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The Current Role of Astym Therapy in The Treatment of Musculoskeletal Disorders
The Current Role of Astym Therapy in The Treatment of Musculoskeletal Disorders
The Current Role of Astym Therapy in The Treatment of Musculoskeletal Disorders
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CLINICAL FEATURE
REVIEW
CONTACT E. Carlos Rodriguez-Merchan ecrmerchan@hotmail.com Department of Orthopaedic Surgery, La Paz University Hospital-IdiPaz, Paseo de la
Castellana 261, Madrid 28046, Spain
© 2019 Informa UK Limited, trading as Taylor & Francis Group
2 E. C. RODRIGUEZ-MERCHAN ET AL.
1 record excluded
17 records reviewed and (not focused on the
screened topic)
0 articles repeated
17 articles assessed for
in Cochrane Cochrane Library search for
eligibility Library: 16 articles “Astym therapy” (n=0)
assessed
eventually
16 studies included
Figure 1. Flow chart of our search strategy regarding the current role of Astym therapy.
(Continued )
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Table 1. (Continued).
These authors analyzed knees based on the presence of flexion deficit or contracture. Further standard treatment after TKA.
stratification was made into knees that received AT before and after a 3-month period of
standard rehabilitation. Differences in range of motion from pre- to post-AT were evaluated by
measuring (1) degree of flexion deficit or contracture and (2) total arc of passive motion.
Improvements in subjective functional status were determined by evaluating Knee Society
scores pre- and post-AT. A two-tailed Student t-test was used to compare weighted mean
differences from pre- to post-AT for the above parameters. The mean flexion deficit improved
significantly in all patients after AT. The mean flexion contracture improved significantly in in
91% of patients after AT therapy. Knees with flexion deficits or contractures both improved in
total arc of motion when compared with pretherapy. Overall, patients who underwent
treatment with AT reported significant mean improvements in both Knee Society objective
and functional scores when compared with their pretherapy objective and functional scores.
No harms were reported.
Chughtai et al 2016 The purpose of this study was to evaluate and compare: (1) range of motion and (2) the rate of The group who underwent IMMPT utilizing AT had a significantly higher proportion of patients
[12] repeat MUA in patients who either underwent innovative multimodal physical therapy with optimal range of motion, which implies the potential efficacy of this regimen to
(IMMPT) or standard-of-care physical therapy (standard) following an MUA after a TKA. These improve range of motion. Furthermore, the IMMPT cohort had a significantly lower
authors performed a retrospective database study of patients who underwent an MUA proportion of repeat manipulations as compared with the standard cohort, which implies
following a TKA (N = 57). There were 16 (28%) men and 41 (72%) women who had a mean that an IMMPT approach could potentially reduce the need for a repeat MUA.
age of 59 years (range, 32–81 years). The patients were stratified into those who underwent
IMMPT (n = 22) and those who underwent standard physical therapy (n = 35). The 6-month
ROM and rate of repeat manipulation between the two cohorts was analyzed by using Student
t-test and Chi-square tests. In addition, we performed a Kaplan-Meier analysis of time to
repeat MUA. The IMMPT cohort had a statistically significant higher proportion of TKAs with an
optimal range of motion as compared with the standard cohort. There was statistically
significant lower proportion of patients who underwent a repeat MUA in the IMMPT as
compared with the standard cohort. There was also a significantly lower incidence and longer
time to MUA in the IMMPT cohort as compared with the standard cohort in the Kaplan-Meier
analysis.
McGinn et al [13] 2016 These authors analyzed all non-obese patients who underwent primary TKAs who started an This study showed an IMMPT protocol utilizing AT is able to significantly reduce the rate of
outpatient physical therapy program within six weeks of their surgery (n = 127 knees). There manipulation following a TKA. Furthermore, this IMMPT approach was also able to achieve
were 86 women and 41 men who had a mean age of 67 years (range, 42 to 88 years). This similar range of motion to the standard physical therapy group while reducing the rate of
cohort was stratified into those who underwent an IMMPT regimen at our institution (n = 47) manipulation, which may indicate similar efficacy in restoring ROM.
and those who underwent standard therapy at an outside institution (N = 80). The ROM and
rate of manipulation between the two groups was compared. There were similar proportions
of those who had an optimal range of motion (≥110 degrees flexion and ≤5 degrees
extension) in the IMMPT group as compared to the standard physical therapy cohort (81% vs.
82%). The IMMPT cohort had a significantly lower proportion of patients who underwent MUA
as compared to the standard therapy cohort (2% vs. 13%).
(Continued )
Table 1. (Continued).
