Successful treatment of a guitarist with a finger joint injury using instrument-assisted soft tissue mobilization: a case report

Finger injuries are common and can greatly affect a musician’s quality of life. A 55-year-old man, who had injured the proximal interphalangeal joint of the left index finger 6 months prior to any intervention, was treated with a manual therapy approach incorporating instrument-assisted soft tissue mobilization (IASTM). Initial examination findings included self-reported pain and functional limitations and physical impairments that significantly impeded his ability to play the acoustic guitar. He was treated once a week for 6 weeks with IASTM, joint mobilization, therapeutic exercise, and ice massage. Additionally, a home exercise program and self-care instructions were provided. The patient gained positive outcomes with improvements in pain (Numerical Pain Rating Scale while playing the guitar: initial 5/10, discharge 1/10) and function (Disability Arm Shoulder Hand Sports-Performing Arts Optional Module: initial 75; discharge 6·25), each reaching a minimum clinically important difference. Importantly, he was able to play the guitar with minimal to no pain as desired. Physical measures also improved, including an immediate gain in finger range of motion with IASTM alone. Manual therapy approaches integrating IASTM may provide an effective conservative treatment strategy for patients with finger/hand conditions in the performing arts and other patient populations.     

Treatment of a patient with post-natal chronic calf pain utilizing instrument-assisted soft tissue mobilization: a case study

Abstract

Musculoskeletal pain is commonly reported by pre- and postnatal women, with the most common complaint being low back pain. However, lower leg pain is also frequently reported by women particularly in the third trimester. The purpose of the case study is to illustrate how instrument-assisted soft tissue mobilization (ISTM) can be used to treat a patient with a 2-year history of chronic calf pain. The subject was a 35-year-old female who developed calf pain during the last trimester of her pregnancy following severe lower leg edema. The calf pain was present for the 2 years following delivery and was described as a dull ache, typically aggravated by direct pressure on the calf, prolonged standing, and stairs. An X-ray, magnetic resonance imaging (MRI) with contrast, and ultrasound Doppler study prior to referral ruled out tumors, vascular, lymphatic, or skeletal bone abnormalities. However, her MRI did show a dense superficial venous tissue asymmetry in the same location of her symptoms. Impairments were minimal; the only asymmetrical objective findings were calf length, strength, and soft tissue restrictions detected on palpation. After nine treatments incorporating an ISTM approach, soft tissue mobility, pain, calf strength, and lower extremity functional scale score all improved and her symptoms were abolished.     

Efficacy of instrument-assisted soft tissue mobilization in comparison to gastrocnemius-soleus stretching for dorsiflexion range of motion: A randomized controlled trial

ObjectivesTo determine the efficacy of IASTM of the gastrocnemius-soleus complex in comparison to a traditional stretching intervention on dorsiflexion ROM.MethodsSixty healthy participants were randomly allocated to one of 3 groups: IASTM (n = 20), stretching (n = 20), or control group (n = 20). The dependent variables for this study was dorsiflexion range of motion (ROM) via three measurement methods which included Modified root position 1- knee extended (MRP1), Modified root position 2- knee flexed (MRP2), and weight bearing lunge test (WBLT). A multivariate analysis of variance (MANOVA) was utilized to analyze the ROM differences between the groups (IASTM, stretching, and control groups), with a post-hoc Tukey and pairwise least significant difference tests to assess individual pairwise differences between the groups.ResultsThe MANOVA found significant ROM differences between the three intervention groups (F_6,110 = 2.40, p = .032). Statistically significant differences were identified between both the IASTM and control as well as the stretching and control group through the WBLT and MRP2 assessments, but not in the MRP1 assessment. Further, there was no statistically significant difference between the IASTM and stretching groups using any of the three methods.ConclusionA single session of IASTM or stretching increased ankle dorsiflexion ROM in WBLT and MRP2. No significant difference was noted in the MRP1. Both IASTM and stretching appear to have a greater effect on soleus muscle flexibility as evidenced by ROM gains measured with the knee in a flexed position. No clinically significant difference was identified between the intervention groups in weight-bearing conditions; thus empowering patients with the use of self-stretching would seemingly be reasonable and efficient. Combined effects of stretching and IASTM warrant further investigation for increasing dorsiflexion range of motion as a summative effect is unknown.     

