Osteopatía Científica最新文献

Objectives

To describe the use of the osteopathic approach in carpal tunnel syndrome (CTS) and in particular cervicothoracic junction manipulation and stretching of the annular ligament of the carpus.

Clinical characteristics

A 43-year-old woman sought osteopathic treatment with a 2-month history of predominantly left incipient bilateral CTS unresponsive to drug therapy.

Intervention and results

Five treatment sessions were carried out in which the thumb move technique was applied to C7/T1 combined with stretching of the carpal ligament for 5 minutes, both on a bilateral basis. The cross-sectional area of the median nerve changed from 10.8 to 5.0 mm² for the left nerve and from 10.6 to 7.8 mm² for the right nerve, values consistent with a change from CTS to normal status. Increases in both manual grip strength and pain threshold to pressure on the carpal tunnel nerve were achieved.

Conclusions

The satisfactory results obtained in this patient and the improvement in the variables analyzed highlights the importance of osteopathy and, specifically, of the techniques used in the treatment of mild and moderate CTS.

Objective

To demonstrate that Ralph Faylor's liver pumping technique does not reduce plasma ammonia levels in individuals with levels above 45 μMol/L to levels considered normal.

Patients, materials and methods

We performed a single-blind randomized clinical trial in 31 patients with ammonia levels above 45 μMol/L, divided in two groups. There were 16 patients in the treatment group and 15 in the control group. In both groups, ammonia levels were measured at five distinct time points: test 1, before the first intervention; test 2, within 7 to 10 min after the first intervention; test 3, 24 h after the first intervention; test 4, 7 days after the first intervention; and test 5, within 7 to 10 min after the fourth intervention (one intervention per week) following the pre-established protocol.

Results

Statistical analysis revealed that the technique and/or its simulation produced no change in serum ammonia levels (P > .05).

Conclusion

In patients with plasma ammonia levels above 45 μMol/L, Ralph Failor's liver pumping technique cannot reduce blood concentrations of this metabolite.

Etymologically, “cervical pain” means “neck pain”, which is common reason for consultation in osteopathic practice. Most people can expect to experience some degree of neck pain in their lifetime. The aim of the thrust technique for C3 left ERS somatic dysfunction is to restore mobility and function of the vertebra. Knowing the benefits and risks of this procedure is as important as knowing how to perform it. After an exhaustive diagnosis, cervical mobility can be restored and pain can be decreased.

Background context

Despite clinical evidence for the benefits of spinal maniputation and the apparent wide usage of it, the biological mechanisms underlying the effects of spinal manipulation are not known. Although this does not negate the clinical effects of spinal manipulation, it hinders acceptance by the wider scientific and health-care communities and hinders rational strategies for improving the delivery of spinal manipulation.

Purpose

The purpose of this review article is to examine the neurophysiological basis for the effects of spinal manipulation.

Study design

A review article discussing primarily basic science literature and clinically oriented basic science studies.

Methods

This review article draws primarily from the peer-reviewed literature available on Medline. Several textbook publications and reports are referenced. A theoretical model is presented describing the relationships between spinal manipulation, segmental biomechanics, the nervous system and end-organ physiology. Experimental data for these relationships are presented.

Results

Biomechanical changes caused by spinal manipulation are thought to have physiological consequences by means of their effects on the inflow of sensory information to the central nervous system. Muscle spindle afferents and Golgi tendon organ afferents are stimulated by spinal manipulation. Smaller-diameter sensory nerve fibers are likely activated, although this has not been demonstrated directly. Mechanical and chemical changes in the intervertebral foramen caused by a herniated intervertebral disc can affect the dorsal roots and dorsal root ganglia, but it is not known if spinal manipulation directly affects these changes. Individuals with herniated lumbar discs have shown clinical improvement in response to spinal manipulation. The phenomenon of central facilitation is known to increase the receptive field of central neurons, enabling either subthreshold or innocuous stimuli access to central pain pathways. Numerous studies show that spinal manipulation increases pain tolerance or its threshold. One mechanism underlying the effects of spinal manipulation may, therefore, be the manipulation's ability to alter central sensory processing by removing subthreshold mechanical or chemical stimuli from paraspinal tissues. Spinal manipulation is also thought to affect reflex neural outputs to both muscle and visceral organs. Substantial evidence demonstrates that spinal manipulation evokes paraspinal muscle reflexes and alters motoneuron excitability. The effects of spinal manipulation on these somatosomatic reflexes may be quite complex, producing excitatory and inhibitory effects. Whereas substantial information also shows that sensory input, especially noxious input, from paraspinal tissues can reflexively elicit sympathetic nerve activity, knowledge about spinal manipulation's effects