Abstract
Application of protocols without parameter standardization and appropriate controls has led manual therapy (MT) and other physiotherapy-based approaches to controversial outcomes. Thus, there is an urgency to carefully define standard protocols that elevate physiotherapy treatments to rigorous scientific demands. One way in which this can be achieved is by studying gene expression and physiological changes that associate to particular, parameter-controlled, treatments in animal models, and translating this knowledge to properly designed, objective, quantitatively-monitored clinical trials (CTs). Here, we propose a molecular physiotherapy approach (MPTA) requiring multidisciplinary teams, to uncover the scientific reasons behind the numerous reports that historically attribute health benefits to MT-treatments. The review focuses on the identification of MT-induced physiological and molecular responses that could be used for the treatment of fibromyalgia (FM) and chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME). The systemic effects associated to mechanical-load responses are considered of particular relevance, as they suggest that defined, low-pain anatomic areas can be selected for MT treatment and yet yield overall benefits, an aspect that might result in it being essential to treat FM. Additionally, MT can provide muscle conditioning to sedentary patients without demanding strenuous physical effort, which is particularly detrimental for CFS/ME patients, placing MT as a real option for integrative medicine programs to improve FM and CFS/ME.
Highlights
Fibromyalgia (FM), according to the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) M79.7, including fibromyositis, fibrositis and myofibrositis, is described as a chronic disease of unknown origin, leading to low pain threshold, together with stiffness and tenderness of the muscles, often accompanied with general fatigue, sleep disturbances, headaches, and memory loss [1,2,3,4]
We have reviewed available preclinical mechanistic evidence from physical treatments of animal models, and identified molecular changes associated to manual therapy (MT) parameters that could improve immune, cognitive and muscular dysfunctions on one side and alleviate pain on another, in an effort to build the initial basis for standardized therapeutic MT protocols to treat patients affected of FM and/or chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME)
We can conclude that there is an urgency to standardize, control, and optimize MT, and physiotherapy protocols in general, as the conflictive results that have been frequently found in the literature may arise from subjective components and the lack of precise parameter definition in these procedures
Summary
Fibromyalgia (FM), according to the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) M79.7, including fibromyositis, fibrositis and myofibrositis, is described as a chronic disease of unknown origin, leading to low pain threshold, together with stiffness and tenderness of the muscles, often accompanied with general fatigue, sleep disturbances, headaches, and memory loss [1,2,3,4]. Mindfulness meditation may be helpful in improving pain perception, it does not suffice for patients to recover their previous daily activity Another non-pharmacological option is provided by gradual exercise therapy (GET). Future MT treatment protocols are expected to be capable of managing the symptoms that compromise daily activities in these patients and improve FM and CFS/ME health status in general Towards this end, we have reviewed available preclinical mechanistic evidence from physical treatments of animal models, and identified molecular changes associated to MT parameters that could improve immune, cognitive and muscular dysfunctions on one side and alleviate pain on another (see Table 1), in an effort to build the initial basis for standardized therapeutic MT protocols to treat patients affected of FM and/or CFS/ME. Validation of efficacy and optimization through CTs must demand close control of selected molecular or other disease-associated quantitative markers to objectively track individual responses of FM and CFS/ME patients to the received MT treatments
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