vez, se utilizó como técnica la encuesta, y el instrumento aplicado para la valoración del dolor cervical fue la escala visual analógica del dolor (EVA). Los resultados de esta técnica respecto a la escala visual analógica (EVA) mediante una valoración inicial y final, reflejaron mejoría en el dolor cervical donde el 68% de las pacientes no presentaron dolor, y el 32% reflejan un dolor leve. Se concluyó, que por medio de la técnica manual craneosacral el dolor disminuyo en un gran porcentaje restableciendo los procesos naturales del equilibrio del cuerpo a través de la terapia manual.
Currently, most people at least once a year have a discomfort in the structure of the neck, considered cervicalgia or cervical pain, which is causing a considerable impact on the lives of people within the family, work and in the community, causing negative effects on the quality of life and in severe cases can lead to disability and functional limitation of movements. Therefore, this study presented the objective of determining the effectiveness of the application of the craniosacral manual technique in women who work at the Catholic University of Santiago de Guayaquil. The methodology used was a quantitative-descriptive approach with an experimental design of the pre-experimental type, with a longitudinal cut, 31 women who work in various areas of the Santiago de Guayaquil Catholic University were used as a sample, in turn, used the survey as a technique, and the instrument applied for the assessment of neck pain was the visual analogue pain scale (VAS). The results of this technique with respect to the visual analog scale (VAS) through an initial and final evaluation, reflected improvement in cervical pain where 68% of the patients did not present pain, and 32% reflected mild pain. It was concluded that through the craniosacral manual technique, the pain decreased by a large percentage, restoring the natural processes of the body's balance through manual therapy.
Atualmente, a maioria das pessoas pelo menos uma vez ao ano apresenta um desconforto na estrutura do pescoço, considerado cervicalgia ou dor cervical, que está causando um impacto considerável na vida das pessoas dentro da família, no trabalho e na comunidade, causando efeitos negativos na qualidade de vida e em casos graves pode levar à incapacidade e limitação funcional dos movimentos. Portanto, este estudo apresentou o objetivo de determinar a eficácia da aplicação da técnica manual craniossacral em mulheres que trabalham na Universidade Católica de Santiago de Guayaquil. A metodologia utilizada foi uma abordagem quantitativo-descritiva com um desenho experimental do tipo pré-experimental, com corte longitudinal, 31 mulheres que trabalham em várias áreas da Universidade Católica de Santiago de Guayaquil foram usadas como amostra, por sua vez, utilizaram a pesquisa como técnica, e o instrumento aplicado para avaliação da cervicalgia foi a escala visual analógica de dor (EVA). Os resultados desta técnica com relação à escala visual analógica (EVA) através de uma avaliação inicial e final, refletiram melhora da dor cervical onde 68% dos pacientes não apresentavam dor, e 32% refletiam dor leve. Concluiu-se que através da técnica manual craniossacral, a dor diminuiu em grande porcentagem, restabelecendo os processos naturais de equilíbrio do corpo através da terapia manual.
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Dolor de CuelloRESUMEN
BACKGROUND: The effectiveness of Manual Therapy (MT) in thumb carpometacarpal osteoarthritis (OA) is unclear. OBJECTIVE: This study aimed to determine the effectiveness of MT for functional outcomes in patients with thumb carpometacarpal OA. DESIGN: Systematic review and meta-analysis of randomized clinical trials. METHODS: An electronic search was performed in the Medline, Central, Embase, PEDro, Lilacs, Cinahl, SPORTDiscus, and Web of Science databases. The eligibility criteria for selecting studies included randomized clinical trials that compared MT versus other interventions in functional outcomes, such as thumb and/or hand function questionnaires, pinch and/or grip strength, thumb and/or hand range of motion, and pain intensity or pressure pain threshold in patients with thumb carpometacarpal OA. RESULTS: Five clinical trials met the eligibility criteria; for the quantitative synthesis, four studies were included. The mean difference (MD) for grip strength was 0.87kg (95% CI = 0.29-1.44, p = .003), for pinch strength was 0.10kg (95% CI = -0.01-0.20, p = .06), and for the pressure pain threshold was 0.64kg/cm2 (95% CI = 0.07-1.20, p = .03). All differences were in favor of the MT group. CONCLUSIONS: In the short-term, there was moderate to high evidence, with statistically significant differences in the functional outcomes, in favor of MT versus sham interventions in patients with thumb carpometacarpal OA. However, these differences are not clinically important.
