Autonomic function and pressure pain threshold following thoracic mobilization in asymptomatic subjects: A randomized controlled trial

Objective

To compare the effects of two different mobilization techniques and a placebo intervention applied to the thoracic spine on heart rate variability (HRV) and pressure pain threshold (PPT) in asymptomatic individuals.

The influence of low-intensity resistance training combined with neuromuscular electrical stimulation on autonomic activity in healthy adults: A randomized controlled cross-over trial

Background:Low-intensity resistance training (RT) combined with neuromuscular electrical stimulation (NMES) is one method of exercise to improve the deterioration of physical function. However, it is unclear whether low-intensity RT combined with NMES (RT + NMES) can be safely implemented.Objective:This study aimed to examine the influence of low-intensity RT + NMES on autonomic activity and cardiovascular responses in healthy adults.Methods:This study was an open-label, randomized controlled cross-over trial. The exercise intensity of isometric knee extension RT was set to 40% of the maximum voluntary contraction (peak torque). NMES was adjusted to a biphasic asymmetrical waveform with the frequency maintained at 50 Hz and a phase duration of 300 μs. The difference in the change in autonomic activity and cardiovascular responses was compared by assessing heart rate variability, blood pressure, and heart rate during RT and RT+NMES.Results:Twenty healthy male college students (mean age 21.0±0.6 years) participated in this study. The ratio of low- and high-frequency components of heart rate variability, systolic blood pressure, and heart rate increased during exercise in the RT and RT+NMES sessions (P<0.05). There were no significant differences in autonomic activity and cardiovascular responses throughout the sessions during RT and RT+NMES.Conclusion:In conclusion, our results demonstrated that low-intensity RT+NMES was safe and did not induce excessive autonomic and cardiovascular responses in healthy adults.     

Effects of myofascial trigger point dry cupping on pain and function in patients with plantar heel pain: A randomized controlled trial

ObjectiveTo investigate the effects of dry cupping on calf muscle myofascial trigger points (MTrPs) on pain and function in patients with plantar heel pain.MethodsSeventy-one patients were randomly divided into an intervention group or control group. Both groups performed stretching exercises for the calf muscle and plantar fascia and ankle dorsiflexion exercises. The intervention group also received dry cupping. The primary outcome measures were visual analogue scale (VAS), pressure pain threshold (PPT), and patient-specific functional scale (PSFS). The secondary outcomes were ankle dorsiflexion range of motion (ROM) and ankle plantar flexor strength. These measurements were performed at baseline, immediately after intervention, and after 2 days.ResultsCurrent VAS significantly decreased immediately in the intervention group (p = 0.002), but not in the control group (p ≥ 0.220). Morning VAS decreased significantly in both groups (p < 0.001) after 2 days, but decreased more in the intervention group (p = 0.006). Trigger point PPT significantly improved immediately in the intervention group (p = 0.003), but not in the control group (p = 0.112). Both groups improved significantly in PSFS (p < 0.001) and ankle dorsiflexion ROM (p < 0.001). Plantar flexor strength significantly increased immediately in the intervention group (p < 0.001), but not in the control group (p = 0.556).ConclusionAdding dry cupping on calf MTrPs to self-stretching and ankle dorsiflexion exercises for patients with plantar heel pain was superior to only self-stretching and active ankle dorsiflexion exercises in pain, ankle dorsiflexion ROM, and plantar flexor strength.     

Effects of non-supervised aerobic exercise on sleep quality and maternal-fetal attachment in pregnant women: A randomized controlled trial

ObjectivesThis study was designed to evaluate the effect in pregnant women of a non-supervised aerobic exercise intervention on sleep quality and maternal-fetal attachment.DesignPretest-posttest randomized controlled trial.SettingPrenatal clinic of a medical center in southern Taiwan.ParticipantsOne hundred and forty eligible, pregnant women were assigned systematically, at a random starting point, to either the experimental group (n = 70) or the control group (n = 70).InterventionParticipants in the experimental group received a 20-minute, low-impact aerobic exercise video on DVD and were instructed to exercise at home at least three times per week for a period of three months. Participants in the control group received routine prenatal care only.Main outcome measuresThe Pittsburgh Sleep Quality Index and Modified Maternal-Fetal Attachment Scale were used to assess outcome measures before the intervention and at four and 12-weeks post-intervention.ResultsThe paired-sample t-tests revealed a significant improvement in sleep quality in the experimental group at 4-weeks posttest, which persisted through 12-weeks posttest. In addition, the experimental group reported a significantly higher mean score for maternal-fetal attachment at 4-weeks posttest than the control group.ConclusionThe results of this study indicate that performing aerobic exercise ameliorates the decline in sleep quality and improves maternal-fetal attachment in women who are pregnant. These findings may be used to encourage pregnant women to regularly perform low-impact aerobic exercise.     

