Manuel Arroyo-Morales

Kinesio Taping reduces disability and pain slightly in chronic non-specific low back pain: a randomised trial

QUESTION Does Kinesio Taping reduce disability, pain, and kinesiophobia in people with chronic non-specific low back pain? DESIGN Randomised trial, with concealed allocation, assessor blinding, and intention-to-treat analysis. PARTICIPANTS Sixty adults with chronic non-specific low back pain. INTERVENTION The experimental intervention was Kinesio Taping over the lumbar spine for one week; the control intervention was sham taping. OUTCOME MEASURES The following outcomes were measured at baseline, immediately after the week with the tape in situ, and four weeks later: Oswestry Disability Index, Roland- Morris Low Back Pain and Disability Questionnaire, pain on a 10-cm visual analogue scale, Tampa kinesiophobia scale, trunk flexion range of motion, and the McQuade test of trunk muscle endurance. RESULTS At one week, the experimental group had significantly greater improvement in disability, by 4 points (95% CI 2 to 6) on the Oswestry score and by 1.2 points (95% CI 0.4 to 2.0) on the Roland-Morris score. However, these effects were not significant four weeks later. The experimental group also had a greater decrease in pain than the control group immediately after treatment (mean between-group difference 1.1cm, 95% CI 0.3 to 1.9), which was maintained four weeks later (1.0cm, 95% CI 0.2 to 1.7). Similarly trunk muscle endurance was significantly better at one week (by 23 sec, 95% CI 14 to 32) and four weeks later (by 18 sec, 95% CI 9 to 26). Other outcomes were not significantly affected. CONCLUSION Kinesio Taping reduced disability and pain in people with chronic non-specific low back pain, but these effects may be too small to be clinically worthwhile. TRIAL REGISTRATION ACTRN12612000402842.

Benefits of starting rehabilitation within 24 hours of primary total knee arthroplasty: randomized clinical trial

Objective: To compare the benefits of initiating rehabilitation treatment within 24 hours versus 48–72 hours after total knee arthroplasty for osteoarthritis. Design: Experimental study with clinical trial design. Subjects: Patients undergoing primary total knee arthroplasty for osteoarthritis were randomly assigned to experimental (n = 153) and control (n = 153) groups. Interventions: Rehabilitation was started within 24 hours post surgery in the experimental group and between 48 hours and 72 hours post surgery in the controls. Main measures: Measurement variables included joint range of motion, muscle strength, pain, autonomy, gait and balance. Results: In comparison with the controls, the experimental group showed significantly shorter hospital stay (by (mean ± standard deviation) 2.09 ± 1.45 days; P < 0.001), fewer rehabilitation sessions until medical discharge (by 4.95 ± 2.34; P < 0.001), lesser pain (by 2.36 ± 2.47 points; P < 0.027), greater joint range of motion in flexion (by 16.29 ± 11.39 degrees; P < 0.012) and extension (by 2.12 ± 3.19; P < 0.035), improved strength in quadriceps (by 0.98 ± 0.54; P < 0.042) and hamstring muscles (by 1.05 ± 0.72; P < 0.041), and higher scores for gait (P < 0.047) and balance (P < 0.045). Conclusion: Initiation of rehabilitation within 24 hours after total knee arthroplasty reduces the mean hospital stay and number of sessions required to achieve autonomy and normal gait and balance.

Short-Term Effects of Kinesio Taping Versus Cervical Thrust Manipulation in Patients With Mechanical Neck Pain: A Randomized Clinical Trial

STUDY DESIGN Randomized clinical trial. OBJECTIVE To compare the effectiveness of cervical spine thrust manipulation to that of Kinesio Taping applied to the neck in individuals with mechanical neck pain, using self-reported pain and disability and cervical range of motion as measures. BACKGROUND The effectiveness of cervical manipulation has received considerable attention in the literature. However, because some patients cannot tolerate cervical thrust manipulation, alternative therapeutic options should be investigated. METHODS Eighty patients (36 women) were randomly assigned to 1 of 2 groups: the manipulation group, which received 2 cervical thrust manipulations, and the tape group, which received Kinesio Taping applied to the neck. Neck pain (11-point numeric pain rating scale), disability (Neck Disability Index), and cervical-range-of-motion data were collected at baseline and 1 week after the intervention by an assessor blinded to the treatment allocation of the patients. Mixed-model analyses of variance were used to examine the effects of the treatment on each outcome variable, with group as the between-subjects variable and time as the within-subjects variable. The primary analysis was the group-by-time interaction. RESULTS No significant group-by-time interactions were found for pain (F = 1.892, P = .447) or disability (F = 0.115, P = .736). The group-by-time interaction was statistically significant for right (F = 7.317, P = .008) and left (F = 9.525, P = .003) cervical rotation range of motion, with the patients who received the cervical thrust manipulation having experienced greater improvement in cervical rotation than those treated with Kinesio Tape (P<.01). No significant group-by-time interactions were found for cervical spine range of motion for flexion (F = 0.944, P = .334), extension (F = 0.122, P = .728), and right (F = 0.220, P = .650) and left (F = 0.389, P = .535) lateral flexion. CONCLUSION Patients with mechanical neck pain who received cervical thrust manipulation or Kinesio Taping exhibited similar reductions in neck pain intensity and disability and similar changes in active cervical range of motion, except for rotation. Changes in neck pain surpassed the minimal clinically important difference, whereas changes in disability did not. Changes in cervical range of motion were small and not clinically meaningful. Because we did not include a control or placebo group in this study, we cannot rule out a placebo effect or natural changes over time as potential reasons for the improvements measured in both groups. LEVEL OF EVIDENCE Therapy, level 1b.

