Objective

This study aims to investigate the relationship between major signal points (MaSPs) of the lower extremities used in court-type Thai traditional massage (CTTM) and the corresponding underlying anatomical structures, as well as to determine the short-term changes in blood flow and skin temperature of volunteers experiencing CTTM.

Methods

MaSPs were identified and marked on cadavers before acrylic color was injected. The underlying structures marked with acrylic colors were observed and the anatomical structures were determined. Then, pressure was applied to each MaSP in human volunteers (lateral side of leg and medial side of leg) and blood flow on right dorsalis pedis artery was measured using duplex ultrasound while skin temperature changes were monitored using an infrared themographic camera.

Results

Short-term changes in the blood flow parameters, volume flow and average velocity, compared to baseline (P < 0.05), were observed on MaSP of the lower extremity, ML4. Changes in the peak systolic velocity of the area ML5 were also observed relative to baseline. The skin temperature of two different MaSPs on the lateral side of leg (LL4 and LL5) and four on the medial side of leg (ML2, ML3, ML4 and ML5) was significantly increased (P < 0.05) at 1 min after pressure application.

Conclusion

This study established the clear correlation between the location of MaSP, as defined in CTTM, and the underlying anatomical structures. The effect of massage can stimulate skin blood flow because results showed increased skin temperature and blood flow characteristics. While these results were statistically significant, they may not be clinically relevant, as the present study focused on the immediate physiological effect of manipulation, rather than treatment effects. Thus, this study will serve as baseline data for further clinical studies in CTTM.

Objective

Ice massage (IM) is one of the treatment procedures used in hydrotherapy. Though its various physiological/therapeutic effects have been reported, effects of IM of the head and spine on heart rate variability (HRV) have not been studied. Thus, this study evaluated the effects of IM of the head and spine on HRV in healthy volunteers.

Methods

 Thirty subjects were randomly divided into 3 sessions: (1) IM, (2) tap water massage (TWM) and (3) prone rest (PR). Heart rate (HR) and HRV were assessed before and after each intervention session.

Results

A significant increase in the mean of the intervals between adjacent QRS complexes or the instantaneous HR (RRI), square root of mean of sum of squares of differences between adjacent normal to normal (NN) intervals (RMSSD), number of interval differences of successive NN intervals greater than 50 milliseconds (NN50), proportion derived by dividing NN50 by total number of NN intervals along with significant reduction in HR after IM session; significant increase in RRI along with significant reduction in HR after TWM, and a significant increase only in RMSSD after PR were observed. However, there was no significant difference between the sessions.

Conclusion

Results of this study suggest that 20 min of IM of the head and spine is effective in reducing HR and improving HRV through vagal dominance in healthy volunteers.W23

Objective: To determine quantitatively if a unique rehabilitation program using traditional Thai massage, herbal treatments and physical therapies could improve activities of daily living, mood and sleep patterns, and pain intensity of stroke patients over time.
Methods: This was a prospective cohort study, conducted over a three-month period. Patients were recruited from a 42-bed rehabilitation centre in Northern Thailand, which admits mainly stroke, head injury and spinal patients for rehabilitation.
Results: There were 62 patients enrolled in the study, with 55% being male. The average age of patients was 59 years and 63% were married. The average time since the initial stroke was 15 months. At baseline, the average Barthel Index score was 50.7, and the average emotion, pain and sleep scores were 2.6, 3.1, and 3.2, respectively. After adjusting for age, gender and time since initial stroke in the longitudinal model, the Barthel Index significantly improved by 6.1 points after one month (P<0.01) and by 14.2 points after three months (P<0.01); emotion significantly improved by 0.7 points after one month (P<0.01) and by 0.9 points after three months (P<0.01); pain significantly improved by 0.5 points after one month (P<0.01) and by 0.5 points after three months (P<0.01); sleep significantly improved by 0.5 points after one month (P<0.01) and by 0.6 points after three months (P<0.01).
Conclusion: This unique stroke rehabilitation program has produced significant improvements in activities of daily living, mood, pain and sleep patterns of stroke patients. These findings warrant the need for further research to compare patients undergoing this program of rehabilitation with patients undergoing more conventional rehabilitation programs.

Objective: To evaluate the efficacy of Tuina and Chinese patent drug Shuxuetong injection in preventing patients undergoing total knee arthroplasty from deep venous thrombosis and in functional rehabilitation.

Methods: A total of 120 patients with diagnosed rheumatoid arthritis in the Department of Orthopaedic Surgery, Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine in China were enrolled for this study. The patients underwent total knee arthroplasty and were divided into treatment group (n=60) and control group (n=60) after surgery. Patients in the control group received conventional rehabilitation training, including using a continuous passive motion machine and training of muscle contractions of the lower limb. Patients in the treatment group were administered Shuxuetong injection and Tuina based on the conventional rehabilitation training. The course of treatment lasted for 2 weeks. Hospital for Special Surgery (HSS) knee score, rate of deep venous thrombosis and range of motion of the knee joint were evaluated before and after treatment.