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Articulaciones Carpometacarpianas , Manipulaciones Musculoesqueléticas , Osteoartritis , Humanos , Pulgar , Osteoartritis/terapia , Fuerza de Pellizco , Fuerza de la Mano , DolorRESUMEN
OBJECTIVE: To determine the effectiveness of manual therapy (MT) for functional outcomes in patients with distal radius fracture (DRF). METHODS: An electronic search was performed in the Medline, Central, Embase, PEDro, Lilacs, CINAHL, SPORTDiscus, and Web of Science databases. The eligibility criteria for selecting studies included randomized clinical trials that included MT techniques with or without other therapeutic interventions in functional outcomes, such as wrist or upper limb function, pain, grip strength, and wrist range of motion in patients older than 18 years with DRF. RESULTS: Eight clinical trials met the eligibility criteria; for the quantitative synthesis, six studies were included. For supervised physiotherapy plus joint mobilization versus home exercise program at 6 weeks follow-up, the mean difference (MD) for wrist flexion was 7.1 degrees (p = 0.20), and extension was 11.99 degrees (p = 0.16). For exercise program plus mobilization with movement versus exercise program at 12 weeks follow-up, the PRWE was -10.2 points (p = 0.02), the DASH was -9.86 points (p = 0.0001), and grip strength was 3.9 percent (p = 0.25). For conventional treatment plus manual lymph drainage versus conventional treatment, for edema the MD at 3-7 days was -14.58 ml (p = 0.03), at 17-21 days -17.96 ml (p = 0.009), at 33-42 days -15.34 ml (p = 0.003), and at 63-68 days -13.97 ml (p = 0.002). CONCLUSION: There was very low to high evidence according to the GRADE rating. Adding mobilization with movement and manual lymphatic drainage showed statistically significant differences in wrist, upper limb function, and hand edema in patients with DRF.
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Manipulaciones Musculoesqueléticas , Fracturas del Radio , Terapia por Ejercicio/métodos , Humanos , Modalidades de Fisioterapia , Fracturas del Radio/terapia , Rango del Movimiento ArticularRESUMEN
Abstract Introduction: Breast cancer is the most common type of cancer among women. Treatments can lead to complications modifying upper limbs movement patterns and generating pain and functionality loss. Kinesiotherapy and myofascial reorganization (MR) have shown positive effects reducing chronic pain and improving upper limbs function. We hypothesize that these techniques can maximize results and reduce treatment time in clinical practice. Objective: To develop a study protocol to verify whether MR associated with kinesiotherapy is more effective than isolated kinesiotherapy to treat chronic pain and upper limb dysfunction in breast cancer survivors. Methods: Participants will be divided into two groups: intervention group (myofascial reorganization + kinesiotherapy) and sham group (traditional massage + kinesiotherapy). Six treatment sessions (once a week) and three-time assessment will occur. Instruments for assessing pain and functionality will be Visual Analogue Scale, Body Pain Diagram, Disabilities of the Arm, Shoulder and Hand Questionnaire, and goniometry. Statistical analysis will be conducted based on intention-to-treat analysis. To analyze the difference of means between groups, we will use T-Student or U Mann-Whitney test. Repeated measures ANOVA will be used to check treatments effects. Significance level for all tests will be 5%. Conclusion: We believe that the developed study protocol will show that MR associated with kinesiotherapy improve chronic pain and upper limbs functionality of breast cancer survivors.
