Manual therapy
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Randomized Controlled Trial Multicenter Study Comparative Study
Primary care randomized clinical trial: manual therapy effectiveness in comparison with TENS in patients with neck pain.
This study investigated effectiveness of manual therapy (MT) with transcutaneous electrical nerve stimulation (TENS) to reduce pain intensity in patients with mechanical neck disorder (MND). A randomized multi-centered controlled clinical trial was performed in 12 Primary Care Physiotherapy Units in Madrid Region. Ninety patients were included with diagnoses of subacute or chronic MND without neurological damage, 47 patients received MT and 43 TENS. ⋯ The success rate decreased to one-third of the patients 6 months after the intervention. No differences can be found in the reduction of pain, in the decrease of disability nor in the quality of life between both therapies. Both analyzed physiotherapy techniques produce a short-term pain reduction that is clinically relevant.
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Randomized Controlled Trial
A randomised controlled study examining the short-term effects of Strain-Counterstrain treatment on quantitative sensory measures at digitally tender points in the low back.
Strain-Counterstrain (SCS) intervention has been claimed to elicit immediate and sustained reductions in tenderness at digitally tender points (DTPs), however, there is little experimental evidence to support this. Twenty-eight volunteer participants with low back pain--LBP (17 females and 11 males with mean [SD] age of 39.2 [11.1] and Oswestry disability index of 15.7 [8.6]) participated in this controlled, within-participants study of the immediate and short-term effects of SCS intervention, on pressure pain threshold (PPT) electrical detection threshold (EDT) and electrical pain threshold (EPT) at DTPs in the low back region. Immediate increases in PPT at DTPs were found following all interventions; control intervention: 30.7 kPa [CI 95% - 3.3-64.8] (p = 0.041), sham-SCS intervention: 48.2kPa [CI 95% 14.8-81.7] (p = 0.008) and SCS intervention: 93.4kPa [CI 95% 60.0-126.9] (p<0.0001). ⋯ Increases in PPT at DTPs following SCS intervention did not appear to be maintained between 24 and 96 h after treatment. A further finding was that the control intervention elicited significant increases in both EDT (p = 0.044) and EPT (p = 0.026). The explanation for these findings is unclear.
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Randomized Controlled Trial
Abdominal muscle contraction thickness and function after specific and general exercises: a randomized controlled trial in chronic low back pain patients.
The aim of this study was to assess changes in deep abdominal muscle function after 8 weeks of exercise in chronic low back pain patients. Patients (n = 109) were randomized to specific ultrasound guided, sling or general exercises. Contraction thickness ratio in transversus abdominis (TrA), obliquus internus (OI) and externus (OE), and TrA lateral slide were assessed during the abdominal drawing-in maneuver by b-mode ultrasound. ⋯ Only modest effects in deep abdominal muscle function were observed, mainly due to reduced activation of OI (contraction thickness ratio: 1.42-1.22, p = 0.01) and reduced TrA lateral slide (1.26-1.01 cm, p = 0.02) in the ultrasound group on the left side. Reduced pain was associated with increased TrA and reduced OI contraction ratio (R(2) = 0.18). It is concluded that 6-8 treatments with specific or general exercises for chronic low back patients attained only marginal changes in contraction thickness and slide in deep abdominal muscles, and could only to a limited extent account for reductions in pain.
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Randomized Controlled Trial
Cervical lateral glide increases nociceptive flexion reflex threshold but not pressure or thermal pain thresholds in chronic whiplash associated disorders: A pilot randomised controlled trial.
Sensory hypersensitivity indicative of augmented central pain processing is a feature of chronic whiplash associated disorders (WAD). This study investigated the immediate effects of a cervical spine manual therapy (SMT) technique on measures of central hyperexcitability. In a randomised, single blind, clinical trial, 39 participants with chronic WAD were randomly assigned to a cervical SMT (lateral glide) or manual contact intervention. ⋯ PPTs at the cervical spine increased following both SMT (mean +/- SE: 24.1 +/- 7.3%) and manual contact (21 +/- 8.4%) with no difference between interventions. There was no difference between interventions for pain ratings with the NFR test, PPTs at the Median Nerve or Tibialis Anterior, heat or cold TPT. SMT may be effective in reducing spinal hyperexcitability in chronic WAD.
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Randomized Controlled Trial Comparative Study
Effect of physical exercise interventions on musculoskeletal pain in all body regions among office workers: a one-year randomized controlled trial.
This study investigated effects of physical exercise on musculoskeletal pain symptoms in all regions of the body, as well as on other musculoskeletal pain in association with neck pain. A single blind randomized controlled trial testing a one-year exercise intervention was performed among 549 office workers; specific neck/shoulder resistance training, all-round physical exercise, or a reference intervention. Pain symptoms were determined by questionnaire screening of twelve selected body regions. ⋯ The additional number of pain regions in neck cases decreased in the two exercise groups only (P<0.01-0.05). In individuals with no or minor pain at baseline, development of pain was minor in all three groups. In conclusion, both specific resistance training and all-round physical exercise for office workers caused better effects than a reference intervention in relieving musculoskeletal pain symptoms in exposed regions of the upper body.