Results: There was no significant difference in HSS knee score and range of motion as compared before and after treatment in two group (P>0.05). The rate of deep venous thrombosis of the treatment group was 13.33%, which was lower than 20% of the control group (P<0.05).

Conclusion: Tuina combined with Shuxuetong injection treatment can prevent deep venous thrombosis in patients with rheumatoid arthritis after total knee arthroplasty.

Objective: To study the changes in median frequency (MF) from a surface electromyogram of skeletal muscles and functional assessment of chronic illness therapy (FACIT) figure scale scores for patients with chronic fatigue syndrome (CFS) before and after Tuina treatment.

Methods: A controlled clinical trial was adopted. Thirty-two patients suffering from CFS were enrolled according to the inclusion criteria from outpatient department of Shanghai Yueyang Hospital of Integrated Chinese and Western Medicine in China; thirty normal people whose gender, age, height and body mass were concordant with the CFS patients were selected as the normal group. Surface electromyography was used to detect the median frequency (MF) of biceps, quadriceps, and waist and back muscle before and after a 20-day course of treatment. CFS patients also were asked to fill out the figure scale of FACIT to evaluate the degree of fatigue.

Results: There was no significant difference in surface electromyography MF of myoelectric signal of biceps and quadriceps between CFS and normal person; however, the waist and back muscle MF of the normal person was significantly lower than that of the CFS patients. Before and after treatment, there were no obvious changes in the MF of myoelectric signals of all muscles. Tuina significantly decreased the scale score of FACIT.

Conclusion: Tuina can improve the symptom of patients with CFS.

Objective

To evaluate the efficacy of manipulation therapy in repairing thin-layer and thick-layer articular cartilage defects in rabbits.
Methods

Twenty-four rabbits were randomly divided into manipulation group and control group. Chondral defects in the center of condylus medialis femoris (punch diameter 2.0 mm, thin-layer defect, without damaging the subchondral bone) and the center of facies patellaris femoris (punch diameter 3.0 mm, thick-layer defect, without damaging the subchondral bone) were made in both side knee joints of the rabbits. Four weeks after chondral defect, the rabbits in the manipulation group were treated with manipulation therapy, while the rabbits in the control group didn't take any therapeutic measure. The rabbits were sacrificed after 4-, 8- and 12-week manipulation treatment to obtain the distal femur. The appearance of the chondral defect was first assessed, and then regenerated tissues were stained respectively with hematoxylin and eosin (HE), safranin O and immunohistochemical methods to observe the changes in pathology. The regenerated tissue O'Driscoll score system was also used to evaluate the efficacy of manipulation therapy.
Results

After manipulation treatment, although the thin-layer articular cartilage defects of the control group were partly repaired, a sharp gap between the regenerated tissue and the normal cartilage was visible. The range of the thick-layer articular cartilage defect in the control group became smaller, and the regenerated tissue only consisted of fiber tissue. On the contrary, both the thin-layer defects and the thick-layer defects in the manipulation group were well repaired. The appearance of the regenerated tissues was close to the normal cartilage. The gap between regenerated tissue and normal tissue was disappeared and the regenerated tissue was well integrated with around tissues. HE staining showed that the regenerated tissues in the manipulation group were similar to hyaline cartilage. Safranin O staining showed that matrix stain of the regenerated tissues in the manipulation group was similar to the normal cartilage, but no stain was observed in the control group. The type Ⅱ collagen immunohistochemical staining showed that the color of the regenerated tissues was a little darker than that of the normal cartilage in the two kinds of defects in the manipulation group, and the two kinds of defects in the control group were little stained. The O'Driscoll cartilage scores of the two kinds of defects in the manipulation group were higher than those in the control group at different time points (P<0.01), but there were no differences in O'Driscoll scores in the manipulation group among the different time points.
Conclusion

Manipulation therapy is effective in repairing the thick-layer and thin-layer articular cartilage defects. The regenerated tissue is constructed with hyaline cartilage.

Objective: The aim of this study is to gain insight and understanding of the perception of Australian patients toward manual therapies. The study also tries to increase our understanding of manual techniques used by manual therapists.
Methods: This is qualitative field research emphasising the sociological perspective, to interpret health services recipients’ meanings in specific social settings. An unstructured interview is the major study design. The interview study method was conducted jointly with clinical observational techniques. A total of 30 subjects who met the selection criteria were selected. Finally 19 patient participants and 5 practitioner participants entered the study.
Results: Most participants in the research got to know physiotherapy through media and referral from general practitioners. After having gained some experience of manual physiotherapy, patients were expecting a fresh approach from Tuina (Chinese manipulative therapy). Although 94% of patient participants were satisfied with Tuina treatment, most of them could not distinguish differences in technique between Tuina and manual physiotherapy. Some patients consider Tuina as a more costly choice. Most practitioners preferred to use stronger pressure-based methods on trigger points while those who had received formal training in Tuina were in favour of much gentler techniques.
Conclusion: Manual physiotherapy is the first-line choice for many Australian patients. Tuina, as a relatively new method, is often considered as the last-resort treatment due to lack of proper private health insurance coverage. However, most patient participants preferred gentler manual methods, such as Tuina, compared with strong force-based approaches. This study stressed patients’ feelings and needs, which may have an impact on clinical outcomes. This study asserts some possible ways to enhance patient care that would include providing relevant education as part of manual therapy courses, encouraging continual development of the therapists and encouraging patient participation in the treatment process.