Associations among musculoskeletal impairments, depression, body image and fatigue in breast cancer survivors within the first year after treatment.

The aim of the current study was to investigate the relationship between pressure pain thresholds, shoulder movement, mood state, pain perception, muscle endurance, quality of life and fatigue in breast cancer survivors (BCS). Fifty-nine BCS reporting fatigue were examined at 6 months post-treatment. Women completed the Piper Fatigue Scale, the Breast Cancer-Specific Quality of Life Questionnaire, the Profile of Mood State, and neck-shoulder visual analogue scale. Additionally, shoulder flexion range of motion, the McQuade test (trunk flexor endurance) and pressure pain thresholds over the C5-C6 joint, the deltoid muscle, the second metacarpal and tibialis anterior muscle were assessed. Fatigue was greater in those patients with higher depression (r= 0.45, P < 0.05), higher shoulder pain (r= 0.39, P < 0.05), higher neck pain (r= 0.46, P < 0.01), lower body image (r=-0.34, P < 0.05) and reduced shoulder movement (r=-0.32, P < 0.05). Regression analyses demonstrated that depression, cervical pain intensity, body image and shoulder mobility were associated with fatigue (r= 0.55, P < 0.001). A psychological state characterised with higher depression and reduced body image and a physical impairment with higher cervical pain intensity and reduced shoulder mobility confirm multidimensional character of fatigue in BCS.

Effects of myofascial release techniques on pain, physical function, and postural stability in patients with fibromyalgia: a randomized controlled trial:

Objective: To determine the effect of myofascial release techniques on pain symptoms, postural stability and physical function in fibromyalgia syndrome. Design: A randomized, placebo-controlled trial was undertaken. Subjects: Eighty-six patients with fibromyalgia syndrome were randomly assigned to an experimental group and a placebo group. Interventions: Patients received treatments for 20 weeks. The experimental group underwent 10 myofascial release modalities and the placebo group received sham short-wave and ultrasound electrotherapy. Main measures: Outcome variables were number of tender points, pain, postural stability, physical function, clinical severity and global clinical assessment of improvement. Outcome measures were assessed before and immediately after, at six months and one year after the last session of the corresponding intervention. Results: After 20 weeks of myofascial therapy, the experimental group showed a significant improvement (P  <  0.05) in painful tender points, McGill Pain Score (20.6 ± 6.3, P < 0.032), physical function (56.10 ± 17.3, P < 0.029), and clinical severity (5.08 ± 1.03, P < 0.039). At six months post intervention, the experimental group had a significantly lower mean number of painful points, pain score (8.25 ± 1.13, P < 0.048), physical function (58.60 ± 16.30, P < 0.049) and clinical severity (5.28 ± 0.97, P < 0.043). At one year post intervention, the only significant improvements were in painful points at second left rib and left gluteal muscle, affective dimension, number of days feeling good and clinical severity. Conclusion: The results suggest that myofascial release techniques can be a complementary therapy for pain symptoms, physical function and clinical severity but do not improve postural stability in patients with fibromyalgia syndrome.

