Open Access
The effect of diacutaneous fibrolysis on patellar position measured using ultrasound scanning in patients with patellofemoral pain syndrome
(Human Kinetics, 2021) Fanlo-Mazas, Pablo; Bueno-Gracia, Elena; Ruiz de Escudero Zapico, Alazne; Tricás-Moreno, José Miguel; Lucha López, María Osoria; Ciencias de la Salud; Osasun Zientziak
Context: Tightness or lack of flexibility of several muscles of the thigh has been associated with patellofemoral joint pain. A tight iliotibial band can lead to laterally located patella and an abnormal patellar tracking pattern. Diacutaneous fibrolysis (DF) is commonly used to reduce muscle tightness, but no studies have evaluated the effects of this technique in the treatment of patients with patellofemoral pain syndrome. Objective: To assess the effect of DF on patellar position in patients with patellofemoral pain syndrome. Design: A single-group, pretest–posttest clinical trial. Setting: University of Zaragoza. Participants: A total of 46 subjects with patellofemoral pain (20 males, 26 females; age: 27.8 [6.9] y). Intervention: Three sessions of DF. Main Outcome Measures: Patellar position measurement using real-time ultrasound scanning; pain intensity measured with visual analog scale and function measured with the Anterior Knee Pain Scale. Results: The application of 3 sessions of DF significantly increased the patellar position at posttreatment evaluation (P < .001) and at 1-week follow-up (P < .001). There was not a significant difference on patellar position between posttreatment and follow-up measurements (P = .28). There were also a statistically significant decrease in pain and increase in function at posttreatment and at 1-week follow-up measurements (P < .001). Conclusion: This study found that patellar position, pain intensity, and function were significantly improved after 3 sessions of DF and at 1-week follow-up.
Open Access
Short- and medium-term effects of manual therapy on the upper cervical spine combined with exercise vs isolated exercise in patients with cervicogenic headache: a randomized controlled trial
(Elsevier, 2022) Rodríguez-Sanz, Jacobo; Malo-Urriés, Miguel; Corral-de-Toro, Jaime; Lucha López, María Osoria; López-de-Celis, Carlos; Pérez-Bellmunt, Albert; Hernández-Secorún, Mar; Ruiz de Escudero Zapico, Alazne; Krauss, John; Hidalgo-García, César; Ciencias de la Salud; Osasun Zientziak
Background: Cervicogenic headache is defined as a unilateral headache associated with a lack of range of motion. The effect of manual therapy applied to the upper cervical spine combined with cervical exercises in this patient population is currently unknown. Objective: To determine if adding manual therapy to an exercise and home-exercise program is more effective by reducing symptoms and improving function in the short- and mid-term than just applying exercises in patients with cervicogenic headache. Methods: Randomized controlled trial. 40 participants with cervicogenic headache were recruited (20 = Manual Therapy + Exercise and 20 = Exercise). Each group received four 20-min sessions weekly and a home exercise regime. Upper cervical flexion and flexion-rotation test, HIT-6, headache intensity, craniocervical flexion test, pain pressure thresholds, GROC-scale, and adherence to self-treatment were measured at the beginning and end of the intervention, and again at 3-(short-term) and 6-month (mid-term) follow-ups. Results: The Manual Therapy + Exercise group showed a statistically significant improvement in all short- and mid-term variables (p <.05) compared to the exercise group except for the variable pain pressure thresholds first metacarpal joint right and left short-term and adherence to self-treatment short-term. Conclusion: Four 20-min sessions of manual therapy and an exercise protocol along with a home exercise regime is more effective in the short and mid-term than an exercise protocol and a home exercise regime for patients with cervicogenic headache. © 2022 Elsevier Ltd
Open Access
The effect of diacutaneous fibrolysis on local and widespread hyperalgesia and muscle length in patients with patellofemoral pain syndrome: secondary analysis of a pretest-posttest clinical trial
(Human Kinetics, 2021-02-16) Fanlo-Mazas, Pablo; Bueno-Gracia, Elena; Ruiz de Escudero Zapico, Alazne; López-de-Celis, Carlos; Hidalgo-García, César; Rodríguez-Sanz, Jacobo; Lucha López, María Osoria; Ciencias de la Salud; Osasun Zientziak
Context: Localized and widespread hyperalgesia has been observed in patients with patellofemoral pain. Diacutaneous fibrolysis (DF) has shown to be effective in reducing pain in several musculoskeletal conditions including patellofemoral pain syndrome, but no studies have evaluated the effects of this technique in reducing localized and widespread hyperalgesia. Objective: To assess the effect of DF on the pressure pain threshold and muscle length tests in patients with patellofemoral pain syndrome. Design: A single-group, pretest–posttest clinical trial. Setting: University of Zaragoza. Participants: Forty-six subjects with patellofemoral pain (20 males and 26 females: age 27.8 [6.9] y). Intervention: Three sessions of DF. Main Outcome Measures: Pressure pain threshold using a handheld pressure algometer (4 sites around the knee, on tibialis anterior muscle, and one remote site on the upper contralateral limb); muscle length test of the iliotibial band, rectus femoris, and hamstring muscles; and patient-perceived treatment effect score. Results: The application of 3 sessions of DF significantly increased the pressure pain threshold in all sites at posttreatment evaluation (P < .001) and at a 1-week follow-up (P < .001). A significant increase in muscle length was also observed at the posttreatment evaluation (P < .001) and 1-week follow-up (P < .001). Ninety-seven percent of the patients reported subjective improvement at posttreatment and at 1-week follow-up. Conclusion: This study found that local and widespread hyperalgesia was significantly reduced after 3 sessions of diacutaneous fibrolysis and at the 1-week follow-up. A significant improvement on muscle length tests was also observed, with high clinical satisfaction among patients.

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