器具辅助软组织松解术联合体外冲击波疗法治疗足底筋膜炎的短期疗效观察

目的 探讨器具辅助软组织松解术（instrument-assisted soft tissue mobilization, IASTM）联合体外冲击波疗法（extracorporeal shock wave therapy, ESWT）对足底筋膜炎（plantar fasciitis, PF）的短期疗效。方法 选择2019年5月至2021年4月在复旦大学附属中山医院康复医学科就诊的足底筋膜炎患者41例,随机分为对照组（n=20）和观察组（n=21）。对照组仅接受ESWT治疗,观察组接受IASTM与ESWT联合治疗。所有患者分别于治疗前、治疗4周后采用视觉模拟评分（visual analogue scale, VAS）、无痛承重负荷（painless weight-bearing load, PWBL）以及足踝功能评估（foot and ankle ability measure, FAAM）中的日常生活活动(activities of daily living, ADL)分量表评估2组治疗效果并比较。结果 治疗后,对照组和观察组的VAS评分分别由（5.58±1.92）分和（5.63±1...     

器械辅助软组织松解技术对于偏瘫肩痛的疗效观察

目的:研究器械辅助软组织松解技术(IASTM)对于偏瘫肩痛(HSP)患者的疗效观察。方法:将HSP患者43例随机分为观察组23例和对照组20例。2组均采用常规个体化康复治疗,观察组加用IASTM对肩周软组织进行治疗,对照组给予手法治疗,共治疗4周。治疗前后评估上肢运动功能采用上肢简化Fugl-Meyer量表评分(FMA-UE)评估,肩关节被动活动度(PROM)采用通用量角器进行测量评估,疼痛采用视觉模拟评分法(VAS)进行评估,日常生活活动能力采用改良Barthel指数(MBI)评估。结果:治疗前,2组患者FMA-UE评分、肩关节PROM、VAS评分以及MBI评分比较均无显著差异,治疗4周后,2组FMA-UE评分、肩关节PROM及MBI评分均较治疗前明显提高(P<0.05),且观察组均优于对照组(P<0.05)。2组VAS评分均较治疗前明显降低(P<0.05),且观察组低于对照组(P<0.05)。结论:IASTM和手法治疗均能改善患者上肢运动功能,PROM,疼痛程度以及ADL能力,且IASTM对HSP患者的改善效果要优于手法治疗。     

聚焦超声治疗慢性软组织损伤的临床研究

目的探讨聚焦超声治疗慢性软组织损伤的安全性和有效性。方法 208例慢性软组织损伤患者,进行聚焦超声治疗,每天1次共治疗5次。治疗前、后进行VAS评分及治疗后功能障碍改善评分,观察近期临床疗效、不良反应。结果所有患者在聚焦超声治疗后均取得了满意的即刻疗效和持续疗效。聚焦超声治疗后全部患者疼痛均有缓解,聚焦超声治疗1次（T1）、疗程结束后1d（T2）、1周（T3）、2周（T4）、3周（T5）、4周（T6）的VAS评分分别为（3.02±0.64）、（1.04±0.4）、（1.46±0.41）、（2.86±0.21）、（3.34±0.26）、（3.47±0.18）分与治疗前比较均显著降低（P〈0.01）;总有效率分别为100.00%、100.00%、89.42%、83.65%、77.40%、75.00%。无严重不良反应发生。结论聚焦超声治疗慢性软组织损伤是一种安全、有效的治疗方法,值得临床推广。     

Inter-clinician and intra-clinician reliability of force application during joint mobilization: A systematic review

Joint mobilizations are commonly used by clinicians to decrease pain and restore joint arthrokinematics following musculoskeletal injury. The force applied during a joint mobilization treatment is subjective to the individual clinician but may have an effect on patient outcomes. The purpose of this systematic review was to critically appraise and synthesize the studies which examined the reliability of clinicians' force application during joint mobilization. A systematic search of PubMed and EBSCO Host databases from inception to March 1, 2013 was conducted to identify studies assessing the reliability of force application during joint mobilizations. Two reviewers utilized the Quality Appraisal of Reliability Studies (QAREL) assessment tool to determine the quality of included studies. The relative reliability of the included studies was examined through intraclass correlation coefficients (ICC) to synthesize study findings. All results were collated qualitatively with a level of evidence approach. A total of seven studies met the eligibility and were included. Five studies were included that assessed inter-clinician reliability, and six studies were included that assessed intra-clinician reliability. The overall level of evidence for inter-clinician reliability was strong for poor-to-moderate reliability (ICC = −0.04 to 0.70). The overall level of evidence for intra-clinician reliability was strong for good reliability (ICC = 0.75–0.99). This systematic review indicates there is variability in force application between clinicians but individual clinicians apply forces consistently. The results of this systematic review suggest innovative instructional methods are needed to improve consistency and validate the forces applied during of joint mobilization treatments. This is particularly evident for improving the consistency of force application across clinicians.     

The effects of instrument-assisted soft tissue mobilization compared to other interventions on pain and function: a systematic review

Background: Instrument-assisted soft tissue mobilization (IASTM) is an emerging intervention in physical therapy. With the increasing prevalence of pain and disability associated with musculoskeletal impairments, it is essential to identify the most effective treatment strategies.

