Connective Tissue Manipulation Research Articles

Manual therapy formyofascial pelvic pain: A case report and narrative review

Background. Myofascial pelvic pain (MFPP) is characterized by the presence of tender myofascial trigger points (MTrPs) in the muscles and fascia of the pelvic floor. Pelvic floor manual therapy is frequently suggested as the first line of treatment for MFPP. Main body of the abstract. The existing literature affirms the beneficial outcomes of manual therapy in the treatment of MFPP and offers a concise summary of how these techniques are applied to patients with MFPP. Literature includes ten techniques; (1) myofascial trigger point release, (2) Thiele massage, (3) internal self-massage, (4) perineal massage, (5) combined manual techniques, (6) pelvic myofascial mobilization, (7) manual visceral therapy, (8) connective tissue manipulation, (9) scar release, and (10) internal coccyx manipulation. Methods. A narrative review was carried out to summarize the available evidence on pelvic floor manual therapy techniques for MFPP. Key content and findings. Upon review of the current research landscape, twenty-five studies met the inclusion criteria. Available evidence suggests that pelvic floor manual therapy is effective in the treatment of MFPP. Conclusion. Although current available studies are limited in number with limitations in study design, manual therapy is considered a promising, effective, and safe option for the treatment of MFPP.

Long-Term Follow-Up Result of Connective Tissue Manipulation in Young Women with Primary Dysmenorrhea: Different Intervention Durations.

The purpose of this study was to reveal the effect of connective tissue manipulation (CTM) on long-term pain severity, fatigue, sleep quality, premenstrual symptom severity, general health status, anxiety, and depression in women with primary dysmenorrhea (PD). Thirty-five women with PD were divided into two groups. CTM was applied to the participants in each group on the days when they were not on menstruation between two menstrual cycles for the group 1 (n=18) and between three menstrual cycles for the group 2 (n=17). Intensity of menstrual pain, the sleep quality, and fatigue status of the participants during dysmenorrhea were evaluated by the Visual Analog Scale (VAS). Depressive symptoms and anxiety were evaluated using the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI), respectively. Also, the Premenstrual Syndrome Scale (PMSS) and the General Health Questionnaire (GHQ) were used to investigate the severity of premenstrual symptoms and mental health status during menstrual period. A significant decrease in the pain severity and fatigue of the participants was observed in both group 1 and group 2 after treatment, after 3rd, and 6th month follow-up (p=0.001). Also, this decrease lasted for 12th month follow-up after treatment in group 2 (p=0.0001). There was no statistically significant improvement in sleep quality within each group (p>0.05). Moreover, none of the parameters were significantly different between two groups (p>0.05). We can suggest that 2-cycle CTM treatment should be preferred in clinical settings to obtain long-lasting effects for decreasing pain, fatigue, and premenstrual symptoms in women with PD. CLINICAL TRIAL NUMBER: NCT04509934. Registration date: 8 November 2020.

The Effects of Connective Tissue Manipulation in Primary Dysmenorrhea: a Randomized Placebo-Controlled Study.

The aim of this study was to identify the effects of connective tissue manipulation (CTM) in primary dysmenorrhea (PD) in a randomized, placebo-controlled design. Thirty-eight nulliparous women with PD were randomly allocated into 3 groups: CTM (n = 13), placebo therapeutic ultrasound (US) (n = 13), and control (n = 12). The primary outcome measure was the maximum and mean menstrual pain intensity at the last menstrual period on the visual analogue scale (VAS). Secondary outcome measures were menstrual symptom frequency and distress score, the number of analgesic/anti-inflammatory drugs used during the last menstrual period, and perception of improvement in dysmenorrhea severity via interventions. The chi-square test and analysis of variance were used to determine within-group and between-group differences. Statistical significance level was determined as p < 0.05. Compared with the placebo US and control groups, it was observed that menstrual pain (VAS mean and VAS maximum), menstrual symptom frequency, and distress level decreased more after treatment (T2) and the 3-month follow-up (T3) in de CTM group (p < 0.001, p = 0.001, p = 0.014, p = 0.015, respectively). There was no difference between the groups in terms of analgesic/anti-inflammatory drugs use (p > 0.05). The rate of individuals reporting perceived improvement at the end of intervention period was higher in the CTM group than in the placebo-US and control groups (p < 0.001). In the 3rd month follow-up, there was no difference between groups in the perception of improvement (p > 0.05). CTM is superior to placebo intervention and control in improving menstrual pain and other menstrual symptoms in PD in the short-term. On the other hand, when the application is terminated, this superiority seems to disappear during the follow-up period.

