The effectiveness of soft tissue massage and exercise for the treatment of non-specific shoulder pain
A review conducted recently by researchers from the Discipline of Physiotherapy, University of Sydney, was published in British Journal of Sports Medicine. The study aims to determine the effectiveness of exercise and soft tissue massage either in isolation or in combination for the treatment of non-specific shoulder problems.
The methods include Database searches for articles from 1966 to December 2011. Studies were eligible if they investigated 'hands on' soft tissue massage performed locally to the shoulder or exercises aimed at improving strength, range of motion or coordination; non-surgical painful shoulder disorders; included participants aged 18-80 years and outcomes measured included pain, disability, range of motion, quality of life, work status, global perceived effect, adverse events or recurrence.
Twenty-three papers met the selection criteria representing 20 individual trials. They found low-quality evidence that soft tissue massage was effective for producing moderate improvements in active flexion and abduction range of motion, pain and functional scores compared with no treatment, immediately after the cessation of treatment.
Exercise was shown to produce greater improvements than placebo, minimal or no treatment in reported pain but these changes were of a magnitude that was less than that considered clinically worthwhile. Exercise did not produce greater improvements in shoulder function than placebo, minimal or no treatment.
They concluded that there is low-quality evidence that soft tissue massage is effective for improving pain, function and range of motion in patients with shoulder pain in the short term. Exercise therapy is effective for producing small improvements in pain but not in function or range of motion. You were pretty disappointed don't you ... So should we wait until more high-quality evidence is available and not recommend any exercise? Do you think such information is useful :-)
The Effects of Repeated Massage on Hypothalamic-Pituitary-Adrenal and Immune Function in Healthy Individuals
A recent study gathered preliminary data about the biologic effects of repeated Swedish massage therapy compared to a light-touch control condition.
The study design was a 5-week comparison of repeated Swedish massage and light touch on oxytocin (OT), arginine-vasopressin (AVP), adrenal corticotropin hormone (ACTH), cortisol (CORT), circulating phenotypic lymphocyte markers, and mitogen-stimulated cytokine function. The setting was an outpatient research unit in an academic medical center.
The study subjects were medically and psychiatrically healthy young adults. The study comprised 45 minutes of Swedish massage or light touch, using highly specified and identical protocols, either weekly or twice weekly for 5 weeks. The outcome measures were mean differences between massage and light touch on OT, AVP, ACTH, CORT, lymphocyte markers, and cytokine levels.
The results showed that compared to the touch control condition, weekly Swedish massage stimulated a sustained pattern of increased circulating phenotypic lymphocyte markers and decreased mitogen-stimulated cytokine production, similar to what was previously reported for a single massage session, while having minimal effect on hypothalamic-pituitary-adrenal function. Twice-weekly massage produced a different response pattern with increased OT levels, decreased AVP, and decreased CORT but little effect on circulating lymphocyte phenotypic markers and a slight increase in mitogen-stimulated interferon-γ, tumor necrosis factor-α, interleukin (IL)-1b and IL-2 levels, suggesting increased production of pro-inflammatory cytokines.
The authors concluded that there are sustained cumulative biologic actions for the massage and touch interventions that persist for several days or a week, and these differ profoundly depending on the dosage (frequency) of sessions. Confirmatory studies in larger samples are needed.
Ethiopian runner Abebe Bikila made history when he earned a gold medal at the 1960 Summer Olympics in Rome. His speed and agility won him the gold, but it was barefoot running that made him a legend. When the shoes Bikila was given for the race didn't fit comfortably, he ditched them for his bare feet. After all, that's the way he had trained for the Olympics in his homeland. Racing shoeless led to success for Bikila, and now, more than 50 years later, runners are continuing to take barefoot strides. Several Olympic runners have followed Bikila and nationally the trend has exploded over the past decade. There's even a national association dedicated to barefoot running. However, scientists are stuck on whether it either prevents or increases injuries.
