Efectos de un programa de inducción miofascial en pacientes oncológicosDiseño cruzado, aleatorizado, simple ciego y controlado con placebo

Abstract

Nowadays, Physiotherapy, is moving away from disability to focus its scope of application on health. From a biopsychosocial framework, the physiotherapist delves into all the physical, environmental, physiological, psychological, economic and social aspects of movement, to use it as a therapeutic resource in the promotion, education and recovery of function (health). Movement is the functional expression of the person underlying complex neuromusculoskeletal, neurocognitive and emotional processes. Achieving it depends on the ability to maintain an organism in perfect harmony, in a successful degree of adaptability to internal and external demands (allostasis, homeostasis) and a perfect level of communication. The fascial system is shown as an indispensable substrate to find these demands and provide the organism with continuity and body unity, while providing the highest degree of information to the nervous system, so that it can operate in the most efficient and effective way. The fascia, the great forgotten tissue, has been the subject of in-depth research in the last twenty years, identifying the crucial role it plays in the processing of movement. Science now shows us how it is altered and injured, and how to approach it in order to recover its capabilities. Manual Therapy, as a primary resource of Physiotherapy, and specifically Myofascial Induction (MI) are effective tools of the physiotherapist to intervence in the fascial system, and thus act in the prevention, maintenance, adaptation and recovery of movement (function). Within the MI procedures, Myofascial Unwinding (MU) maneuvers are particularly coherent with the construction of the mentioned body dynamics. Through a manual stimulus, a technical sequence containing cortical and angular aspects of movement is facilitated, fully involving the patient. This is a new way of working in Physiotherapy and that is why still has little research. The scientific literature prescribes its use for the recovery of neuro-orthopedic, post-traumatic and degenerative problems. Among these, we identify the side effects suffered by patients after cancer treatment. Medical procedures are increasingly successful, but inevitably numerous sequelae arise that detract from quality of life. We have identified them in breast cancer (BC) and head and neck cancer (HNC) survivors and have proposed their treatment with IM (through the MU procedure). Therefore, the objectives of the present dissertation were: To investigate the immediate effects of MI (vs. shortwave placebo as a control) on perceived pain, cervical and shoulder range of motion, and mood in CM survivors with shoulder/ arm morbidity. As a secondary objective we examined the relationships between pain modifications and cervical and shoulder range of motion on the CM-affected side (study I). To analyze the short-term effects of a single session of MI on neural mechanosensitivity through range of motion, symptom reproduction and pressure pain thresholds, and upper limb neurodynamic testing compared to a placebo control. As a secondary objective, to determine the possible influence or not of patient attitudes towards massage in CM survivors (study II). Finally, to determine the immediate effects of MI compared to a placebo control on cervical and shoulder pain, cervical and shoulder range of motion, maximum mouth opening and cervical muscle function in CCC survivors with neck/ shoulder morbidity (study III). The results of the Doctoral Thesis provide scientific evidence supporting the use of a novel treatment program in Physiotherapy through MI for the recovery and improvement of painful processes and movement disorders as sequelae present in CM and CCC survivors. Finally, these results improve our knowledge about the influence of MI, and specifically MU, in the functional recovery of these patients, raising the need for its treatment through Physiotherapy and Manual Therapy as part of the multidisciplinary oncological rehabilitation team.