RESUMO

OBJECTIVE: To investigate the effect of osteopathic visceral manipulation (OVM) on disability and pain intensity in individuals with functional constipation and chronic nonspecific low back pain. METHODS: This study is a randomized controlled trial with a blinded assessor. Seventy-six volunteers with functional constipation and chronic nonspecific low back pain were randomized to two groups: OVM and sham OVM. The primary clinical outcome was pain intensity measured using a numeric rating scale (NRS) and disability measured using the Oswestry Disability Index (ODI). The secondary outcomes were electromyographic signals measured during the flexion-extension cycle, the finger-to-floor distance during complete flexion of the trunk and the Fear-Avoidance Beliefs Questionnaire (FABQ). All outcomes were determined after six weeks of treatment as well as three months after randomization. RESULTS: The OVM group reported a reduction in pain intensity after six weeks of treatment and at the three-month evaluation (p < .0002) and the sham group reported a reduction in pain intensity after three-month evaluation (p < .007). For the ODI was also found in the OVM group six weeks after the end of treatment (treatment effect = -6.59, 95% CI: -12.01 to -1.17, p = .01) and at the three-month evaluation (treatment effect = -6.02, 95% CI: -11.55 to -0.49, p = .03). Significant differences were also found for paravertebral muscle activity during the dynamic phases (flexion and extension) six-week evaluations. CONCLUSIONS: The OVM group demonstrated a reduction in pain intensity and improvement in disability after six-weeks and three-month follow-up while the sham group reduction in pain three-month follow-up.

Assuntos

Dor Crônica , Dor Lombar , Osteopatia , Humanos , Dor Lombar/terapia , Resultado do Tratamento , Constipação Intestinal , Medo , Avaliação da Deficiência , Dor Crônica/terapia

RESUMO

BACKGROUND: Studies evaluating kinematics lead to different conclusions, not all changes appear in all assessed tasks and in all subgroups of patients with patellofemoral pain (PFP). The inconsistencies between studies could be reduced if we knew which task separates patients best from healthy controls. RESEARCH QUESTION: Identify which functional task, between gait, forward step down (FSD), lateral step down (LSD), stair ascent and descent and propulsion and landing phase of the single leg hop test (SLHT), differentiates the three-dimensional kinematics of women with patellofemoral pain from asymptomatic women. METHODS: This cross-sectional study evaluated thirty-five PFP and thirty-five asymptomatic women during the execution of the following tasks: gait, FSD, LSD, stair ascent and descent and the propulsion and landing phase of single leg hop test. Frontal, sagittal and transverse plane angles of the trunk, pelvis and hip, frontal and sagittal plane angles of the knee, ankle dorsiflexion, foot progression angle and hindfoot eversion were analyzed through the Movement Deviation Profile (MDP). To compare the groups, the multivariate analysis with Bonferroni post hoc test were used, with a significance level of p < 0.01. To identify which task presented the most difference between the groups, the Z-score of the mean MDP was calculated. RESULTS: For all tasks, the groups presented significant differences. According to the Z-score, the groups got farther apart considering the MDP for each task in the following order: LSD (7.97), FSD (7.62), landing phase of SLHT (3.43), gait (2.85), propulsion phase of SLHT (1.64), descending stairs (1.63) and ascending stairs (1.00). SIGNIFICANCE: We suggest that step down tests should be included in the assessment of PFP patients, since these tests most differentiate the kinematics of women with and without PFP. Identifying the tasks with the highest sensitivity to detect the kinematic differences is expected to improve clinical decision-making.

Assuntos

Fenômenos Biomecânicos , Teste de Esforço , Síndrome da Dor Patelofemoral/fisiopatologia , Adulto , Estudos Transversais , Feminino , Pé/fisiopatologia , Marcha , Humanos , Joelho/fisiopatologia , Extremidade Inferior/fisiopatologia , Movimento , Dor/fisiopatologia , Pelve/fisiopatologia , Tronco/fisiopatologia , Adulto Jovem

RESUMO

UNLABELLED: There is a growing interest in musculoskeletal rehabilitation for young active individuals with non-arthritic hip pathology. History and physical examination can be useful to classify those with non-arthritic intra-articular hip pathology as having impingement or instability. However, the specific type of deformity leading to symptoms may not be apparent from this evaluation, which may compromise the clinical decision-making. Several radiological indexes have been described in the literature for individuals with non-arthritic hip pathology. These indexes identify and quantify acetabular and femoral deformities that may contribute to instability and impingement. The aim of this paper is to discuss clinical indications, methods, and the use of hip radiological images or radiology reports as they relate to physical examination findings for those with non-arthritic hip pathology. LEVEL OF EVIDENCE: 5.