The effect of aerobic exercise on immune biomarkers and symptoms severity and progression in patients with COVID-19: A randomized control trial

BackgroundThe World Health Organization in March 2020 has announced that COVID-19 is a world pandemic because the number of infected cases increases rapidly. however, there are several available vaccines, their protection is limited to a certain period. Thus, the role of modalities that improve immune functions should be performed to counter COVID-19 viral load and decrease mortality rates.ObjectiveTo investigate the effect of aerobic exercise on immune biomarkers, disease severity, and progression in patients with COVID-19.DesignA randomized controlled study.ParticipantsThirty patients with COVID-19 participated in this study. Participants’ age ranged from 24 to 45 years old. Participants had a mild or moderate COVID-19. Participants were assigned randomly into two groups, exercise and control groups. There were two main dependent variables including blood immune markers and severity of respiratory symptoms.InterventionsAll participants performed 2 weeks of moderate-intensity aerobic exercise for 40 min/session, 3 sessions/week. The measurements were performed at baseline, and after 2-weeks.ResultsAt baseline measurements, there were non-significant differences between both groups in the Wisconsin scale total score, Leucocytes, Lymphocytes, Interleukin-6, Interleukin-10, Immunoglobulin-A, and TNF-α (P > .05). After the intervention, the Wisconsin scale (patient-oriented illness-specific quality-of-life) total score significantly decreased in the intervention group (P < .05); while, Leucocytes, Lymphocytes, and Immunoglobulin-A significantly increased in the intervention group (P < .05).ConclusionThe current study indicated that 2 weeks of moderate-intensity aerobic exercise decreased the severity and progression of COVID-19 associated disorders and quality of life. Also, a 2-weeks of aerobic exercise positively affected immune function by increasing the amounts of Leucocytes, Lymphocytes, Immunoglobulin A.     

Spinal mobilization vs conventional physiotherapy in the management of chronic low back pain due to spinal disk degeneration: a randomized controlled trial

Objectives: The aim of the study was to examine the efficacy of spinal mobilization in subjects with low back pain (LBP) and associated spinal disk degeneration.

Methods: Seventy-five subjects suffering from chronic LBP (>3 months) were randomly allocated into 3 groups of 25 subjects each. Each group received five treatment sessions with the first group receiving manual therapy (MT) (spinal mobilization), the second a sham treatment, and the third conventional physiotherapy (CP) (stretching exercises, transcutaneous electrical nerve stimulation, and massage). Subjects were assessed for their pain intensity using the numerical pain rating scale and for their self-reported disability using the Oswestry and Roland-Morris Questionnaire at baseline and after the completion of the five treatment sessions.

Results: Paired t-tests showed a significant improvement for all outcome measures in the MT and CP group (p < 0.05). Analysis of covariance revealed that the MT group had significant improvement in all outcome measures in comparison with the sham and CP group (p < 0.05), whereas no significant difference was observed between the sham and CP group (p > 0.05).

Discussion: MT is preferable to CP in order to reduce the pain intensity and disability in subjects with chronic LBP and associated disk degeneration. The findings of this study may lead to the establishment of spinal mobilization as one of the most preferable approaches for the management of LBP due to disk degeneration.

Level of evidence: 1b.     