Widespread mechanical pain hypersensitivity as a sign of central sensitization after breast cancer surgery: comparison between mastectomy and lumpectomy

OBJECTIVE To investigate the differences in widespread pressure pain hypersensitivity after two surgery approaches for breast cancer: mastectomy or lumpectomy. DESIGN A cross-sectional blinded study. SETTING Widespread pressure pain hypersensitivity has been suggested as a sign of central sensitization. No study has previously investigated the presence of widespread pain pressure hypersensitivity after breast cancer surgery. PATIENTS Twenty-one women (age: 52±9 years old) who had received lumpectomy after breast cancer, 21 women (mean age: 50±10 years old) who had received mastectomy surgery after breast cancer, and 21 healthy women (age: 51±10 years old) participated. OUTCOME MEASURES Pressure pain thresholds (PPT) were bilaterally assessed over C5-C6 zygapophyseal joint, deltoid muscle, second metacarpal, and the tibialis anterior muscle. RESULTS Women with mastectomy had greater intensity of neck (t= -2.897; P=0.006) and shoulder/axillary (t= -2.609; P=0.013) pain as compared with those who received lumpectomy. The results showed that PPT were significantly decreased bilaterally over the C5-C6 zygapophyseal joint, deltoid muscle, second metacarpal, and tibialis anterior muscle in both lumpectomy and mastectomy groups as compared with healthy women in all points (P<0.001), without differences between both breast cancer groups (P=0.954). No significant differences in the magnitude of PPT levels between both breast cancer groups were found (all, P>0.450). PPT levels over some areas were negatively associated with the intensity of pain in the mastectomy, but not lumpectomy, group. CONCLUSION The current study found widespread pressure pain hyperalgesia in women who received breast cancer surgery suggesting central spreading sensitization. The degree of central sensitization was similar between lumpectomy and mastectomy surgery.

The handgrip strength test as a measure of function in breast cancer survivors: relationship to cancer-related symptoms and physical and physiologic parameters.

ObjectiveThe aim of this study was to examine the relationship of muscular strength, as measured by the handgrip strength (HGS) test, with pain, fitness, fatigue, mood, and autonomic nervous system function in breast cancer survivors. DesignA cross-sectional study comprising 95 breast cancer survivors was conducted. HGS; heart rate variability; pressure pain threshold of the neck, shoulder, hand, and tibia of the affected side; and fitness level (6-min walk test, neck-shoulder mobility, vertical jump, sit-to-stand test, and trunk curl test) were assessed as outcomes. Participants completed the Fatigue Piper Scale and Profile of Mood States questionnaires and the neck-shoulder visual analog scale. Correlation was conducted to examine the relationship of HGS with pain, fitness, fatigue, and mood. ResultsWe observed a fair relationship of HGS with shoulder pain and a moderate to fair relationship with fitness (all P < 0.01; &rgr; range, 0.24–0.56). The relationship between HGS and heart rate variability (high-frequency domain) was weak (P = 0.049, &rgr; = 0.23). Likewise, the relationship between HGS and Profile of Mood States subscales ranged from weak to fair (all P < 0.001; &rgr; range, −0.22 to −0.36). HGS showed a weak relationship with Fatigue Piper Scale (all P < 0.01; &rgr; range, −0.28 to −0.35). Passive shoulder flexion, fatigue, and vertical jump were independent and significant predictors of HGS (P < 0.01; R2 = 0.466). ConclusionsThese results suggest that the HGS test might be an important correlate of health in breast cancer survivors. This finding suggests that HGS could be recommended as an adjuvant method of evaluation, which may help with efficiency of clinical practice. Further research on breast cancer patients is needed to confirm or refute these findings.

Exercise, Manual Therapy, and Education with or Without High-Intensity Deep-Water Running for Nonspecific Chronic Low Back Pain A Pragmatic Randomized Controlled Trial

Objectives: The aim of this study on persons with nonspecific chronic low back pain was to evaluate the effect of a multimodal physical therapy program with or without the addition of deep-water running on pain, physical disability, and general health. Design: A randomized controlled trial involving 46 subjects with nonspecific chronic low back pain were treated three times a week for 15 wks. Each group received 60 mins of multimodal physical therapy program (an individualized exercise program; manual therapy; and back care, pain education, and information on an active lifestyle), whereas one group performed additional 20-min sessions of deep-water running at an individual workload of the aerobic threshold. Results: Both interventions resulted in significant improvements in pain, disability, and physical health. The mean change in pain, disability, and physical health state were −36.1 ± 25.1 mm on the visual analog scale, −3.0 ± 4.8 points for the Roland Morris Questionnaire, and 10.6 ± 12.9 points for the Short Form-12 for the physical therapy plus deep-water running group and −34.1 ± 26.0 mm on the visual analog scale, −1.6 ± 1.5 points for the Roland Morris Questionnaire, and 8.9 ± 13.0 points for the Short Form-12 for the physical therapy alone group. Conclusions: Pain, disability, health status, muscle strength and endurance, and lumbar range of motion significantly improved in both groups. The addition of a deep-water running program at an individual workload of the aerobic threshold to the multimodal physical therapy program produced a significant improvement in pain in patients with nonspecific chronic low back pain, but this was not significantly different when compared with multimodal physical therapy program alone. Disability, health status, muscle strength and endurance, and lumbar range of motion significantly improved to a similar level in both intervention groups.