Efficacy of Physiotherapy Treatment in Primary Dysmenorrhea: A Systematic Review and Meta-Analysis.

Primary dysmenorrhea (PD) refers to painful cramps before and/or during menstruation. There is a need for emphasis on alternative methods of conservative treatment, so as to reduce the dependence on drugs for alleviating the symptoms. The aim was to find out the effectiveness of some physiotherapy techniques in the treatment of PD. A systematic review and meta-analysis was conducted according to PRISMA standards. The descriptors were “dysmenorrhea”, “physical the-rapy”, “physiotherapy”, and “manual therapy”. The search was performed in five databases: Scopus, PubMed, PEDro, Web of Science, and Medline, in February 2021. The inclusion criteria were randomized controlled trials over the last six years. Articles not related to the treatment of PD or using pharmacology as the main treatment were excluded. Nine articles met the objectives and criteria, with a total of 692 participants. The most used scale to measure pain was the VAS (visual analogue scale). The main techniques were isometric exercises, massage therapy, yoga, electrotherapy, connective tissue manipulation, stretching, kinesio tape, progressive relaxation exercises and aerobic dance. Meta-analysis shows benefits of physiotherapy treatment for pain relief compared with no intervention or placebo (MD: −1.13, 95% CI: −1.61 to −0.64, I2: 88%). The current low-quality evidence suggests that physiotherapy may provide a clinically significant reduction in menstrual pain intensity. Given the overall health benefits of physiotherapy and the low risk of side effects reported, women may consider using it, either alone or in conjunction with other therapeutic modalities.

Comparison of Connective Tissue Manipulation and Abdominal Massage Combined With Usual Care vs Usual Care Alone for Chronic Constipation: A Randomized Controlled Trial

ObjectiveThe aim of the present study was to determine and compare the effects of connective tissue manipulation (CTM) and abdominal massage when combined with usual care on the symptoms of constipation and quality of life (QoL) immediately following a 4-week treatment in patients suffering from chronic constipation. MethodsA total of 60 patients with chronic constipation were randomly assigned to CTM, abdominal massage, or control groups. Connective tissue manipulation and abdominal massage were conducted at 5 sessions a week for 4 weeks. Each session was approximately 15 to 20 minutes. The severity of constipation by the Constipation Severity Instrument, symptoms of constipation by a bowel diary and Bristol Stool Scale, and QoL by patient assessment of QoL questionnaire were evaluated at baseline and at the end of 4 weeks. ResultsThere were significant differences in the changes in constipation severity (P < .001), symptoms of constipation (P ≤ .001), and QoL (P < .001) among the 3 groups. However, based on pair-wise analysis, there were no significant differences in the changes of the severity and symptoms of constipation and QoL between the CTM and abdominal massage groups (P > .05). ConclusionThe findings of the present study revealed that compared to usual care alone, the combination of usual care and CTM or abdominal massage may be more beneficial for chronic constipation. However, the superiority of CTM or abdominal massage was not observed. Further high-quality studies with long-term follow-up are needed to investigate the optimal massage therapy program in patients with chronic constipation.

Adding connective tissue manipulation to physiotherapy for chronic low back pain improves pain, mobility, and well-being: a randomized controlled trial.

This study aimed to evaluate the effectiveness of connective tissue manipulation (CTM) for improving pain, mobility, and well-being in chronic low back pain (CLBP). Sixty-six patients with CLBP were randomized to three groups: CTM, sham massage (SM) and control groups. The groups got standardized physiotherapy and the related applications 5 days/wk, 3 weeks. Pain intensity, mobility, and well-being (Hospital Anxiety and Depression Scale [HADS], Oswestry Disability Index [ODI], and Short Form-36 [SF-36]) were assessed before and after the applications. Pain, mobility, and disability improved in all groups (P<0.05). There were differences in resting pain, HADS, and SF-36 scores in CTM, resting pain in SM, and SF-36 scores in controls (P<0.05). Activity pain, HADS scores decreased, mobility and physical component of the SF-36 in-creased in CTM compared to SM (P<0.05). Pain, ODI, and HADS scores decreased, mobility and SF-36 increased in CTM, and ODI scores decreased in SM compared to controls (P<0.05). In conclusion, pain intensity during activity and at night and disability decreased, and spinal mobility increased in all groups. However, CTM showed superiority in improving pain, mobility, and well-being in patients with CLBP.