Resumo Introdução: O câncer de mama é o tipo de câncer mais comum entre as mulheres. Os tratamentos podem levar a complicações, modificando os padrões de movimento dos membros superiores e gerando dor e perda de funcionalidade. A cinesioterapia e a reorganização miofascial (RM) têm demonstrado efeitos positivos na redução da dor crônica e na melhora da função dos membros superiores. A hipótese do presente estudo é que essas técnicas podem maximizar os resultados e reduzir o tempo de tratamento na prática clínica. Objetivo: Desenvolver um protocolo para verificar se a RM associada à cinesioterapia é mais eficaz do que a cinesioterapia isolada no tratamento da dor crônica e disfunção do membro superior em sobreviventes de câncer de mama. Métodos: As participantes serão divididas em dois grupos: grupo intervenção (reorganização miofascial + cinesioterapia) e grupo sham (massagem tradicional + cinesioterapia). Serão realizadas seis sessões de tratamento (uma vez por semana) e três avaliações. Os instrumentos de avaliação da dor e da funcionalidade serão a Escala Visual Analógica, o Diagrama de Dor Corporal, o Questionário de Deficiências do Braço, Ombro e Mão e a goniometria. A análise estatística será realizada com base na análise de intenção de tratar. Para analisar a diferença de médias entre os grupos, serão utilizados o teste T-Student ou U Mann-Whitney. ANOVA de medidas repetidas será utilizada para verificar os efeitos dos tratamentos. O nível de significância para todos os testes será de 5%. Conclusão: Espera-se que a RM associada à cinesioterapia melhore a dor crônica e a funcionalidade dos membros superiores de sobreviventes de câncer de mama.
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Objetivo: Descrever a importância da intervenção fisioterapêutica para mulheres com vaginismo. Fonte de dados: Foram utilizadas as bases de dados SciELO, PubMed, Biblioteca Virtual de Saúde (BVS) e Literatura Cinza, incluindo artigos nacionais e internacionais, sem delimitação temporal. Foram propostas para as buscas as seguintes palavras-chave e operadores boleanos: [("vaginismus") AND ("physiotherapy" OR "intervention" OR "efficiency")], sendo esses posteriormente adequados para as demais bases que foram utilizadas nesta revisão sistemática. Seleção dos estudos: A seleção dos estudos foi realizada por três examinadores independentes. Coleta de dados: Inicialmente foram excluídos estudos com base no título, em seguida os resumos foram analisados e, dos 353 artigos encontrados inicialmente, quatro foram elegíveis para esta revisão. Síntese dos dados: Os artigos incluídos descreveram que o tratamento fisioterapêutico é de extrema importância para as mulheres com vaginismo, pois aumenta a força e o controle sobre a musculatura do assoalho pélvico, diminuindo os sintomas do vaginismo e promovendo o incremento da satisfação sexual. Conclusão: A intervenção fisioterapêutica é imprescindível para mulheres que apresentam vaginismo, tendo em vista que suas técnicas têm efetividade na prevenção e tratamento do vaginismo, além de promover melhora importante na qualidade de vida e na satisfação sexual das mulheres.(AU)
Objective: To describe the importance of physical therapy intervention for women with vaginismus. Data source: The SciELO, PubMed, Virtual Health Library (BVS) and Gray Literature databases were used, including national and international articles, without temporal delimitation. The following keywords and Boolean operators were proposed for the searches: [("vaginismus") AND ("physiotherapy" OR "intervention" OR "efficiency")], which were later suitable for the other bases that were used in this systematic review. Study selection: Study selection was performed by three independent examiners. Data collection: Initially, studies were excluded based on the title, then the abstracts were analyzed and of the 353 articles found initially, 4 were eligible for this review. Data synthesis: The articles included described that physical therapy treatment is extremely important for women with vaginismus, as it increases strength and control over the pelvic floor muscles, decreasing the symptoms of vaginismus and promoting increased sexual satisfaction. Conclusion: Physical therapy intervention is essential for women who have vaginismus, considering that its techniques are effective in preventing and treating vaginismus, in addition to promoting an important improvement in women's quality of life and sexual satisfaction.(AU)
