María Aguilar-García

Background: Fibromyalgia (FM) is a chronic pain condition primarily linked to central sensitization, although peripheral tissue-related factors have also been suggested. Ultrasound strain elastography (SEL) provides a semi-quantitative, operator-dependent estimate of tissue deformation under standardized compression, yet evidence comparing SEL findings and pressure pain sensitivity between FM and healthy controls at standardized tender-point sites remains limited. Objective: To compare pressure pain threshold (PPT) and SEL-derived tissue deformation between women with FM and healthy controls across standardized FM tender-point sites. Methods: In this cross-sectional study, 84 women (42 with FM; 42 healthy controls) were recruited from a private rehabilitation center in Málaga (Spain). PPT and SEL were assessed bilaterally at 13 standardized tender-point sites. Between-group differences were examined using Student’s t-test or the Mann–Whitney U test according to distribution. Results: Women with FM exhibited lower PPT across all assessed sites (p < 0.01) and lower SEL-derived deformation scores at most sites, whereas no between-group SEL differences were observed at the dominant and non-dominant forearm, non-dominant lower cervical region, dominant paraspinal region, and bilateral lateral pectoral region. Conclusions: Compared with controls, women with FM showed reduced pressure pain thresholds and site-dependent differences in SEL-derived tissue deformation at standardized tender-point sites. Given the cross-sectional and exploratory design, SEL findings should be interpreted cautiously and considered non-diagnostic; heterogeneity across anatomical sites should be considered in future confirmatory and longitudinal studies.

The study aimed to determine if combined physiotherapy treatments offer additional benefits over exercise-only programs for shoulder pain and to identify the most effective combined treatment. A systematic review, registered in PROSPERO (CRD42023417709), and meta-analyses were conducted. Quality analysis was performed using the PEDro scale on randomized clinical trials published from 2018 to 2023. Twenty articles met the inclusion criteria. The most commonly used combination was exercise plus manual therapy, without being statistically superior to exercise alone. The meta-analysis indicated that combining exercise with low-level laser therapy (mean difference of −1.06, 95% CI: −1.51 to −0.60) and high-intensity laser therapy (mean difference of −0.53, 95% CI: −1.12 to 0.06) resulted in the greatest reduction in SPADI scores. Adding manual therapy provided limited additional benefit (mean difference of −0.24, 95% CI: −0.74 to 0.27). Progressive exercise with advice or telerehabilitation yielded modest improvements. The multimodal meta-analysis for DASH scores showed significant improvement (mean difference of −1.06, 95% CI: −1.51 to −0.60). In conclusion, therapeutic exercise is the cornerstone of shoulder pain treatment, with the addition of laser therapy showing substantial benefits. Manual therapy and educational interventions offer some benefits but are not consistently superior. More rigorous studies are needed.

The purpose of this study was to analyze the changes in the elasticity and temperature of the patellar tendon produced by the application of a radiofrequency at 448 kHz (CRMR) just after and 7 days after the intervention. An open controlled clinical trial was used with participants being recruited from a private clinic. The experimental group (n = 22) received a 448 kHz CRMR treatment while the control group (n = 22) did not receive any type of intervention. Quantitative ultrasound strain elastography (SEL) and thermography were used to collect data from 4 different areas of the patellar tendon. These areas were measured at the start (T0), just after (T1), and seven days after (T2) the intervention. There were thermal changes immediately after the intervention (p < 0.001). In addition, when the measurements were collected just after the intervention and seven days after they were analyzed, significant changes (p < 0.001) in temperature were observed in the tendons of both groups. Finally, a low but significant association (r = 0.434, p < 0.04) was observed between the elastic properties of the tendon at its insertion in the patella and thermal changes just after the 448 kHz intervention.

Adhesive capsulitis, characterized by progressive fibrosis, causes a gradual, painful loss of both active and passive articular motion, leading to the final contracture of the joint capsule. The condition commonly referred to as “frozen ankle” (FA), which Goldman was the first to use, relates to the ankle joint and is challenging to both diagnose and treat. Data acquired from people who suffer from this type of damage in other joints such as the shoulder, hip, and wrist also exists. Despite the fact that a well-defined model for the medical management of FA does not exist, a wide spectrum of local treatments, both surgical and non-surgical, exist. This review gives an overview of the current scientific position of the frozen ankle in terms of evolutionary factors, etiology, the different mechanisms of action involved, current treatment options, and other possible interventions based on recent discoveries of pathophysiological mechanisms. The application of extracorporeal shockwave therapy, stretching exercises, and corticosteroid injections combined with physical therapy modalities that enhance pain management, range of motion, and functional capacity is highly advisable for the treatment of adhesive capsulitis, commonly known as “frozen joints”. Furthermore, the addition of interventions both impacting and analyzing chronic hypoxia, low-grade inflammation, and sedentary life is proposed.

