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International Myotherapy Society |
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Cervico-brachial neuralgia
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A cross-over study comparing classical Physiotherapy and a new manual treatment, Brachy-Myotherapy.
M. Molina, Physiotherapist, and Mr J. Polak, MD, President of the International Myotherapy Society, member of the American Association of Orthopaedic Medicine
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Abstract
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This cross-over study compares classical Physiotherapy (rehabilitation) with a naw manual method, Brachy-Myotherapy. 5 sessions of each have succesively been performed on 31 patients (13 men and 18 women) suffering of cervico-brachial neuralgia, coming spontaneously at Mr Molina's practicle between the beginning of the study (June 1998) and its end (March 1999).
Patients have been avaluated before treatment, after Physiotherapy thus before Brachy-Myotherapy, and after Brachy-Myotherapy. No patient having the inclusion criteria has been excluded of the study during the it's time of the study.
The evaluation criteria are 3:
- pain (measures with analogical visual side)
- functional handicap, also measured with AVS
- the doses of medicines taken.
The disease seeming due to lasting contractures, examining finds these contractures.
A) Pain
- before treatment it was of an average 49% AVS (extremes 20 - 90)
- after 5 sessions of physiotherapy it was of an average 45% AVS (extr. 0 in 50, average improvement = 29%).
B) Handicap (average)
- Before treatment was 49% (extr. 10 - 94)
- After 5 sessions of physiotherapy it was 43% (extr. 10 in 80%), average omprovement = 6%
- After 5 Brachy-Myotherapy sessions it was 15% (extr. 0 in 50%, average improvement = 28%)
C) When there were medicines associated to the treatment (22 cases on the 31) they were:
a) After Physiotherapy:
- increased in 2 cases
- decreased in 0 cases
- abolished in 0 cases
- unchanged in 20 cases, and:
b) After Brachy-Myotherapy:
- increased in 2 cases
- decreased in 10 cases
- abolished in 9 cases
- unchanged in 3 cases
- An average weak improvement by Physiotherapy but much more important by an identical number of Brachy-Myotherapy sessions
- An abolition of any medical treatment (for the CBN) for 9 patients on the 22 concerned after Brachy-Myotherapy, thus nearly half of these patients, whereas none after Physiotherapy
- No patient have been ecluded during the time of the study
- A total disappearance of the pain (thus complete cure) in 7 cases on the 31 after 5 Brachy-Myotherapy sessions.
It seems thus to us that Brachy-Myotherapy is more adapted to joint periodies than the classical Physiotherapy.
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 Key-words:
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Arm; Brachy-Myotherapy; Cervico-brachial neuralgia; Osteo-arthosis;¨Pain; Physiotherapy
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Introduction
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In this cross-over study concerning 31 cases of cervico-brachial neuralgia (CBN) were compared the effects of 5 sessions of classical Physiotherapy (massages, mobilizations, ultrasounds, stretching, infrared and/or heat) followed by 5 sessions of Brachy-Myotherapy.
This "sciatica of the arm" [3] is a frequent pathology, occuring especially between 20 and 60 years. Its symptoms are a diffuse pain (according to the concerned nerve [2]) sometimes accompanied by paresthesias [2]. Are concerned the nervous roots of the brachial plexus (C5 to D1) [2]. It begins usually progressively after a trauma, microtraums, or unusual and lasting positions of the neck [2, 3], all factors which, as we can notice, increase muscular tonus by creating a strech reflex, and can thus create or decompensate cervical contractures.
When examining the patient one finds sometimes an abnormal attitude, officially considered an antalgic (which is unlikely, since if it were so treating these contractures should increase the pain, but exactly the opposite occurs: pain disappears when the contractures - and only them - are treated). Appart from pain in the arm, symptoms may include stiff neck with head forward (cervical extension) and lateral stope, on the healthy side or on the painful side! [2, 3] An attempt of mobilization of the neck may increases the pain [2].
Natural evolution or with antalgic drigs takes about 2 months to 1 year and even more [3]. Algodystrophy is the main complication [3].
Radiographs do either not show anything, or may show ordinary signs of degenerative ostheoarthrisis, or troubles of cervical statics (pinching on one side, loss of the physiological cervical curvature, or even its inversion). Sometimes one observes a narrowing of the intervertebral foramens [2].
Classical treatment is rest (with possibly the bearing of a supple cervical necklace), physiotherapy, accompanied by antalgic drugs (paracétamol, nonstroid anti-inflamatory drugs, soporifics at night, etc.). If this turns out to be insufficient one can use corticoids (with their side-effects) or even morphin-like drugs, with can lead to hospitalization [2]. Vertebral manipulations are not recomended in case of advanced degenerative ostheoarthrisis or during acute painful phases! [2] Infiltrations are not recommended either [2]; surgery can turn out to be necessary if the treatment described above is ineffective after 2 months, or if there is a too important professional handicap [2].
Differential diagnostics consists in eliminating a neuralgia symptomatic of a tumor [2] or localised pains in the joints of the arm.
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Patients and methods
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All the 31 patients (13 men and 18 women) who came to Mr Molina's physiotherapy practice between the beginning of the study (June 1998) and its end (March 1999) and answering the inclusion criteria were studied.