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Humanos , Femenino , Dolor Pélvico/terapia , Vaginismo/terapia , Toxinas Botulínicas/uso terapéutico , Terapia por Estimulación Eléctrica/métodos , Diafragma Pélvico/fisiopatología , Manipulaciones Musculoesqueléticas/métodosRESUMEN
BACKGROUND: Corticosteroid injection and dry needling have been used in the treatment of musculoskeletal conditions, but it is unclear which intervention is the most effective. The purpose of this study was to compare the effects of corticosteroid injection and dry needling for musculoskeletal conditions at short-, medium-, and long-term follow-up. METHODS: Electronic databases were searched up to 31 October 2021. Two researchers independently screened titles, abstracts and full-text articles. Randomized clinical trials (RCTs) that investigated the effectiveness of dry needling compared to corticosteroid injection in patients over 18 years with a musculoskeletal condition were included in the review. The studies had to report pain and/or disability as outcome. Risk of bias was assessed by using the revised Cochrane Collaboration tool (RoB 2.0). Quality of evidence was evaluated by using the GRADE approach. RESULTS: Six studies were included (n = 384 participants). Four musculoskeletal conditions were investigated. There is very low-quality evidence that CSI is superior to DN for reducing heel pain (plantar fasciitis) and lateral elbow pain at short- and medium-term follow-up, but not for myofascial pain and greater trochanteric pain. There is very low-quality evidence that DN is more effective than CSI at long-term follow-up for reducing pain in people with plantar fasciitis and lateral epicondylitis. Very low-certainty evidence shows that there is no difference between DN and CSI for disability at short-term follow-up. One study showed that CSI is superior to DN at medium-term follow-up and another observed that DN is superior to CSI for reducing disability at long-term. CONCLUSIONS: There are no differences between DN and CSI in pain or disability for myofascial pain and greater trochanteric pain syndrome. Very-low certainty evidence suggests that CSI is superior to DN at shorter follow-up periods, whereas DN seems to be more effective than CSI at longer follow-up durations for improving pain in plantar fasciitis and lateral epicondylitis. Large RCTs with higher methodological quality are needed in order to draw more incisive conclusions. PROSPERO REGISTRATION NUMBER: CRD42020148650.
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Personas con Discapacidad , Punción Seca , Dolor Musculoesquelético , Corticoesteroides/uso terapéutico , Humanos , Dolor Musculoesquelético/terapia , Dimensión del DolorRESUMEN
| INTRODUÇÃO: A fascite plantar (FP) é uma causa comum de dor no calcanhar e deformidade da articulação do tornozelo. Mais de 11% -15% da população com sintomas nos pés precisa de cuidados de longo prazo. Foi comprovado que várias intervenções de fisioterapia com terapia convencional, que inclui terapia manual, ajudam nessa condição. OBJETIVO: Avaliar o efeito do fortalecimento do abdutor do quadril e da terapia manual (MT) em paciente com fascite plantar (FP). MÉTODOS: O desenho do estudo será um ensaio de controle randomizado de dois grupos, pré-teste e pós-teste. Um total de 30 participantes do sexo masculino e feminino com idade acima de 18-60 anos com dores provocadas pelos primeiros passos da manhã, dor na região plantar do calcanhar, serão alocados aleatoriamente em dois grupos - o Grupo A receberá terapia manual (TM) com fisioterapia convencional enquanto o Grupo B receberá fortalecimento dos abdutores do quadril com fisioterapia convencional. Ambos os grupos receberão 16 sessões de tratamento por 4 dias em cada semana durante 4 semanas. "Foot Function Index", "Podia scan", "Teste de queda do navicular" serão usados como medida de desfecho e serão avaliados na 1ª semana e na 4ª semana de tratamento em ambos os grupos. CONCLUSÃO: Os pacientes que recebem a intervenção de fortalecimento do abdutor do quadril podem ter resultados positivos quando comparados à intervenção de MT entre pacientes com FP. Este será o primeiro estudo a comparar o efeito do fortalecimento dos abdutores do quadril e da terapia manual. REGISTRO DE ENSAIO: Registro de Ensaios Clínicos - Índia. (CTRI / 2020/04/024541)