Purpose. This study was aimed at verifying both the intraobserver and interobserver reliability of measuring plantar fascia stiffness for a given image in healthy active adults. Methodology. This study is reported following the Guidelines of Reporting Reliability and Agreement Studies. A total of 20 plantar fascia from healthy volunteers were analyzed. The thickness of the plantar fascia was measured vertically from the anterior edge of the inferior calcaneal border to the inferior border of the plantar fascia and the ultrasound elastography measurement was taken at the calcaneal insertion of the plantar fascia with the region of interest one centimeter away from the insertion. Results. The ultrasound strain elastography measurements: the right intraobserver 1 showed an ICC value of 0.9 and the left intraobserver 1 showed an ICC value of 0.78, while the right intraobserver 2 showed an ICC value of 0.91 and the left intraobserver 2 showed an ICC value of 0.83. Interobserver measurements showed excellent reliability with a right ICC value of 0.8 and a left ICC value of 0.9 for the plantar fascia thickness measurements. Discussion. The results of this study showed a strong correlation between left and right plantar fascia thickness. The intraobserver reliability was excellent for both plantar fascia ultrasound strain elastography and thickness measurements, with interobserver measurements showing excellent reliability.

The main objective of this literature review was to analyze the efficacy of (PBM) therapy application on subjects with chronic pain and inflammation, and furthermore, to evaluate the methodological quality of the collected literature. The search was conducted using five databases: PubMed, ProQuest, Scopus, Web of Science, and PEDro. The keywords “low level laser therapy”, “chronic pain”, and “inflammation” provided the selection of RCTs that were published within the last 5 years, conducted in humans, and written in English. The PEDro Internal Validity Scale (IVS) checklist was used to evaluate the risk of bias in the included studies. A total of 11 articles were selected, all of them RCTs. Of the articles, five showed that PBM positively influences chronic pain, while another showed the same but only in the short term. In two other articles, the patient’s inflammation improved markedly. In one article there was no improvement in chronic pain and in another, there was no improvement in inflammation. Four articles demonstrated that PBM is beneficial in acute pain. Furthermore, six studies were given an “excellent” score and the remaining five a “good” score based on the IVS. Photobiomodulation has beneficial effects on chronic pain and inflammation, although more research needs to be completed in this line for this to be clarified as the existence of RCTs on this subject is limited.

The main goal of this study is to analyze photobiomodulation therapy’s effectiveness on improving sports practice. Secondarily, the included studies were methodologically analyzed to verify their quality. A review and appraisal of literature found in Web of Science, ProQuest and Scopus databases was carried out. To evaluate the risk of bias of the included studies. The Physiotherapy Evidence Database (PEDro) scale and PEDro Internal Validity Scale (IVS) checklists were used. The included randomized clinical trials were in English, conducted on humans and published since 2016. A total of 15 randomized clinical trials were included, 4 of which found an improvement in oxygen volume after an aerobic stress test, while 2 showed no change. Muscle damage decreased in five studies, however, in two of them muscle damage did not change. Blood lactate concentration decreased in two of the studies, while in three of them there was no difference. Muscle soreness was lower in three studies, however, in four of the articles no change was demonstrated. All selected studies were of good methodological quality. On the IVS, six RCTs had a high internal quality and nine of them moderate. Photobiomodulation therapy has a positive effect on sports performance. Scientific studies on the subject are limited and more research in this line is needed.

Nowadays, there is evidence related to the impact that psychological factors have on symptoms, specifically vegetative ones, and on the autonomic nervous system in patients with fibromyalgia (FM). However, there are no studies to correlate the level of association between psychological factors and the elastic properties of tissue in the FM population. Elastic properties of soft tissue reflect age- and disease-related changes in the mechanical functions of soft tissue, and mechanical failure has a profound impact on morbidity and mortality. The study has a cross-sectional observational design with 42 participants recruited from a private clinic and rehabilitation service. The Pain Catastrophizing Scale, Tampa Kinesiophobia Scale and Self-Efficacy Scale were used to assess psychological factors. The elastic properties of the tissue in the characteristic painful points, which patients suffering from FM described, were assessed by strain elastography. A low and significant level of association was found between pain catastrophising scale (PCS) and the non-dominant lateral epicondyle (r = −0.318; p = 0.045). Kinesiophobia was found to be related to the dominant lateral epicondyle (r = 0.403; p = 0.010), the non-dominant knee (r = −0.34; p = 0.027) and the dominant forearm (r = 0.360; p = 0.010). Self-Efficacy showed a low level of association with the non-dominant supraspinatus (r = −0.338; p = 0.033) and the non-dominant medial epicondyle (r = −0.326; p = 0.040). Psychological factors and the elastic properties of tissue seem to be associated in patients suffering from FM. The most profound association between psychological factors and non-dominant parts of the body could be related to neglect and non-use of those parts of the body.