"Bikila may have been on to something," said Carey Rothschild, an instructor of physical therapy at the University of Central Florida in Orlando who specializes in orthopedic sports injuries. "The research is really not conclusive on whether one approach is better than the other. But what is clear is that it's really a matter of developing a good running form and sticking to it, not suddenly changing it." Rothschild, a 12-year runner who has completed the Boston Marathon three times, reviewed research and found injuries happened with or without shoes. So she conducted a survey with the help of the Track Shack in Orlando to get to the bottom of the controversy.
What she found was striking. Most people said they turned to barefoot running in the hopes of improving performance and reducing injuries. Ironically, those who said they never tried it avoided it for fear it would cause injuries and slow their times. However, research shows that there are risks to running no matter what someone puts on his or her feet. Barefoot runners tend to land on their mid or forefoot as opposed to the heel, which good athletic shoes try to cushion.
Some studies suggest that barefoot running causes a higher level of stress fractures on the front part of the foot and increased soreness in the calves. But runners who wear athletic shoes can also suffer everything from knee injuries to hip problems, related to repeated stress from impact forces at the heel. "There is no perfect recipe," said Rothschild, a resident of Winter Park.
In a paper publishing in the Journal of Strength & Conditioning Research, Rothschild reviews the research and provides a guide for those who want to explore barefoot running as a way to train for marathons. It's a 10-12 week program that slowly eases people who run in shoes onto their bare feet. She suggests getting a thorough physical examination and biomechanical assessment from a physical therapist or other trained professional so that strength and flexibility deficits can be identified and addressed first. That should be done before gradually transitioning to bare feet.
"The bottom line is that when a runner goes from shoes to no shoes, their body may not automatically change its gait," Rothschild said. "But there are ways to help make that transition smoother and lower the risk of injuries." The researcher concludes that barefoot running in and of itself is neither good nor bad. As with running in shoes, proper training and conditioning are essential. However, Rothschild does offer a warning. Anyone with lower extremity or deformity or with a disease that creates a lack of sensation on the feet should probably avoid barefoot running because they can't necessarily feel injuries resulting from running on hard surfaces.
Reference: Carey E. Rothschild. Primitive Running. Journal of Strength and Conditioning Research, 2012; 26 (8): 2021 DOI: 10.1519/JSC.0b013e31823a3c54
Biomechanical properties of fascial tissues and their role as pain generators
Robert Schleip and co. from Fascia Research Project, at Ulm University, wrote a review last year on the load bearing functions of fascial tissues and their proneness to micro tearing during physiological or excessive loading, to review histological evidence for a proprioceptive as well as nociceptive innervation of fascia, and to emphasize the potential role of injury, inflammation, and/or neural sensitization of the posterior layer of the human lumbar fascia in non-specific low back pain. I
They found that in addition to a tensional load bearing function of tendons and ligaments, muscles transmit a significant portion of their force via their epimysia to laterally positioned tissues, such as to synergistic or antagonistic muscles. Fascial tissues are commonly used as elastic springs [catapult action] during oscillatory movements, such as walking, hopping, or running, in which the supporting skeletal muscles contract rather isometrically. They are prone to viscoelastic deformations such as creep, hysteresis, and relaxation. Such temporary deformations alter fascial stiffness and may take several hours for recovery. There is a gradual transition zone between reversible viscoelastic deformation and complete tissue tearing. Micro tearing of collagenous fibers and their interconnections have been documented in this zone.
They also found that fascia is densely innervated by myelinated nerve endings which are assumed to serve a proprioceptive function. These are Pacini [and paciniform] corpuscles, Golgi tendon organs, and Ruffini endings. In addition they are innervated by free endings, containing substance P, suggestive of a nociceptive function. New findings suggest that noicipetive activity of epimysial fasciae play a major role in delayed onset muscle soreness subsequent to repetitive concentric exercise.
They concluded that fascial tissues serve important load bearing functions. The innervation of fascia indicates a sensory role as an organ for propriocepton, and also a potential nociceptive function. Micro tearing and/or inflammation of fascia can be a direct source of musculoskeletal pain. Fascia may be an indirect source of back pain. Read the full article here http://www.mfcupping.com/PDF/
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