BACKGROUND: Plantar fasciitis (PF) is a common cause of heel pain and deformity of the ankle joint. More than 11%- 15% of the population with foot symptoms need long-term care. Various physical therapy intervention with conventional therapy, including manual therapy, has been proven to help this condition. OBJECTIVE: To evaluate the effect of Hip abductor strengthening and Manual therapy (MT) in a patient with Plantar Fasciitis (PF). METHODS: The design of the study will be A Two Group PretestPosttest randomized control trial. A total of 30 male and female participants aging above 18-60 years experiencing pain provoked by taking the first few steps in the morning, pain in the plantar heel region, will be allocated randomly into two groups- Group A will receive Manual therapy (MT) with conventional physiotherapy while Group B will receive hip abductors strengthening with conventional physiotherapy. Both groups will receive 16 sessions of treatment for 4 days each week for 4 weeks. "Foot function index," "Podiascan," "Navicular drop test" will be used as outcome measures and will be evaluated at the first week and fourth week of treatment in both the groups. CONCLUSION: The patients who receive Hip Abductor Strengthening intervention may have positive results compared to the MT intervention among patients with PF. This will be the first study to compare the effect of hip abductors strengthening and manual therapy. TRIAL REGISTRATION: Clinical Trial Registry- India. (CTRI/2020/04/024541)
Asunto(s)
Fascitis Plantar , Manipulaciones Musculoesqueléticas , MétodosRESUMEN
OBJECTIVE: To evaluate the immediate effect of neural mobilization on the voice quality, self-perceived phonatory effort, and laryngeal muscles of women with behavioral dysphonia. METHOD: This is an intrasubject comparative study. The research included 21 women aged 18 to 59 years with vocal complaints. Therefore, the selection of this sample excluded the lower limit of the voice change period and the upper limit of presbyphonia. The participants were assessed by voice acoustic and auditory-perceptual analysis, self-reported vocal effort, and laryngeal palpation performed at three moments: at baseline, after 10 minutes of vocal resting, and after manual therapy. The participants were divided into two groups: the group with 10 minutes of vocal resting (G1) and the group with intervention (G2). The patients in the intervention group underwent manual therapy using neural mobilization in the laryngeal region. For the statistical analysis, a descriptive analysis of the data was performed first with measures of central tendency and dispersion. Subsequently, the Anderson-Darling test was used to verify sample normality. To analyze the difference between three groups were used the parametric One-Way ANOVA or the non-parametric Friedman's test. The McNemar's or chi-squared tests were used to compare categorical variables and to compare an ordinal variable a non-parametric Wilcoxon test was used. The Gwet's AC1 test was used to assess intra-rater agreement in the auditory-perceptual analysis response. RESULTS: Neural mobilization in the laryngeal region showed no positive effects on the acoustic voice parameters and voice quality of women with dysphonia. Phonatory effort improved after neural mobilization in the laryngeal region (p = 0.004). There was no significant change in supralaryngeal resistance, lateral laryngeal resistance, and laryngeal position after neural mobilization in the laryngeal region. CONCLUSION: Neural mobilization improved phonatory comfort but did have any effect on the voice quality and laryngeal musculature of women with dysphonia.