The Effects of Connective Tissue Manipulation in Primary Dysmenorrhea

The Effects of Connective Tissue Manipulation in Primary Dysmenorrhea

Acute Effects of Connective Tissue Manipulation on Autonomic Function in Healthy Young Women

Background: Connective tissue manipulation (CTM) has therapeutic effects on diseases with autonomic imbalance, yet its mechanisms of action are not clearly identified. Objective: The aim of this study was to investigate acute autonomic responses to CTM in healthy young women with various physical activity levels. Method: The study was designed as a nonrandomized, controlled single-center study. Healthy women aged between 18 and 25 years were assigned to a connective tissue manipulation group (CTMG) (n = 150) or a control group (CG) (n = 60). CTM was applied to the CTMG while the CG did not receive any intervention. Respiratory rate (RR), heart rate, systolic/diastolic blood pressures (SP/DP), oxygen saturation (OS) and body temperature were measured. The International Physical Activity Questionnaire short form was used to determine physical activity levels. ­Results: Analysis revealed significant reduction in SP and DP and an increment in RR in the CTMG (p < 0.05). RR increased and SP decreased among inactive, SP decreased among moderately active, and SP and OS decreased among highly active participants in the CTMG (p < 0.05). There were no significant alterations in the CG (p > 0.05). Conclusions: CTM has an immediate reducing effect on sympathetic activity in healthy young women independently from the physical activity level. Future studies are needed to clarify long-term effects of CTM on autonomic functions in healthy individuals.

Short-term effects of connective tissue manipulation in women with primary dysmenorrhea: A randomized controlled trial

AimTo evaluate the short-term effectiveness of connective tissue manipulation (CTM) for relieving menstrual pain and symptoms in primary dysmenorrhea (PD). MethodsForty-four women with PD were randomly assigned to treatment (n = 21) or control group (n = 23). While the control group was given only advising, the treatment group additionally received CTM. The primary outcome was the menstrual pain intensity by Visual Analogue Scale. Secondary outcomes included the number of pain medications, menstrual pain catastrophizing by Pain Catastrophizing Scale (PCS), menstrual symptoms by Menstrual Symptom Questionnaire (MSQ) and menstrual attitude by Menstrual Attitude Questionnaire (MAQ). ResultsCompared with the control group, CTM group showed statistically significant improvement in pain, medication use, PCS, MSQ (p = 0.001) and in the perception of menstruation as a natural event (p = 0.029). However, no significant differences were detected between groups for some aspects of MAQ (p > 0.05). ConclusionsCTM seems to be an effective approach in the short-term in PD.

The effects of connective tissue manipulation and Kinesio Taping on chronic constipation in children with cerebral palsy: a randomized controlled trial

Purpose: The aim of this study was to investigate the effects of connective tissue manipulation (CTM) and Kinesio Taping® (KT) on constipation and quality of life in children with cerebral palsy (CP).Method: This study was designed as a randomized controlled trial. Forty children diagnosed with chronic constipation based on Rome III criteria were randomly assigned to CTM group [6 females, 7 males; 8 y 6 mo (SD = 3y 4 mo)], KT group [7 female, 7 male; 8y 7 mo (SD =3y 5 mo)] or control group [6 female, 7 male; 8y 3 mo (SD = 3y 6 mo)]. All patients were assessed with 7-day bowel diaries, Bristol Stool Form Scale (BSFS), Visual Analog Scale (VAS), and Pediatric Quality of Life Inventory (PEDsQL). Kruskal-Wallis, Wilcoxon’s signed-rank, and Mann–Whitney U tests were used to determine intra-group and inter-group differences. The level of significance was p < 0.05.Results: Among the CTM, KT, and control groups, there were statistically significant differences regarding the changes in defecation frequency (2.46, 3.00, 0.30, ES 1.16, p < 0.001), duration of defecation (5.07, 5.35, 0.15, ES 2.37, p = 0.003), BSFS (1.84, 2.14, 0.07, ES 0.91, p < 0.001), VAS (4.83, 3.87, 0.23, ES 1.98, p < 0.001), and PEDsQL total scores (7, 14, 8.36, −0.85, ES 4.08, p < 0.001).Conclusions: This study revealed that CTM and KT seem equally effective physiotherapy approaches for the treatment of pediatric constipation and these approaches may be added to bowel rehabilitation program.Implications for rehabilitationCTM and KT have similar effectiveness in alleviating the constipation-related symptoms and improving quality of life in children with CP.CTM and KT can be integrated into bowel rehabilitation programs.Considering the characteristics of patients, these treatment options can be used as an alternative of each other by physiotherapists.