Myofascial trigger points in neck and shoulder muscles and widespread pressure pain hypersensitivtiy in patients with postmastectomy pain: evidence of peripheral and central sensitization

ObjectiveTo describe the presence of widespread pressure pain hyperalgesia and myofascial trigger points (TrPs) in neck and shoulder muscles in patients with postmastectomy pain. MethodsTwenty-nine women (mean age: 50±8 y) with postmastectomy pain and 23 matched healthy controls (mean age: 50±9 y) participated. Pressure pain thresholds (PPT) were bilaterally assessed over the C5-C6 zygapophyseal joint, the deltoid muscle, the second metacarpal, and the tibialis anterior muscle. TrPs in the upper trapezius, suboccipital, levator scapulae, sternocleidomastoid, scalene, infraspinatus, and pectoralis major muscles were explored. TrPs were considered active if the local and referred pain reproduced symptoms and the patient recognized the pain as familiar. ResultsTwenty-five (86%) patients reported neck pain whereas 20 (69%) patients showed shoulder/axillary pain. The results showed that PPT levels were significantly decreased bilaterally over the C5-C6 zygapophyseal joint, deltoid muscle, second metacarpal, and tibialis anterior muscle in patients with postmastectomy pain as compared with controls (all sites, P<0.001). No significant differences in the magnitude of PPT decrease between sites were found (P=0.222). The mean number of active TrPs for each woman with postmastectomy pain was 5.4±1.8. Healthy controls only had latent TrPs (0.5±0.6). Patients with postmastectomy pain showed a greater number of TrPs than controls (P<0.001). In all muscles, there was significantly more active TrPs in patients with postmastectomy pain as compared with controls (P<0.001). Active TrPs in the pectoralis major (n=27, 93%), infraspinatus (n=23, 79%), and upper trapezius (n=19, 65%) muscles were the most prevalent in the affected side in the postmastectomy group. The number of active TrPs was positively correlated with neck (rs=0.392, P=0.036) and shoulder/axillary (rs=0.437, P=0.018) pain intensity. ConclusionsOur findings revealed bilateral widespread pressure pain hypersensitivity in patients with postmastectomy pain. In addition, the local and referred pain elicited by active TrPs reproduced neck and shoulder/axillary complaints in these patients. These results suggest peripheral and central sensitization in patients with postmastectomy pain.

Normalization of widespread pressure pain hypersensitivity after total hip replacement in patients with hip osteoarthritis is associated with clinical and functional improvements

OBJECTIVE To evaluate the relevance of ongoing nociceptive joint inputs to the maintenance of widespread pain hypersensitivity in patients with hip osteoarthritis (OA) and to determine whether a reversal in the widespread pressure hypersensitivity together with an improvement in pain and function occurs after total hip replacement in these patients. METHODS Forty patients with hip OA participated. Twenty patients underwent total hip replacement, and the other 20 patients were assigned to a waiting list. Pressure-pain thresholds (PPTs) over the second metacarpal bone and the gluteus medius, vastus medialis, vastus lateralis, and tibialis anterior muscles were assessed bilaterally with a pressure algometer before and 3 months after total hip replacement surgery. Assessments of pain intensity (by visual analog scale [VAS]), physical function (by the Western Ontario and McMaster Universities Osteoarthritis Index), and health status (by the Short Form 12 health survey and the EuroQol 5-domain index) were also performed. RESULTS Patients who underwent total hip arthroplasty exhibited a reduction in widespread pressure pain hyperalgesia (increases in PPTs) over local and distant pain-free areas, as compared with before surgery and as compared with the patients assigned to the waiting list. PPTs were related to hip pain intensity, and significant correlations were found between higher VAS scores and lower average PPTs over all points assessed (-0.409 < r < -0.306, P < 0.05). Patients who underwent total hip arthroplasty exhibited a greater decrease in pain intensity and greater increases in function and health status than did those who were on the waiting list. Changes in the intensity of hip pain were moderately associated with changes in pressure pain sensitivity in the hip arthroplasty group. CONCLUSION Normalization of widespread pressure pain hyperalgesia was found after successful hip joint replacement in patients with hip OA. Altered pain processing seems to be driven by ongoing peripheral joint pathology, which stresses the importance of reducing pain in OA.