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RESUMEN Introducción: La artropatía hemofílica (AH) cursa con diferentes manifestaciones clínicas importantes, como son las hemorragias articulares, el dolor, la disminución de la amplitud del movimiento y las alteraciones funcionales que pueden causar secuelas en la funciona lidad y movilidad. El ejercicio físico adaptado a los pacientes con hemofilia puede ser una adecuada estrategia terapéutica, que repercuta positivamente sobre la calidad de vida de dichos sujetos. Objetivos: Evaluar la eficacia de la rehabilitación física en el tratamiento de la artropatía hemofílica. Materiales y métodos: Se ha realizado una revisión sistemática y metaánálisis de ensayos clí nicos (seleccionados según criterios de elegibilidad). Para ello, se han utilizado las siguientes bases de datos: PEDro, Pubmed, Scopus y Web of Science. Se empleó la escala «PEDro¼ para evaluar la calidad metodológica de los estudios. Resultados: Tras aplicar los criterios de inclusión y exclusión, en la revisión final fueron incluidos siete artículos, los cuales aportaron resultados favorables sobre la fuerza y el diá metro muscular, el rango de movilidad, el estado articular y la calidad de vida. De ellos, dos estudios aportaron datos para metaanálisis, con resultados favorables sobre la variable dolor [Diferencia de medias estandarizada (DME) = -2,64; IC 95%: (-4,26; 1,03)]. Conclusiones: Se encontró evidencia sobre la eficacia de la rehabilitación física en el trata miento de la artropatía hemofílica. El ejercicio terapéutico (ET) es el principal tratamiento realizado; con este se obtuvieron mejoras significativas en distintas variables físicas.
ABSTRACT Introduction: Haemophilic arthropathy presents with different important clinical disorders, such as joint disease, pain, decreased range of motion, and functional alterations that can produce limitations in functionality and mobility. The physical exercise adapted to patients with haemophilia can be an adequate therapeutic strategy, having a positive impact on the quality of life of these subjects. Objectives: To identify the published clinical trials that evaluate the efficacy of physical rehabilitation in the treatment of haemophilic arthropathy. Materials and methods: A systematic review and meta-analysis of clinical trials was con ducted (using pre-defined eligibility criteria). The literature search was performed in the databases: PEDro, Pubmed, Scopus, and Web of Science. The quality of the methods used in the studies was evaluated using the PEDro scale. Results: After applying the inclusion and exclusion criteria, 7 studies were included in this review, providing favourable results on muscle strength and circumference, range of motion, joint disease, and quality of life. Moreover, 2 articles contributed information to the meta-analysis, showing favourable results on pain [Standardised mean difference (SMD) = -2.64; 95% CI: (-4.26; 1.03)]. Conclusions: This systematic review found evidence on the efficacy of physical rehabilitation in the treatment for haemophilic arthropathy. Therapeutic exercise is the main treatment carried out, obtaining significant improvements in the different physical outcomes.
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Humanos , Niño , Persona de Mediana Edad , Rehabilitación , Terapéutica , Trastornos de la Coagulación Sanguínea , Atención al Paciente , Enfermedades Hematológicas y Linfáticas , Hemofilia ARESUMEN
BACKGROUND: Valgus hindfoot is a very common postural deviation, and the associated foot pronation can be a triggering factor for diseases such as tarsal tunnel syndrome. RESEARCH QUESTION: This work compares two techniques for hindfoot valgus correction: GPR (Global Postural Reeducation) and PIMT (Postural Integration by Manual Therapy). METHODS: Sixty young adult subjects from the Brazilian Army with unilateral hindfoot valgus were selected and divided into two groups of 30 subjects, one treated with GPR and the other treated with PIMT. Differences between normal and valgus hindfeet (plantar surface and body weight load) for each subject were measured and analysed, using a baropodometer with subjects in static standing position for 5s. Measurements were performed before and after each treatment session (4 weeks, once a week), and 4 weeks after the end of treatment. RESULTS: Data shows that both treatments were equally effective for improving symmetry in body weight load between feet and plantar surface. After 4 weeks from the end of treatment, both treatments were equally effective for body weight load symmetry, but plantar surface symmetry was better in PIMT treated subjects. SIGNIFICANCE: This study shows that PIMT technique can be validated as a physical therapy procedure, at least for valgus hindfoot.