Comparative effects of tensioning and sliding neural mobilization on peripheral and autonomic nervous system function: A randomized controlled trial

Background:Although different types of neural mobilization (NM) exercises induce different amounts of longitudinal nerve excursion and strain, the question whether the increased longitudinal stress and nerve excursion from sliding or tensioning intervention may subtly affect the neural functions has not been answered yet.Objective:To compare the effects of tensioning NM versus sliding NM of the median nerve on peripheral and autonomic nervous system function.Methods:In this randomized controlled trial, 90 participants were randomly assigned to tensioning NM, sliding NM, or sham NM. The neurophysiological outcome measures included peak-to-peak amplitude of the dermatomal somatosensory evoked potential (DSSEP) for dermatomes C6, C7, C8, and T1. Secondary outcome measures included amplitude and latency of skin sympathetic response. All outcome measures were assessed pretreatment, immediately after the two weeks of treatment and one week after the last session of the treatment.Results:A 2-way repeated measures ANOVA revealed significant differences between the three groups. The post hoc analysis indicated that tensioning NM significantly decreased the dermatomal amplitude for C6, C7, C8, and T1 (p<0.005). Sympathetic skin responses in the gliding NM group showed lower amplitudes and prolonged latencies post-treatment when compared to tensioning NM group (p<0.05). In contrast, no significant changes were observed in the DSSEPs and skin sympathetic responses for participants in the sham treatment group (p>0.05).Conclusions:A tensioning NM on the median nerve had a possible adverse effect on the neurophysiology variables of the nerves involved in the neural mobilization. Thus, tensioning NM with the current parameters that place increased stress and strain on the peripheral nervous system should be avoided.     

Short term relief of multisite chronicpain with Bowen Therapy: A double-blind,randomized controlled trial

IntroductionBowen Therapy, a form of soft tissue manipulation, is commonly used to treat musculoskeletal conditions; yet, there is little evidence for its efficacy. The goal of the study was to investigate the impact of Bowen Therapy on pain and function in people with chronic pain in multiple locations. Additionally, we examined the mechanisms of effect through monitoring the nociceptive and autonomic nervous systems.MethodThe study was a double-blind, randomized controlled trial involving 31 people with chronic pain. Participants were randomized into real and sham therapy groups. Each group received 6 sessions of therapy over 8 weeks. The primary outcome measures of pain and function were assessed using standard questionnaires. Quantitative sensory testing was used to assess the nociceptive system, while recordings of heart rate variability and skin conductance were used to assess the autonomic nervous system. Outcome measures were assessed at baseline and at 1- and 6-weeks following completion of the intervention.ResultsThe real therapy group had a significantly lower pain score 1-week following the intervention compared to the sham group. There were no differences between groups at the final follow-up or in the function measures. There was no significant change in the nociceptive measures but there was evidence of increased activation of the sympathetic nervous system.DiscussionBowen Therapy gave rise to a short-term reduction in pain that was not evident in a sham therapy group. The mechanisms of action of Bowen Therapy remain uncertain but may involve sympathoexcitation.     

Effects of lymphatic drainage therapy on autonomic nervous system responses in healthy subjects: A single blind randomized controlled trial

ObjectivesThis study aimed to determine effects of lymphatic drainage therapy (LDT) on autonomic nervous system (ANS) responses by comparing including Hoffmann reflex (H reflex), heart rate variability (HRV), salivary alpha-amylase (sAA) and muscle tone (via straight leg raise (SLR)) in healthy participants.MethodsA single blind randomized controlled trial evaluating sixty-six healthy participants including 58 females and 8 males aged between 40 and 65 years. All participants were blinded and randomized to either experimental group (EXP: LDT) or control group (CT: rest). LDT was applied to participants 45 min in experimental group. The LDT is light movement applied by an experienced physical therapist, starting from neck, deep abdomen, and along to the leg. While for the control group, participants received 45 min supine on the treatment table. Tests for evaluating ANS such as Hoffmann reflex (H reflex), heart rate variability (HRV), salivary alpha-amylase (sAA) and straight leg raise (SLR) were assessed at pre and post intervention.ResultsThe findings demonstrated that H reflex decreased significantly after applying LDT; within and between groups (p < 0.05). Whereas, it increased significantly in control group. First tension (R1) indicated by participants during SLR significantly improved within both groups. However, there were no significant differences of HRV and sAA in either LDT or control groups.ConclusionThis study demonstrated that LDT decreased autonomic activity via decreased spinal reflex excitability and tension in healthy participants.     