Authors Year Results Comments
Bhave et al [14] 2016 This report assessed changes in ROM, pain, function, and patellar tendon length after AT (joint Conservative management of recalcitrant knee joint stiffness after primary TKA can be effective
mobilization use). A 38-year-old male professional skier had a right TKA 3 months before in restoring knee mobility and reducing pain and activity limitation. A multimodal approach
presentation with 2 subsequent manipulations under anesthesia secondary to persistent knee using AT, customized knee bracing, and targeted joint mobilization can be effective in
stiffness. He had patellar baja on radiograph, a reduced arc of ROM, reduced patellar mobility resolving knee joint stiffness.
and muscular extensibility, and pain to palpation along the patellar tendon. He had 12 visits of
physical therapy with the use of AT, patellar mobilization, and tibio-femoral mobilizations with
movement. The patient also used a customized knee device at home for prolonged knee
extension stretching. The patient was treated for 12 visits, along with home use of customized
bracing for knee extension. Significant improvements were seen in pain, function, and ROM.
He returned to work full-time, ambulated prolonged distances, and negotiated stairs pain-free.
He also demonstrated resolution of patellar baja radiographically.
Scheer et al [15] 2016 An eight-year-old female with cerebral palsy was referred to physical therapy for the treatment The results of this case report indicate that physical therapy rehabilitation utilizing an AT
of bilateral hamstring inflexibility and Achilles tendinopathy. Treatment focused on an AT protocol can successfully achieve gains in flexibility and strength and allow for improved
protocol of eccentric exercise, stretching, active and passive range of motion, gait training, and function of bilateral lower extremities in a patient with cerebral palsy. Based on the findings
a home exercise program. The patient underwent a total of 11 physical therapy treatment of this case report, clinicians should consider the use of AT in treating musculoskeletal soft
sessions. At the conclusion of treatment, the patient demonstrated improved resting muscle tissue dysfunction in pediatric patients with cerebral palsy.
tone in bilateral lower extremities with active 90/90 hamstring flexibility measured at 165° and
ankle dorsiflexion active range of motion of 5° without pain at 0° and 90° knee flexion. The
patient exhibited an improved gait pattern with even stride length and diminished genu
recurvatum, decreased pain with standing and walking, discontinued use of ankle-foot
orthoses, and improved activity tolerance and overall function for daily activities.
Davies et al [5] 2016 This study examined the effects of AT on activities of daily living in women who had undergone In this study AT improved active range of motion in the involved quadrant and also improved
a mastectomy following a diagnosis of breast cancer. A quasi-experiment involving 40 women, function in patients following a mastectomy.
following a mastectomy, evaluated five outcome measures pre- and post-AT. All five
measurement scores: Disabilities of the Arm, Shoulder, and Hand Outcome Measure; a clothing
questionnaire on their ability to wear a bra; Patient-Specific Functional Scale; active ROM of
shoulder flexion; and active range of motion of abduction were also measured and all
demonstrated significant changes.
Miller et al [16] 2017 The purpose of this case was to describe using AT in treating spastic diplegic cerebral palsy (CP). AT was effective in treating a child with spastic diplegic CP, resulting in enhanced strength,
A 6-year-old female was treated more than 9 months (36 sessions) for decreased flexibility, flexibility, and gait.
muscle weakness, spasticity, and abnormal gait. Gait performed with articulated ankle-foot
orthoses (75% of the time) or foot orthosis (25%); lack of active dorsiflexion (DF); lack of heel
strike during gait; spasticity in hamstrings, gastrocnemius, hip adductors; hamstring flexibility
(90/90 test position) 50° right and 60° left; gastrocnemius flexibility neutral bilaterally; and
Peabody Developmental Motor Scales, second edition (PDMS-2) age equivalence (in months)
23 locomotion, 25 object manipulation, and 21 stationary tasks. Therapeutic interventions
included AT, stretching, strengthening, neuromuscular reeducation, and gait training. At
6 months, flexibility improved bilaterally to 10° past neutral in gastrocnemius and 0° in
hamstrings. The PDMS-2 age equivalence scores were 27 locomotion, 32 object manipulation,
and 28 stationary tasks. At discharge, patient ambulated full-time with foot orthosis, exhibiting
improved stride length bilaterally with active ankle DF to initiate heel strike. Spasticity was
unchanged.
Chughtai et al [3] 2019 This systematic review evaluated the published literature related to AT on various The authors stated that due to the fact that some of these studies were case reports, larger
musculoskeletal disorders. Specifically, the authors assessed the effectiveness of this studies will be needed in order to confirm the benefits of AT on a variety of musculoskeletal
therapeutic method on disorders related to the: knee, upper extremity, hamstring muscles, disorders.
ankle, and Achilles tendon injuries.
MUA = Manipulation under anesthesia; ROM = Range of motion; TKA = Total knee arthroplasty.
POSTGRADUATE MEDICINE
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