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Deformidades del Pie , Pie , Humanos , Modalidades de Fisioterapia , Adulto JovenRESUMEN
Myofascial pain syndrome (MPS), trigger points (TrPs), and dry needling (DN) continue to be of interest to researchers and clinicians worldwide. In this quarterly overview, we included studies from 19 countries, including Pakistan, Iran, Spain, Israel, the US, Australia, Turkey, the UK, China, Italy, Germany, Brazil, Denmark, Canada, Saudi Arabia, Egypt, India, New Zealand, and Thailand. As encouraging as it may be that myofascial pain is being considered worldwide, it is frustrating how many studies do not include a proper control group making them not very useful. It is not clear why researchers would go through the trouble of setting up a study, which requires many hours of work and dedication, and not produce a meaningful paper for clinicians and researchers alike. Fortunately, several papers are high quality studies. This overview covers 39 basic research studies, systematic reviews and meta-analyses, clinical studies, and a few case reports.
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Terapia por Acupuntura , Manipulaciones Musculoesqueléticas , Síndromes del Dolor Miofascial , Australia , Brasil , Canadá , Humanos , India , Irán , Israel , Italia , Síndromes del Dolor Miofascial/epidemiología , Síndromes del Dolor Miofascial/terapia , Dolor , España , Tailandia , Puntos DisparadoresRESUMEN
Introdução: A manipulação visceral é atualmente um tratamento usado amplamente pelos osteopatas no mundo, contudo, sua base de mecanismos ainda é pouco esclarecida, havendo certa escassez de pesquisas publicadas sobre tais intervenções. O conceito para o tratamento se baseia na ação sobre aderências fáscias que supostamente afetam a hemodinâmica visceral, desregulação autonômica, fatores psicossomáticos e ptose visceral, repercutindo de maneira direta no bom funcionamento das demais estruturas do corpo. Objetivo: O estudo tem como objetivo mensurar as variações imediatas da resposta sintomática dolorosa por pressão na coluna lombar pela manipulação visceral. Métodos: Trata-se de um estudo experimental, com abordagem longitudinal e caráter quantitativo. Constituído por amostra de doze indivíduos divididos em G1 (uso de manipulação visceral), G2 (uso de placebo) e uso do algômetro de pressão nos músculos paravertebrais corresponde ao nível topográfico da quinta vértebra lombar. Para análise estatística dos dados obtidos, foi aplicado o teste t de Student para amostras pareadas no software Bioestat. Além disso, o nível de rejeição da hipótese de nulidade foi estabelecido em 0,05 ou 5%. Resultados: Obteve-se relevância em um ponto de vista estatístico na análise do grupo submetido a manipulação visceral. Quando comparado a outras evidências recentes, os resultados obtidos pelo estudo revelam dados condizentes. Conclusão: Os resultados deste estudo fornecem informações confiáveis que vão nortear a futura utilização da manipulação visceral na dor lombar crônica, mostrando bom prognóstico em curto prazo. (AU)
Introduction: Visceral manipulation is currently a treatment widely used by osteopaths worldwide, however, its basis of mechanisms is still poorly understood, and there is a lack of published research on such interventions. The concept for treatment is based on the action on fascia adhesions that supposedly affect visceral hemodynamics, autonomic dysregulation, psychosomatic factors, and visceral ptosis, directly affecting the proper functioning of other body structures. Objective: This study aimed to measure the immediate variations in the symptomatic painful response to pressure in the lumbar spine by visceral manipulation. Methods: This is an experimental study, with a longitudinal approach and quantitative character. Consisting of a sample of twelve individuals divided into G1 (use of visceral manipulation), G2 (use of placebo) and use of the pressure algometer in the paravertebral muscles corresponds to the topographic level of the fifth lumbar vertebra. For statistical analysis of the data obtained, the Student's t test was applied to paired samples using the Bioestat software. In addition, the level of rejection of the null hypothesis was set at 0.05 or 5%. Results: Relevance was obtained from a statistical point of view in the analysis of the groups submitted to visceral manipulation. When compared to other recent evidence, the results obtained by the study reveal consistent data. Conclusion: The results of this study provide reliable information that will guide the future use of visceral manipulation in chronic low back pain, showing a good prognosis in the short term. (AU)