Evidence-based medicine (EBM), which aims to get the best evidence from medical research, is a growing international movement in health care. Because of this new shift in medical practice, great attention should be paid to how to introduce EBM into Chinese Tuina, and this is a good opportunity for the development of Chinese Tuina. To adopt EBM will be beneficial to developing Chinese Tuina, improving clinical research, renewing education mode and getting more academic achievement. So it is necessary to establish a new experimental methodology combined with EBM in order to get great progress in Chinese Tuina.

Background
Musicians are frequently affected by playing-related musculoskeletal disorders (PRMD). Common solutions used by Western medicine to treat musculoskeletal pain include rehabilitation programs and drugs, but their results are sometimes disappointing.
Objective
To study the effects of self-administered exercises based on Tuina techniques on the pain intensity caused by PRMD of professional orchestra musicians, using numeric visual scale (NVS).
Design, setting, participants and interventions
We performed a prospective, controlled, single-blinded, randomized study with musicians suffering from PRMD. Participating musicians were randomly distributed into the experimental (n = 39) and the control (n = 30) groups. After an individual diagnostic assessment, specific Tuina self-administered exercises were developed and taught to the participants. Musicians were instructed to repeat the exercises every day for 3 weeks.
Main outcome measures
Pain intensity was measured by NVS before the intervention and after 1, 3, 5, 10, 15 and 20 d of treatment. The procedure was the same for the control group, however the Tuina exercises were executed in points away from the commonly-used acupuncture points.
Results
In the treatment group, but not the control group, pain intensity was significantly reduced on days 1, 3, 5, 10, 15 and 20.
Conclusion
The results obtained are consistent with the hypothesis that self-administered exercises based on Tuina techniques could help professional musicians controlling the pain caused by PRMD. Although our results are very promising, further studies are needed employing a larger sample size and double blinding designs.

Background
Musicians are a prone group to suffer from working-related musculoskeletal disorder (WRMD). Conventional solutions to control musculoskeletal pain include pharmacological treatment and rehabilitation programs but their efficiency is sometimes disappointing.
Objective
The aim of this research is to study the immediate effects of Tuina techniques on WRMD of professional orchestra musicians from the north of Portugal.
Design, setting, participants and interventions
We performed a prospective, controlled, single-blinded, randomized study. Professional orchestra musicians with a diagnosis of WRMD were randomly distributed into the experimental group (n = 39) and the control group (n = 30). During an individual interview, Chinese diagnosis took place and treatment points were chosen. Real acupoints were treated by Tuina techniques into the experimental group and non-specific skin points were treated into the control group. Pain was measured by verbal numerical scale before and immediately after intervention.
Results
After one treatment session, pain was reduced in 91.8% of the cases for the experimental group and 7.9% for the control group.
Conclusion
Although results showed that Tuina techniques are effectively reducing WRMD in professional orchestra musicians of the north of Portugal, further investigations with stronger measurements, double-blinding designs and bigger simple sizes are needed.

Tuina manipulation has long been used in the treatment of lumbar intervertebral disc herniation, although its therapeutic mechanisms remain uncertain. The specific characteristic syndrome of this disease is lumbocrural pain in varying degrees, which is due to mechanical compression, aseptic inflammation, blood circulation disturbance and dystrophy. These factors can act on the involved nerve roots and give rise to nerve conduction disturbance. Since the blood circulation disturbance and nerve roots dystrophy are the most important pathogenic aspects of this disease, the therapeutic effect of Tuina manipulation on lumbar intervertebral disc herniation is related to them directly or indirectly.

Background: Total knee replacement surgery is commonly used in end-stage diseases of the knee. It is important for improving surgical efficacy and patient satisfaction by promoting early rehabilitation of patients and improving knee function.

Objective: To observe the effects of early application of Tuina treatment on quadriceps surface electromyography (EMG) in patients with rheumatoid arthritis having undergone total knee arthroplasty.

Design, setting, participants and intervention: The study was performed at the Orthopedic Department of Huashan Hospital, Fudan University, and the Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine from June 2010 to September 2011. A total of 66 patients with rheumatoid arthritis who had undergone total knee replacement surgery were randomly divided into control group and observation group, 33 cases in each. The patients in the control group were administered with continuous passive training (CPM), and the patients in the observation group were treated with CPM combined with Tuina, from prior surgery to four weeks post-surgery.

Main outcome measures: The knee function was evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire at baseline and 4 weeks after the surgery. Quadriceps surface EMG was also detected at the same time points.

Results: After 4 weeks of Tuina and comprehensive rehabilitation intervention, the WOMAC questionnaire score of the observation group was decreased compared with the control group (P<0.01); median frequency and integrated electromyography of the rectus femoris and vastus medialis muscles, which were recorded by EMG, in the observation group were higher than those in the control group (P<0.01).

Conclusion: Tuina can improve the recovery of patients who have undergone total knee replacement by increasing quadriceps EMG.