Objective: To systematically examine evidence on the effectiveness of IASTM, compared to other interventions on patients with pain and disability resulting from musculoskeletal impairments.

Methods: Numerous databases were searched using the terms Instrument Assisted Soft Tissue, Pain, Function, Graston, and soft tissue mobilization (STM). Inclusion criteria included: randomized clinical trials on patients with musculoskeletal impairments, STM had to be a treatment intervention, performed on human subjects, and had to capture a measure of pain or function. Articles were excluded if they were not published in English or if the subjects were of the pediatric or geriatric populations. Included articles were appraised using the Physiotherapy Evidence Database (PEDro) scale.

Results: Seven studies met the inclusion criteria. All seven articles scored a minimum 4/10 on the PEDro scale. The studies involved treatment of numerous anatomical locations and the majority of the studies demonstrated significant improvements in pain and/or range of motion when compared to control or other conservative treatment groups.

Conclusions: These outcomes support the idea that IASTM may have an impact on physiological changes by providing an increase in blood flow, reduction in tissue viscosity, myofascial release, interruption of pain receptors, and improvement of flexibility of underlying tissue. It is suggested that IASTM is an effective treatment intervention for reducing pain and improving function in less than a three-month period.     

牙龈瘤切除后同期使用冠向复位瓣修复大面积软组织缺损一例

牙龈瘤是一种牙龈增生性疾病,好发于尖牙及前磨牙区唇颊侧牙龈乳头,女性患者多于男性患者。较大的瘤体切除后常伴有角化龈变窄以及骨面、根面暴露等不良预后。该文报告在牙周黏膜科就诊的1例牙龈瘤患者,在手术切除牙龈瘤的同时结合膜龈手术的基本原理,使用冠向复位瓣覆盖暴露骨面及根面,最大程度地避免感染、骨吸收、根面暴露、根面牙本质过...     

Effectiveness of the end-range mobilization and scapular mobilization approach in a subgroup of subjects with frozen shoulder syndrome: a randomized control trial

Treatment strategies targeting abnormal shoulder kinematics may prevent pathology or if the pathology develops, shorten its duration. We examined the effectiveness of the end-range mobilization/scapular mobilization treatment approach (EMSMTA) in a subgroup of subjects with frozen shoulder syndrome (FSS). Based on the kinematics criteria from a prediction method, 34 subjects with FSS were recruited. Eleven subjects were assigned to the control group, and 23 subjects who met the criteria were randomly assigned to the criteria-control group with a standardized physical therapy program or to the EMSMTA group. Subjects attended treatment sessions twice a week for 8 weeks. Range of motion (ROM), disability score, and shoulder complex kinematics were obtained at the beginning, 4 weeks, and 8 weeks. Subjects in the EMSMTA group experienced greater improvement in outcomes compared with the criteria-control group at 4 weeks (mean difference = 0.2 of normalized hand-behind-back reach) and 8 weeks (mean difference = 22.4 degrees humeral external rotation, 0.31 of normalized hand-behind-back reach, 7.5 disability, 5 degrees tipping and 0.32 rhythm ratio). Similar improvements were found between the EMSMTA group and control group. The EMSMTA was more effective than a standardized physical therapy program in a subgroup of subjects who fit the criteria from a prediction method.     

动态干扰电抽吸法治疗腰部软组织损伤

目的　观察动态干扰电抽吸法对腰部软组织损伤的治疗效果。方法　 1 73例腰部软组织损伤患者被随机分成三组 ,分别采用动态干扰电抽吸法 (治疗组 )、静态干扰电流 (对照组 )、感应电点送 (对照组 )进行治疗。结果　治疗组痊愈显效率 77.97%。两对照组痊愈显效率分别为 50 %和 4 9.4 4%。治疗组疗效明显优于对照组。 ( χ2 =2 2 .0 9% ,P值 <0 .0 1 )结论　动态干扰电抽吸法对腰部软组织损伤具有较好疗效     

奇正消痛贴治疗急性软组织损伤130例临床观察

目的观察奇正消痛贴治疗急性软组织损伤的临床疗效。方法将130例急性软组织损伤患者,随机分为治疗组和对照组,每组各65例,治疗组运用奇正消痛贴治疗,对照组予跌打镇痛膏治疗,观察两组疗效。结果治疗组治愈39例(60.0%),显效22例(23.8%),无效4例(6.2%);对照组治愈26例(40.0%),有效28例(43.1%),无效11例(16.9%)。两组疗效相比,治疗组总有效率明显优于对照组(P<0.05)。结论奇正消痛贴治疗急性软组织损伤的临床疗效满意。     

Lower extremity thrust and non-thrust joint mobilization for patellofemoral pain syndrome: a case report