Effects of dry needling on pain,pressure pain threshold and psychological distress in patients with mild to moderate hip osteoarthritis: Secondary analysis of a randomized controlled trial

ObjectiveTo determine the changes produced by dry needling in active myofascial trigger points in hip muscles compared to a sham needling on pain intensity, main pain area, pressure pain threshold and psychological distress in patients with hip osteoarthritis.DesignSecondary analysis of a single-centre, randomized, double-blinded, clinical trial.Intervention30 participants with mild to moderate hip osteoarthritis were randomly assigned to DN group (n = 15) or sham DN group (n = 15). DN group received three sessions of penetrating DN, and sham DN group received three sessions of non-penetrating DN in hip muscles.Main outcome measures: Pain intensity (Visual Analogue Scale), main pain area (body chart), pressure pain threshold (algometry), psychological distress (Hospital Anxiety and Depression Scale) and self-reported improvement (Global Rate of Change) were measured before and after treatment.ResultsDN group showed statistically significant improvements with large effect sizes for pain intensity (p < 0.001; E.S: 2.7), pressure pain thresholds (p < 0.05; E.S: 1.3-1.8) and psychological distress (p = 0.002; E.S: 1.5) compared to sham DN group. The DN group described a self-reported improvement categorised as quite a bit, great or very great deal better (n = 12, 80%). No statistically significant differences were found between baseline and postintervention in the sham DN group in any variable (p > 0.05).ConclusionsThree sessions of dry needling were more effective than sham dry needling for improving pain intensity, pressure pain threshold and psychological distress in patients with mild to moderate hip osteoarthritis in the short term.     

Aerobic exercise training in addition to conventional physiotherapy for chronic low back pain: a randomized controlled trial

Chan CW, Mok NW, Yeung EW. Aerobic exercise training in addition to conventional physiotherapy for chronic low back pain: a randomized controlled trial.

Objective

To examine the effect of adding aerobic exercise to conventional physiotherapy treatment for patients with chronic low back pain (LBP) in reducing pain and disability.

Design

Randomized controlled trial.

Setting

A physiotherapy outpatient setting in Hong Kong.

Participants

Patients with chronic LBP (N=46) were recruited and randomly assigned to either a control (n=22) or an intervention (n=24) group.

Interventions

An 8-week intervention; both groups received conventional physiotherapy with additional individually tailored aerobic exercise prescribed only to the intervention group.

Main Outcome Measures

Visual analog pain scale, Aberdeen Low Back Pain Disability Scale, and physical fitness measurements were taken at baseline, 8 weeks, and 12 months from the commencement of the intervention. Multivariate analysis of variance was performed to examine between-group differences.

Results

Both groups demonstrated a significant reduction in pain (P<.001) and an improvement in disability (P<.001) at 8 weeks and 12 months; however, no differences were observed between groups. There was no significant difference in LBP relapse at 12 months between the 2 groups (χ²=2.30, P=.13).

Conclusions

The addition of aerobic training to conventional physiotherapy treatment did not enhance either short- or long-term improvement of pain and disability in patients with chronic LBP.     

Spinal manipulation does not affect pressure pain thresholds in the absence of neuromodulators: a randomized controlled trial

Background: Measurement of pressure pain threshold (PPT) is a way to determine one of the many potential treatment effects of spinal manipulative therapy.

Objective: To determine how multiple spinal manipulations administered in a single-session affected PPTs at local and distal sites in asymptomatic individuals.

Methods: Participants were randomly assigned into one of three groups: Group one (n = 18) received a lumbar manipulation followed by a cervical manipulation. Group two (n = 17) received a cervical manipulation followed by a lumbar manipulation. The control group (n = 19) received two bouts of five minutes of rest. At baseline and after each intervention or rest period, each participant’s PPTs were obtained using a handheld algometer. The PPTs were tested bilaterally over the lateral epicondyles of the humerus and over the mid-bellies of the upper trapezius, lumbar paraspinal, and the tibialis anterior muscles. This study was registered with ClinicalTrials.gov, and its Identifier is NCT02828501.

