Clin J Pain. 2014 Jul;30(7):589-97. doi: 10.1097/AJP.0000000000000008.
Castro-Sánchez AM1, Aguilar-Ferrándiz ME, Matarán-Peñarrocha GA, Sánchez-Joya Mdel M, Arroyo-Morales M, Fernández-de-las-Peñas C.
Abstract
OBJECTIVE:
To investigate the therapeutic effects of a manual therapy protocol for improving pain, function, pressure pain thresholds (PPT), quality of sleep, and depressive symptoms in women and men with fibromyalgia syndrome (FMS).
MATERIALS AND METHODS:
Eighty-nine patients were randomly assigned to experimental or control group. The experimental group (24 female, 21 male) received 5 sessions of manual therapy and the control group (24 female, 21 male) did not receive any intervention. PPT, pain, impact of FMS symptoms, quality of sleep, and depressive symptoms were assessed in both groups at baseline and after 48 hours of the last intervention in the experimental group.
RESULTS:
The analysis of covariance found significant Group×Time×Sex interactions for McGill PPI and Center for Epidemiologic Studies Depressive Symptoms Scale (P<0.01) was also found: men exhibited a larger effect size for depressive symptoms than women, whereas women exhibited a greater effect size than men in the McGill PPI. A significant Group×Time×Sex interaction for PPT over suboccipital, upper trapezius, supraspinatus, second rib, gluteal region, and tibialis anterior muscle was also found: men included in the experimental group experienced significant greater improvements in PPT as compared with women with FMS in the experimental group.
CONCLUSIONS:
Manual therapy protocol was effective for improving pain intensity, widespread pressure pain sensitivity, impact of FMS symptoms, sleep quality, and depressive symptoms. In addition, sex differences were observed in response to treatment: women and men get similar improvements in quality of sleep and tender point count, whereas women showed a greater reduction in pain and impact of FMS symptoms than men, but men reported higher decreases in depressive symptoms and pressure hypersensitivity than women.
PMID: 24281285 DOI: 10.1097/AJP.0000000000000008
[Indexed for MEDLINE]
From the paper:
The experimental group underwent a protocol of MT for a 45-minute session for 5 weeks (1/wk). The treatment was applied by a physiotherapist specialized in MTs.19,20,39,40 The protocol was as the following.19,20,39,40
(1) Suboccipital release: The patient was in the supine position and the therapist sat at the head of the bed. The therapist placed her hands under the head of the patient and used the fingers to palpate the spinous process of cervical vertebrae and moved upwards until making contact with occipital condyles. The fingers then moved to the space between the condyles and the spinous process of the axis, where pressure was exerted by the fingers of both hands.
(2) Release of the pectoral region: The patient was in supine position. The therapist stood at the head of the bed and placed her arms crossed with 1 hand at each edge of the sternum below the clavicles, exerting a 3-dimensional pressure.
3) Diaphragm release: The patient sat on the bed and the therapist stood behind her in body-to-body contact, placing both hands under the costal arch (lateral to xiphoid apophysis of sternum) and then sliding them (producing friction) from the center to the side of the costal arch. This was repeated 3 times.
(4) Lumbosacral decompression: The patient was in the supine position and the therapist was seated at 1 side of the bed. The therapist placed 1 hand below the sacrum and the other at the upper border of the pubic symphysis, applying a slight anterior-posterior pressure for 90 to 120 seconds.
(5) Release of the psoas fascia: The patient was placed in the supine position. The therapist stood at the side of the psoas muscle to be treated and placed both hands overlapped with fingers vertical to the muscle at 3 cm lateral to the navel, producing friction.
(6) Thoracic spine extension manipulation in prone (highvelocity low-amplitude): The patient was placed in prone and the therapist performs 3 times a posterior-anterior manipulation from T3 to T12 with both hands crossed during expiration breathing.