A 40-year old female presented to physical therapy with a one-year history of insidious right anteromedial and anterolateral knee pain. Additionally, the patient had a history of multiple lateral ankle sprains bilaterally, the last sprain occurring on the right ankle 1 year prior to the onset of knee pain. The patient was evaluated and given a physical therapy diagnosis of patellofemoral pain syndrome (PFPS), with associated talocrural and tibiofemoral joint hypomobility limiting ankle dorsiflexion and knee extension, respectively. Treatment included a high-velocity low amplitude thrust manipulation to the talocrural joint, which helped restore normal ankle dorsiflexion range of motion. The patient also received tibiofemoral joint non-thrust manual therapy to regain normal knee extension mobility prior to implementing further functional progression exercises to her home program (HEP). This case report highlights the importance of a detailed evaluation of knee and ankle joint mobility in patients presenting with anterior knee pain. Further, manual physical therapy to the lower extremity was found to be successful in restoring normal movement patterns and pain-free function in a patient with chronic anterior knee pain.     

Massage therapy treatment and outcomes in a patient with Charcot-Marie-Tooth disease: A case report

BackgroundCharcot-Marie-Tooth (CMT) disease, a progressive hereditary peripheral neuropathy, leads to muscle weakness, wasting, and sensory and motor nerve deprivation. The two main types of CMT are CMT1 (demyelinating) and CMT2 (axonal). Initial findings include foot deformities and sensory changes with progression to altered gait, diminished reflexes, and muscle wasting and weakness. Treatment is aimed at reducing symptoms with physiotherapy, orthotics, splints, braces, fatigue and pain management and possible surgical intervention. Research is limited on the effects of massage or other complementary and alternative medicines (CAM) on CMT.ObjectiveTo determine whether massage therapy would aid in reducing bilateral foot and lumbar pain and increasing lumbar range of motion (ROM) in a CMT patient.MethodA 44-year-old male with CMT presented with lumbar and bilateral foot pain, and foot deformities. Treatment aims were to decrease lumbar and foot pain and increase lumbar ROM. A tape measure was used to measure lumbar flexion and extension pre- and post-treatment. The Numerical Rating Scale (NRS) was used to evaluate foot and lumbar pain intensity before and after each treatment. Rhythmical superficial touch, myofascial release, and petrissage techniques were applied to the back, legs, and neck. A massage therapy student provided treatments over seven weeks.ResultsBilateral foot and lumbar pain decreased and lumbar flexion and extension increased post-treatment, and overall. All other lumbar movements increased overall.ConclusionMassage therapy may positively affect pain intensity and ROM associated with CMT. Future studies linking massage therapy and CMT are needed.     

A multimodal physical therapy approach to the management of a patient with temporomandibular dysfunction and head and neck lymphedema: a case report

Objective and importance:

There is a paucity of research that investigates therapeutic interventions of patients with concurrent head and neck lymphedema and temporomandibular dysfunction (TMD). The purpose of this case report is to describe the management and outcomes of a patient with head and neck lymphedema and TMD using a multimodal physical therapy approach.

Clinical presentation:

A 74-year-old male with a past medical history of head and neck lymphedema and TMD was referred to physical therapy with chief complaints of inability to open his mouth in order to eat solid food, increased neck lymphedema, temporomadibular joint pain, and inability to speak for prolonged periods of time.

Interventions:

The patient was treated for three visits over 4 weeks. Treatment included complete decongestive therapy (CDT), manual therapy, therapeutic exercise, and a home exercise program. Upon discharge, the patient had improved mandibular depression, decreased head and neck lymphedema, improved deep neck flexor endurance, decreased pain, and improved function on the Patient Specific Functional Scale (PSFS).

Conclusion:

Utilization of a multimodal physical therapy approach to treat a patient with a complex presentation yielded positive outcomes. Further research on outcomes and treatment approaches in patients with TMD and head and neck lymphedema is warranted.     

Challenges encountered during the management of pediatric facial soft tissue injury from a mobile battery blast: A case report

In case of parotid gland injury, one has to be aware of the fact that post‐operative complications like duct injury, leakage are very common. At times, a simple conservative approach turns out to be effective in managing complications of this nature.     

搽剂 1号对软组织损伤局部修复作用的影响

目的研究搽剂1号对软组织损伤局部修复的影响.方法用大鼠建立软组织损伤实验模型,外用搽剂1号治疗,以正红花油为阳性对照,观察该药对实验性软组织损伤局部肿胀、病理改变的影响,结果搽剂1号有明显的消肿作用(P<0.01或P<0.05),能明显减轻局部组织白细胞的浸润程度和肥大细胞的脱颗粒率(P<0.05),其作用与正红花基本相当.结论该药具有良好的治疗软组织损伤的作用,为临床应用提供了科学依据.