Therapeutic effects of connective tissue manipulation on wound healing and bacterial colonization count among patients with diabetic foot ulcer

This study investigated the therapeutic effects of connective tissue manipulation (CTM) in diabetic foot ulcer (DFU). A total of 20 participants (10 in CTM group and 10 in conventional treatment group (CG)) with DFU underwent the conventional DFU treatment. In addition, the CTM group received CTM twice per week for 6 weeks. The percentage wound area reduction (PWAR) and bacterial colonization count (BCC) in log10colony-forming units (CFU) per ml wound fluid was evaluated at baseline and six weeks. Results showed a significant change in PWAR in CTM (p<0.05, t=3.82, Df=9, CI L=0.98 U=3.81) and CG (p<0.05, t=2.97, Df=9,CI L=0.26 U=1.98). Mean reduction of BCC showed a significant reduction (p<0.05), with percentage of BCC reduction higher in CTM group (6.45%) than CG (3.55%). The findings suggest CTM as an effective adjunct therapy for DFU to enhance conventional treatments.

Effect of Connective Tissue Manipulation on Symptoms and Quality of Life in Patients With Chronic Constipation: A Randomized Controlled Trial

ObjectiveThe purpose of this study was to examine the effects of connective tissue manipulation (CTM) on the severity of constipation and health-related quality of life in individuals diagnosed with chronic constipation. MethodsFifty patients with a diagnosis of chronic constipation according to Rome III criteria were recruited and randomized to an intervention (n = 25) or control group (n = 25). The intervention group received CTM in addition to the lifestyle advice, whereas the control group was given only lifestyle advice for constipation. All assessments were performed at baseline and at the end of 4 weeks. The primary outcome measure was the Constipation Severity Instrument. Secondary outcomes included Patient Assessment of Constipation Quality of Life Questionnaire, Bristol Stool Scale, and 7-day bowel diary. Differences between groups were analyzed with t tests, Mann-Whitney U test and χ2 test. ResultsCompared with the control group, subjects in the intervention group reported significantly greater improvement in total and subscale scores of the Constipation Severity Instrument and Patient Assessment of Constipation Quality of Life Questionnaire (P < .05). Based on the results from bowel diaries, the improvements in the number of bowel movements, duration of defecation, stool consistency, and the feeling of incomplete evacuation in the intervention group were also significantly more than the control group (P < .05). ConclusionThis study showed that CTM and lifestyle advice were superior to reducing symptoms of constipation and quality of life compared with lifestyle advice alone for patients with chronic constipation.

Efficacy of Splinting Variations in Two Different Treatment Protocols in Trigger Thumb

Introduction: The aim of this study was to evaluate the comparative final outcome of two different conservative treatment protocols for trigger thumb using three different types of splints with varying restrictions of interphalangeal (IP), metacarpophalangeal (MCP), and carpometacarpal (CMC) joint motions of the thumb and with additional exercise programs. Materials and Methods: Twenty-nine patients with 43 trigger thumbs were included in this study. Participants were divided into two treatment protocol groups and used three different types of thumb splints (1 daytime consistent to both groups and 2 different nighttime) with an additional exercise program and connective tissue manipulation (CTM). Patients were seen for follow-up after 10 weeks of the treatment; the preoutcome and postoutcome measures were assessed by stages of stenosing tenosynovitis (SST) and Visual Analog Scale (VAS). The data were analyzed to determine the efficacy of splint protocol intervention in relation to each other. Results: After using the thumb splints, there were statistically significant improvements in both SST and VAS scores in both groups (P < 0.05). This study demonstrates the benefit of splint usage and an additional exercise program with CTM in the conservative treatment of trigger thumb. Conclusions: Keeping in mind that splint 3 was used with both groups, splint 1 of the night splints that limited IP, MCP, and CMC joint flexion and extension was found to be more effective for conservative treatment in trigger thumb.

