Osteopatía Científica最新文献

Introduction

Plantar fasciitis is a common cause of feet pain in adults, at the age between 40 and 60 years old, predominately on the feminine population. They show pain when palpated on the calcaneal tubercle and they even present miofacial trigger points on the portion proximal to the medial gastrocnemius and soleus muscles.

Objectives

Identify if the deactivation techniques in calf muscles offer plantar pain reduction on patients.

Material and methods

60 patients were evaluated and divided into two groups of 30 volunteers each: control group (group 1) and experimental group (group 2). All patients were submitted to filling out the life quality questionnaire SF-36, before they were sent to their specific treatments. To the group treated, a protocol was carried out, in addition to the techniques proposed on the study of trigger-points deactivation of the main muscles involved on the plantar fasciitis. Once the treatment was over, after four sessions, the patients answered the questionnaire about life quality again.

Results

Through the descriptive analysis of the present study, all the variables presented a normal distribution, evidencing the initial homogeneity of the total sample. The comparative analysis between the groups post-intervention presented significant statistic differences, by a p < 0,05 to the domain “pain” of questionnaire SF-36.

Conclusions

Differences were found on the reduction of the algic scenario presented before and after the intervention between the groups.

Introduction

The ankle flexion-extension test for STFJ (superior tibiofibular joint) is used by osteopaths to identify lesions at that level. Scientific evaluation requires the comparison of test results to referential tests, such as radiographs.

Aim

To show that the diagnostic use of the mobility test in the ankle flexo-extension for the superior tibiofibular joint shows reliability and operational validity when applied with accuracy and precision, supported by X-ray images.

Material and methods

Three trained operators evaluated a study group of 51 individuals, consisting of 30 (58.82 %) female subjects and 21 (41.18 %) male subjects, of which 33 (64.71%) were included as symptomatic and 18 (35.29) asymptomatic.

Results

X-rays taken of the STFJ in ankle flexion and extension, of which 19 (37.25 %) showed dysfunction and 32 (62.74 %) did not. Comparing the observations with the results of X-rays, there were no differences in the area (P=.05). Comparing the ankle flexion-extension mobility test with the x-ray results, the null hypothesis (P>.05) is accepted and therefore, the differences between the observer and the Rx is due to chance.

Conclusions

The ankle flexion-extension test for STFJ confirms the presence of an osteopathic lesion with a sensitivity of 85 % and specificity 73,33 %. An assurance by a positive predictive value of 69.99 % and a negative predictive value of 86.85 %. The pressure algometry on the head of the fibula and the finger-floor test do not provide relevant information for diagnosis. With a trained operator, the test allows a low cost diagnosis and avoids radiation exposure to the patient.

Objectives

To assess the results reached in the articular amplitude (goniometry) and the pressure pain threshold (PPT) (algometry) in the myofascial trigger point (MTP), after the application of muscular energy techniques (MET) and thrust techniques (TT), in the piriformis muscle spasm. Assessment of the intra- and interobserver reliability.

Hypothesis

The MET and TT, applied in the piriform muscle provoke an immediate increase in the its extensibility and pain relief in its MTP.

Material and methods

We designed a clinical, randomised, simple blinded and controlled study, including 80 subjects, randomly divided into three groups. The first “intervention group” (n = 28) received the MET, the second “intervention group” (n = 27) received TT, and the “Control Group” (n = 8) received placebo technique. In all groups pressure pain threshold (PPT) (algometry) on piriform MTP was studied, and also pain perception, evidenced on a visual analogue scale (VAS), goniometry of the inner hip rotation, and photogrammetry. We have carried out statistical analysis (Kolmogorov-Smirnov test, CCI, chi-square and ANOVA).

Results

Reliance analysis, intra- and interobserver (p > .05) showed non-significant differences. The statistical analyses performed corroborated the similarity between the groups before intervention. Analysis of the intervention effects reached significant values (P < .05) in all the studied variables, thus confirming the effect of the applied techniques in the “Intervention” groups, and also in the individual cases.

Conclusions

The MET and TT, applied in the piriformis muscle, provoked an immediate increase in its extensibility and pain relief in the pressure of its MTP.

Objective

To provide an objective assessment of the immediate effect of bladder lift manipulation on the pain threshold of the tibialis anterior trigger point (TATP) and fifth lumbar spinous process (5LSP).

Material and methods

An experimental, controlled, simple randomized, single-blind study was conducted on a sample of 86 patients (two groups of 43 patients), male (44) and female (42), aged 20 to 60. The criteria for patient inclusion was the presence of a painful area located in a palpable taut band in the tibialis anterior (TA) muscle with ankle instability and pain in the 5LSP. Subjects in the experimental group (EG) were treated with a bladder lift maneuver, while patients in the control group (CG) were treated by pumping manipulation of the right thumb trapeziometacarpal joint (TMJ). Pain thresholds in the TATP and 5LSP were measured in both groups, both before and after manipulation.