Results: Repeated-measures ANOVAs and Kruskal–Wallis tests showed no significant within- or between-group differences in PPT. Within-group effect sizes in the changes of PPT ranged from ?.48 at the left paraspinal muscles to .24 at the left lateral humeral epicondyle. Statistical power to detect significant differences at α of 0.05 was calculated to be 0.94.

Conclusions: This study suggests that in young adults who do not have current or recent symptoms of spinal pain, multiple within-session treatments of cervical and lumbar spinal manipulation fail to influence PPTs. Changes in PPT that are observed in symptomatic individuals are likely to be primarily influenced by pain-related neuromodulators rather than by an isolated, mechanical effect of spinal manipulation.     

The role of the Back Rx exercise program in diskogenic low back pain: a prospective randomized trial

OBJECTIVE: To determine the efficacy of the Back Rx program in patients with diskogenic low back pain (LBP). DESIGN: Prospective, randomized study. SETTING: Outpatient setting of a major university teaching hospital. PARTICIPANTS: Subjects with LBP greater than leg pain for at least 3 months duration and magnetic resonance imaging evidence of disk pathology. Fifty of 87 eligible patients consented and were randomized into age- and sex-matched groups. INTERVENTIONS: Group I participated in the Back Rx program for 15 minutes a day, 3 times a week. All patients, from both groups, received celecoxib (200 mg) and hydrocodone (5 mg) with acetaminophen (500 mg) as needed, and wore a lumbar cryobrace for 15 minutes before bedtime. MAIN OUTCOME MEASURES: Roland-Morris Disability Questionnaire score, numeric pain rating score, patient satisfaction score, measured forward flexion, use of celecoxib, hydrocodone, and acetaminophen, time off work, and rate of symptom recurrence. RESULTS: At minimal 12-month follow-up, 70% of group I reported over 50% pain reduction with good or better patient satisfaction, compared with 33% in group II (P=.001). Average daily hydrocodone and acetaminophen use and time off work were less for group I (all, P<.05). Recurrence of symptoms at the end of the year was less for group I (P=.001). CONCLUSIONS: Back Rx exercises, combined with use of a lumbar cryobrace and oral medications, yielded superior therapeutic results than with use of medications and cryobrace alone. Also significant was the reduced rate of recurrence in these patients.     

The effects of neck mobilization in patients with chronic neck pain: A randomized controlled trial

Objective

To determine the effect of mobilization and routine physiotherapy on pain, disability, neck range of motion (ROM) and neck muscle endurance (NME) in patients having chronic mechanical neck pain (NP).

A randomized clinical trial of self-stretching with and without mindful breathing - immediate effect on pressure pain and range of motion in myofascial pain syndrome

IntroductionThe stretching intervention of the current study was applied from several principles and the latest updated method of slowed and synchronized patterns between self-stretching with mindful breathing (MB) and eyes closed period before and after the self-stretching was performed at least four times repeatedly within 150 s per each pose.ObjectiveTo investigate effects of self-stretching in five poses with and without MB on pain and cervical range of motion (CROM).DesignThe study was a randomized clinical trial with a blinded assessor.SettingThe participants were 30 females per group, aged 30–59 years with myofascial pain syndrome (MPS).Main outcome measuresThe participants were evaluated via the pressure pain threshold (PPT) at the upper trapezius muscles and the CROM.ResultsBoth groups showed that the PPT at upper trapezius muscles significantly increased after performing the stretching (p < 0.001). The ROM in the MB group significantly increased in extension, left and right lateral flexion, and left rotation (p < 0.05).ConclusionSelf-stretching with mindful breathing was designed to allow for effects within the shortest time in patients with myofascial pain syndrome. Since this treatment is a non-pharmacological intervention and was considered as part of active self-care, we suggest that this therapy could be used as alternative therapy for patients with MPS.     