Investigation of the effects of connective tissue mobilisation on quality of life and emotional status in healthy subjects.

Connective Tissue Massage (CTM) or Manipulation is a bodywork technique which lies at the interface between alternative approaches. The autonomic balancing responses to CTM can be useful in the treatment of anxiety. This study was planned to investigate the effects of connective tissue mobilization (CTM) on quality of life and emotional status in healthy subjects. Design; Prospective trial, Setting; Treatment and Population. The study was conducted on 100 volunteers (students). Students in second class were in CTM group (20,49±1,37 years) and students (19,50±1,15 years) educating in class 1 were in control group. Participants were assessed before and after CTM according to flexibility of trunk flexion, hamstring muscles, trunk hyperextension and lateral flexion. It was used The SF-36 Health-Related Quality of Life Inventory (SF-36) to assess general health status and Beck Depression Scale was used for assessing emotional status. It was observed a significant increase at lateral flexion to the right of trunk (p=0,03) in CTM group after application. It was found a significant difference (p=0,009) in emotional status between groups. It was found differences at general health level (p=0,001), limitations in emotional role (p=0,016) in SF-36. It was some differences in depression status and some subscales of SF-36 (general health, social status, emotional well-being, pain and energy levels) in favour of control group before application. It was no difference between groups after application. CTM could be used for minimizing depressive symptoms, improving quality of life in healthy young subjects.

Connective tissue manipulation: A review of theory and clinical evidence

Connective tissue manipulation or connective tissue massage (bindegewebsmassage) is a manual reflex therapy in that it is applied with the therapist's hands which are in contact with the patient's skin. The assessment of the patient and the clinical decision-making that directs treatment is based on a theoretical model that assumes a reflex effect on the autonomic nervous system which is induced by manipulating the fascial layers within and beneath the skin to stimulate cutaneo-visceral reflexes. This paper reviews the literature and current research findings to establish the theoretical framework for CTM and the evidence for its clinical effects. The rationale for the principles of treatment are discussed and the evidence for the clinical effectiveness assessed through an analytical review of the clinical research.

Effects of mechanical massage, manual lymphatic drainage and connective tissue manipulation techniques on fat mass in women with cellulite

Effects of mechanical massage, manual lymphatic drainage and connective tissue manipulation techniques on fat mass in women with cellulite

Effects of mechanical massage, manual lymphatic drainage and connective tissue manipulation techniques on fat mass in women with cellulite

To evaluate and compare the effectiveness of three different noninvasive treatment techniques on fat mass and regional fat thickness of the patients with cellulites. Sixty subjects were randomized into three groups. Group 1 (n = 20) treated with mechanical massage (MM), group 2 (n = 20) treated with manual lymphatic drainage (MLD) and group 3 (n = 20) treated with connective tissue manipulation (CTM) techniques. Subjects were evaluated by using standardized photographs, body composition analyzer (TBF 300) (body weight (BW), body mass index (BMI), fat %, fat mass (FM), fat free mass (FFM), total body water (TBW)), circumference measurement from thigh, waist-hip ratio (WHR), fat thickness measurements from abdomen, suprailium and thigh regions with skin fold caliper. All groups had an improvement in thinning of the subcutaneous fat after the treatment (P < 0.05). Thigh circumference decreased by an average of 0.5 cm in all groups and thigh fat thickness decreased 1.66 mm in Group 1, 2.21 mm in Group 2 and 3.03 mm in Group 3. Abdomen and suprailium fat thicknesses decreased 2.4 and 2.58 mm in Group 1, 1.78 and 2 mm in Group 2 and 1.23 and 0.64 mm in Group 3, respectively. The mean difference in waist-hip ratio was 0.1 cm in all groups. All the treatment techniques are effective in decreasing the regional fat values of the patients with cellulites.