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Humanos , Femenino , Dolor de la Región Lumbar/terapia , Manipulaciones Musculoesqueléticas/métodos , Estudios LongitudinalesRESUMEN
Introducción: La prevalencia anual de dolor cervical oscila entre un 16,7% y un 75,1%, durando alrededor de 6 meses o más en el 14% de los casos, desencadenando en restricción del movimiento y dolor principalmente. Esto podría deberse a la relación entre la cabeza, columna cervical y estructuras relacionadas a la articulación temporomandibular (ATM). El objetivo de esta investigación es describir a través de la evidencia científica el efecto de las técnicas manuales orales en la disminución del dolor cervical. Métodos: Se incluyeron ensayos clínicos aleatorizados y revisiones sistemáticas encontrados en las bases de datos PubMed, Cochrane y PEDro. Realizando la extracción de datos a través de una tabla estructurada para cada tipo de estudio. Resultados: De 10 estudios seleccionados, 3 corresponden a revisiones sistemáticas y 7 a ensayos clínicos, donde la disminución del dolor cervical fue significativa al aplicar la terapia manual con ejercicios por sobre la terapia manual por sí sola. Por otro lado, las técnicas orofaciales fueron beneficiosas al combinarlas con terapia manual en comparación con un tratamiento habitual. No se encontraron diferencias significativas al aplicar ejercicios de Maitland y movilizaciones en comparación con ejercicios de flexibilidad, fortalecimiento, ejercicios de Mulligan y movilizaciones. Conclusión: Los resultados son debatibles, ya que la terapia manual por sí sola o combinada con ejercicios es la técnica más efectiva no solo en la disminución del dolor cervical, también en la mejoría de la calidad de vida.
Introduction: The annual prevalence of cervical pain ranges from 16.7% to 75.1%, lasting about 6 months or more in 14% of cases, triggering mainly movement restriction and pain. This could be due to the relationship between the head, cervical spine and structures related to the temporomandibular joint (TMJ). The objective of this research is to describe through scientific evidence the effect of oral techniques in reducing cervical pain. Methods: Randomized clinical trials and systematic reviews found in the PubMed, Cochrane and PEDro databases were included. Data extraction was done through a structured table for each type of study. Results: Out of 10 selected studies, 3 correspond to systematic reviews and 7 to clinical trials, where the decrease in neck pain was significant when applying manual therapy with exercises over manual therapy alone. On the other hand, orofacial techniques were beneficial when combined with manual therapy compared to an usual treatment. No significant differences were found when applying Maitland exercises and mobilizations compared to flexibility, strengthening, Mulligan exercises, and mobilizations (p<0.05). Conclusion: The results are debatable, as manual therapy alone or combined with exercises is the most effective technique not only in reducing neck pain, but also in improving quality of life.
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OBJETIVE: To evaluate the effects of Chinese scalp acupuncture in patients diagnosed with temporomandibular disorders (TMD) on pain, sleep, and quality of life (QOL), and compare these results with the results from traditional therapies. METHODS: Sixty patients diagnosed with TMD using the research diagnostic criteria for temporomandibular disorders (RDC/TMD) were allocated into four treatment groups: counseling (C = 15), occlusal splint (OS = 15), scalp acupuncture (SA = 15), and manual therapy (MT = 15). Participants were re-evaluated within 1 month. Three questionnaires were used to access sleep disorders, QOL, and pain: The Pittsburgh Sleep Quality Index (PSQI), World Health Organization Quality of Life (WHOQOL-bref), and the Visual Analogue Scale (VAS), respectively. The data obtained were analyzed using the Statistical Package for the Social Science program (SPSS 22.0). RESULTS: The SA group significantly improved pain (P = .015), as well as the OS (P = .01) and MT groups (P = .014). Only the OS (P = .002) and MT (P = .029) groups improved sleep. MT group significantly improved QOL in terms of the physical domain of the WHOQOL-bref (P = .011) and the OS group in the psychological domain (P = .012). CONCLUSIONS: The scalp acupuncture proved to be another alternative for pain relief in patients with TMD, demonstrating positive results in the short term. However, it was not as effective in improving quality of life and sleep.