Effects of the craniocervical flexion and isometric neck exercise compared in patients with chronic neck pain: A randomized controlled trial

ABSTRACT

Introduction: The present study compared the effects of neck isometric exercise (NIE) and craniocervical flexion exercise (CFE) on cervical lordosis, muscle endurance of cervical flexion, neck disability index (NDI), and active cervical range of motion (ACROM) in all three planes in patients with non-specific, chronic neck pain (CNP). Materials and Methods: Forty-one patients from a university hospital-based rehabilitation center were randomly assigned to an experimental (22 patients performing CFE) or control (19 patients performing NIE) group. All patients performed three 30-second repetitions of stretching exercises for the neck flexor, extensor, lateral flexor, and rotator as warm-up and cool-down exercises. The patients in the experimental group then underwent CFE 30 minutes/day, 3 times a week, for 8 weeks, while the control group underwent NIE. The main outcome measures were pain on visual analogue scale (VAS) and perceived disability based on the neck disability index (NDI). The secondary outcomes were cervical lordosis measured by an absolute rotation angle (ARA), muscle endurance of cervical flexion, and ACROM. Results: Both groups showed improved pain, NDI, endurance of the cervical flexor muscles, and ACROM in all three planes after 8 weeks (p < 0.001 for all). All these outcomes, except for the NDI, showed significantly greater improvements following CFE than following NIE (p < 0.05 for all). In particular, a significantly improved ARA of cervical lordosis was found following CFE but not following NIE (p < 0.05). Conclusions: CFE targeted at retraining the craniocervical flexor muscles was useful for improving or restoring the pain, cervical lordosis, and neck-related function disorders among patients with non-specific CNP.     

Deep massage to posterior calf muscles in combination with neural mobilization exercises as a treatment for heel pain: A pilot randomized clinical trial

BackgroundPlantar heel pain syndrome (PHPS) is a common foot disorder; however, there is limited clinical evidence on which to base treatment. Repeated clinical observations indicating heel pain during heel rise and minisquat on the affected leg, involving activation of posterior calf muscles, formed the basis of this study.ObjectiveTo compare deep massage therapy to posterior calf muscles and neural mobilization with a self-stretch exercise program (DMS) to a common treatment protocol of ultrasound therapy to the painful heel area with the same self-stretch exercises (USS).MethodsPatients with PHPS were assigned to a program of 8 treatments over a period of 4–6 weeks in a single-blind randomized clinical trial. Functional status (FS) at admission and discharge from therapy as measured by the Foot & Ankle Computerized Adaptive Test was the main outcome measure.ResultsSixty-nine patients were included in the trial (mean age 53, standard deviation (SD) 13, range 25–86, 57% women), 36 received DMS treatment and 33 with USS. The overall group-by-time interaction for the mixed-model analysis of variance (ANOVA) was found statistically significant (p = 0.034), with a change of (mean (confidence interval, CI)) 15 (9–21) and 6 (1–11) FS points for the DMS and USS groups, respectively.ConclusionsData indicated that both treatment protocols resulted in an overall short-term improvement, however, DMS treatment was significantly more effective in treating PHPS than USS treatment.     

The effect of remote ischemic postconditioning on autonomic function in patients with acute ischemic stroke: A Randomized Controlled Trail

ObjectiveThe evidence for the effect of remote ischemic postconditioning(RIpostC) on autonomic function in patients with acute ischemic stroke(AIS) is lacking and the neural mechanism underlying the protection of RIpostC remains speculative. This trial was aimed to evaluated the efficiency of RIpostC on autonomic function in AIS patients.DesignOne hundred and six AIS patients were included in this prospective, randomized, placebo-controlled trial. Patients in intervention group (n = 57) received 4 cycles of alternating inflation (cuff inflation to 200 mmHg) and deflation for 5 min on healthy upper arm once a day for 30 days. The control group underwent a sham inflation and deflation cycles. Autonomic function was evaluated by heart rate variability (HRV).ResultsAll HRV parameters except for the ratio of low frequency to high frequency (P = 0.101) increased significantly with time (P < 0.001) in the two groups. The value of standard deviation of all normal R-R intervals(SDNN) and high frequency at day7 and day30 and the value of the percent of difference between adjacent normal R-R intervals (pNN50) at day 30 in RIpostC group was significantly higher than that of the sham-RIpostC group(P < 0.05). A significant time-by-group interaction was observed in SDNN、pNN50、and high frequency over time between two groups (P < 0.05).Conclusions30-day RIpostC could improve autonomic function in AIS patients through the enhancement of the total autonomic nerve activity and vagus nerve activity. The mechanism of RIpostC mediating autonomic function needs to be further investigated.