Short and Long-Term Results of Connective Tissue Manipulation and Combined Ultrasound Therapy in Patients with Fibromyalgia

Objective The aim of the study was to evaluate the short-term and 1-year follow-up results of connective tissue manipulation and combined ultrasound (US) therapy (US and high-voltage pulsed galvanic stimulation) in terms of pain, complaint of nonrestorative sleep, and impact on the functional activities in patients with fibromyalgia (FM). Methods This is an observational prospective cohort study of 20 female patients with FM. Intensity of pain, complaint of nonrestorative sleep, and impact of FM on functional activities were evaluated by visual analogue scales. All evaluations were performed before and after 20 sessions of treatment, which included connective tissue manipulation of the back daily, for a total of 20 sessions, and combined US therapy of the upper back region every other session. One-year follow-up evaluations were performed on 14 subjects. Friedman test was used to analyze time-dependent changes. Results Statistical analyses revealed that pain intensity, impact of FM on functional activities, and complaints of nonrestorative sleep improved after the treatment program ( P < .05). Conclusion Methods used in this study seemed to be helpful in improving pain intensity, complaints of nonrestorative sleep, and impact on functional activities in patients with FM.

Are Manual Therapies Effective in Reducing Pain From Tension-Type Headache?

A systematic review was performed to establish whether manual therapies have specific efficacy in reducing pain from tension-type headache (TTH). Computerized literature searches were performed in MEDLINE, EMBASE, AMED, MANTIS, CINAHL, PEDro, and Cochrane databases. Papers were included if they described clinical (open noncontrolled studies) or randomized controlled trials in which any form of manual therapy was used for TTH, and if they were published after 1994 in the English language. The methodologic quality of the trials was assessed using the PEDro scale. Levels of scientific evidence, based on the quality and the outcomes of the studies, were established for each manual therapy: strong, moderate, limited, and inconclusive evidence. Only six studies met the inclusion criteria. These trials evaluated different manual therapy modalities: spinal manipulation (three trials), classic massage (one trial), connective tissue manipulation (two trials), soft tissue massage (one trial), Dr. Cyriax's vertebral mobilization (one trial), manual traction (one trial), and CV-4 craniosacral technique (one trial). Methodologic PEDro quality scores ranged from 2 to 8 points out of a theoretical maximum of 10 points (mean=5.8+/-2.1). Analysis of the quality and the outcomes of all trials did not provide rigorous evidence that manual therapies have a positive effect in reducing pain from TTH: spinal manipulative therapy showed inconclusive evidence of effectiveness (level 4), whereas soft tissue techniques showed limited evidence (level 3). The authors found no rigorous evidence that manual therapies have a positive effect in the evolution of TTH. The most urgent need for further research is to establish the efficacy beyond placebo of the different manual therapies currently applied in patients with TTH.

The effectiveness of physiotherapy and manipulation in patients with tension-type headache: a systematic review

The study design is a systematic review of randomised clinical trials (RCTs). The objectives of the present study are to assess the effectiveness of physiotherapy and (spinal) manipulation in patients with tension-type headache (TTH). No systematic review exists concerning the effectiveness of physiotherapy and (spinal) manipulation primarily focussing on TTH. Literature was searched using a computerised search of MEDLINE, EMBASE and the Cochrane library. Only RCTs including physiotherapy and/or (spinal) manipulation used in the treatment of TTH in adults were selected. Two reviewers independently assessed the methodological quality of the RCTs using the Delphi-list. A study was considered of high quality if it satisfied at least six points on the methodological quality list. Twelve publications met the inclusion criteria, including three dual or overlapping publications resulting in eight studies included. These studies showed a large variety of interventions, such as chiropractic spinal manipulation, connective tissue manipulation or physiotherapy. Only two studies were considered to be of high quality, but showed inconsistent results. Because of clinical heterogeneity and poor methodological quality in many studies, it appeared to be not possible to draw valid conclusions. Therefore, we conclude that there is insufficient evidence to either support or refute the effectiveness of physiotherapy and (spinal) manipulation in patients with TTH.