The measurement recorded for both groups were subjected to statistical analysis with SPPS 17.0, performing Kolmogorov Smirnov test, Student t Test and correlation study (Pearson r correlation coefficient).

Results

The results of statistical analysis showed that pain threshold was significantly reduced in the EG (P<.05) with respect to the CG, as determined by pre- and post- intervention measurements on a Visual Analogue Scale (VAS). No significant changes in pain threshold (P>.05) were found. A Digital Pressure Algometry (DPA), performed both in the EG and the CG, showed a significant change in pain threshold (P<.05), with a negative value for the CG. Statistics “p” values were similar for the TATP and 5LSP. A correlation study (Pearson r correlation coefficient) confirmed the results obtained.

Conclusions

The results of the statistical analysis confirmed our hypothesis: bladder lift manipulation causes pain threshold changes in the TATP and 5LSP immediately after the maneuver.

Objectives

To determine whether the global manipulation (OAA) by Fryette modifies the space between the base of the cranium and the first cervical. Also to find out if manipulated individuals with an oral splint drastically improve their indications in relation to the controlled group.

Material and methods

A randomised, double blind, controlled, experimental trial, with three external evaluators. There was a control group (n = 22), and an experimental group (n = 22) which received the technique (OAA). There were pre-, inter-, and post-evaluations in each group, which included the active opening of the mouth (AOM) test and the pressure pain threshold of the myotome C1 (PPT). All of the subjects were given pre- and post-digital radiography readings.

Results

Statistically significant differences were identified in the digital radiography readings after the use of the manipulation technique (P < .05); thus there was an increase in the pressure pain threshold and the active opening of the mouth (P < .00) compared to the controlled group.

Conclusions

The technique (OAA) and the use of the oral splint produce radiological changes to (6.5) between the base of occipital and the atlas in patients with bruxism. In the opening of the mouth and pain threshold it was shown to be more effective than using the oral splint only.

Introduction

Pain is a complex perception that comprehends a variable proportion of nociceptive input. Not only involves an unpleasant experience, it also has an emotional impact on its relevance and a cognitive component over its origin. The cognitive component builds up over the years influenced by own experiences of pain, observing of other people's experiences and expert information. The expectations and believes that lead from that learning process create a positive (placebo) and negative (nocebo) potential modulation.

Material and methods

A randomized, double-blinded, clinical trial with control group is carried out. Both groups received a vertebral manipulation (VM), but the experimental group is provided with information that generates expectations of improvement after the manipulation. 98 patients were included in the study. These patients presented trigger points (TP) in latent state on the superior trapezius related to a C3 homolateral lesion on extension-rotationsidebending (ERS). Changes on pain perception on the TP were quantified through algometry and visual analogical scale (VAS).

Results

The experimental group shows a better improvement in the two parameters. Both values showed a tendency to statistical significance: P =.09 for pain threshold and 0,05 for VAS.

Conclusions

The initial hypothesis is rejected. It would be advisable to carry out similar trials on other pathologies that occur with chronic spontaneous pain, since believes and expectations of improvement on these cases could have higher impact on pain modulation.

Purpose

To analise, in a comparative way, between two groups, the presence or not of uterine contractions after the Upledger balancing of the sphenobasilar synchondrosis (SBS) technique.

Hypothesis

The Upledger balancing manoeuvre of the SBS doesn’t provoke any immediate contraction in pregnant women in their last three weeks of pregnancy.

Material and methods

It was a randomized, double blinded controlled clinical trial. Once we had checked that there were no uterine contractions before the application of the technique, we did post-intervention measurements to asses the presence/non presence of the uterine contractions in 118 patients (with no SBS known disturbances), being distributed in two homogeneous groups: intervention and control, with 59 patients each. To do our measurements we used a phetal monitor.

This study is an experimental design, planned with independent samples with the same assignment to verify the immediate efficacy of this manoeuvre in pregnant women, in their last three weeks of pregnancy, through the comparison of the results obtained in both groups: those who receive the technique and those who don’t.

Results

The Upledger balancing manoeuvre of the SBS and the placebo are strongly different in the effect of the studied treatment. Level of significance: 95% as statistically significative, with dichotomical variables for both the groups and the effect.

Conclusions

The Upledger balancing manoeuvre of the SBS provokes uterine contractions on pregnant women in their last three weeks of pregnancy during the 5 minutes after the performance of the technique.

Our main concern is to expose the relationship between the pain and the therapeutic strategies used in the osteopathy. At the same time, to justify the application to the pain treatment. We revised the literature about the pain and the different control mechanisms and the possible therapeutics strategies. Therapeutics strategies used in the osteopathy seems to be justified in the pain treatment. Although we need to consider the multiple variables related with the pain and the different types of pain in order to set a proper treatment.