The inclusion criterion was pain and/or diffuse formications, more or less linear, in the upper limb.
The criterion of exclusion was a pain localized in a joint or due to a tumor.
Every patient had a first exactly 5 sessions of classic physiotherapy (massages, mobilizations, ultrasounds, stretchings, infrared, and/or heat) which was then replaced by exactly 5 Brachy-Myotherapy sessions.
Evaluation was made:
-before treatment
-after the 5 sessions of physiotherapy and - after the 5 Brachy-Myotherapy sessions, (wether the treatment be finished or not).
Brachy-Myotherapy is a purely manual therapy that treasts muscular contractions by shortening passively for a short time the concerned muscles (and sometimes muscles located further away but that are part of the pathological process). It has been teached for more than 10 years in France, and about 1200 physicians and physiotherapists have been trained by Dr Polak, MD, who perfected the method. Several studies have been printed in several professional magazines in France and in Switzerland (about Theory, Electromyographic controls, Hallux Valgus pain and deformation, Elbow pain, Neck pain with ostheoarthrosis, throught treatment of Migraines, Sports medicine, treatment of Anckle sprains, and manual treatment straightening lastingly Idiopathic scoliosis, treatment of Cluster headache, etc.).
It is easy to learn and to practice, can be used in chronic or acute cases, has many indications. It has been tested successfully by 150 medical doctors on about 60 different diseases, all linked to lasting contractures, on several thousand cases and is without any danger. Its seems to work by stopping a neurological loop called "Beta loop") that seems to be created by traumas on certain muscles.
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Evaluation
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In the present study evaluation was made according to 3 criteria:
1- pain, measured with analogical visual side (AVS);
2- functional handicap, also measured with analogical visual slide;
3- the doses of medicines taken.
The ancienty of the pathology varied from 1 week to 5 years (!), with an average of 10 weeks.
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Results (see also tables)
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A) Pain
> Before treatment it was of an average 49% AVS (extremes 20 - 90),
> After 5 sessions of physiotherapy it was of an average 45% AVS (extr. 20 in 80, average improvement = 4%)
> After 5 Brachy-Myotherapy sessions it was of an average 16% (extr. 0 in 50, average improvement = 29%).
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B) Handicap (average)
> Before treatment was 49% (extr. 10 - 94)
> After 5 sessions of physiotherapy it was 43% (extr. 10 in 80%), average improvement = 6%
> After 5 Brachy-Myotherapy sessions it was 15% (extr. 0 in 50, average improvement = 28%).
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C)
When there were medicines associated to the treatment (22 cases on the 31) they were:
a) After physiotherapy
- increased in 2 cases
- abolished in 0 cases
- decreased in 0 cases
- unchanged in no cases exept worsened
b) After Brachy-Myotherapy
- increased in 0 cases
- decreased in 10 cases
- abolished in 9 cases
- unchaged in 3 cases
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Discussion
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Let us at first indicate some biasses, of which we however do not think that they may notably have falsified results.
1) Simultaneous taking of medicines, but:
- they were symptomatic and not a thorought treatment, and:
- taken only on demand, their possible decrease is on the contrary a valid criterion of improvement of the patient.
2) The same therapist for 2 methods, but this is almost inevitable in city practice: a patient comes to see a precise therapist and does not want to see someone else.
3) Physiotherapy always preceded Brachy-Myotherapy. It had probably been more interesting to invert this order 1 once every 2 patients, but for practical reasons this was not possible to be done (in a city cabinet, the immediate satisfaction of the patient - that means to begin with the treatment he expected is necessary to satisfy him, even tought in a second time another treatment can be proponed).
4) The physiotherapic treatment was not always srictly identical; but that of Brachy-Myotherapy neither: the therapeutic methods estimated here are not standard, but of therapy adapted to every particular case. It is necessary to adapt treatment to the patient, to his pathology and to the possible associated diseases.
Keeping this in mind, one observes:
- an average weak improvement by physiotherapy but much more important by an identical number of Brachy-Myotherapy sessions (see graphics)
- an abolition of any medical treatment (for the CBN) for 9 patients on the 22 concerned after Brachy-Myotherapy, thus nearly half of these patients, whereas none after physiotherapy.
- a total disappearance of the pain (thus complete cure) in 7 cases on the 31 after 5 Brachy-Myotherapy sessions, or near the quarter, none after 5 physiotherapy sessions.
- a more important improvement (residual pain fixed arbitrarily between 0 and 20%) for 12 patients of the 31 after Brachy-Myotherapy, or about 1/3, 1 case only after physiotherapy
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Conclusion
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It seems to us that Brachy-Myotherapy is more adapted to CBN than the classic Physiotherapy.
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References
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1. J. Polak: Cervicalgies, contractures antalgiques ou étiologiques, Kinésithérapeute praticien, 1997
2. Tavernier, Maillefort, Piroh: Diagnostic et traitement des cervicalgies; EMC Elsevier app. Loc. 14-365-A-10, 1996
3. Vignon: Cervicarthrose; EMC Elsevier App. Loc. 14310, A, 1983
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