Efficacy of manual lymph drainage and myofascial therapy in patients with fibromyalgia
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M. Algar-Ramírez · E. Úbeda-D’Ocasar · J. P. Hervás-Pérez Department of Physiotherapy, Faculty of Education and Health, Camilo José Cela University, Urb. Villafranca del Castillo, Villanueva de la Cañada, Madrid, Spain
Efficacy of manual lymph drainage and myofascial therapy in patients with fibromyalgia A systematic review
Supplementary Information The online version of this article (https://doi. org/10.1007/s00482-020-00520-7) includes the PRISMA 2009 checklist. Contributions and additional material are available at www. springermedizin.de. Please enter the article title in the search field, the additional material can be found under “Ergänzende Inhalte”.
Introduction Fibromyalgia (FM) is a syndrome of unknown origin characterized by chronic widespread pain and numerous other symptoms including fatigue, insomnia, stiff joints, depression, concentration and memory problems, myofascial pain and tender points. Among all rheumatic diseases, FM is highly prevalent in Spain (representing 12.2% of all primary care visits) and is among the most severe with a detrimental impact on the quality of life of patients who often find it difficult to perform activities of daily life. FM shows a higher prevalence in women (4.2%) than men (0.2%). Although there is currently no cure for fibromyalgia, new therapeutic options have been the focus of research efforts [1, 2, 4–7]. Several studies have identified biochemical, neuroendocrine, muscular
and psychological abnormalities in patients with FM. These alterations lead to neuronal activity and myofascial tissue changes [4, 5]. Pain perception in FM has been linked to central nervous system (CNS) modifications causing a persistent state of high reactivity known as central sensitization. Central sensitization makes peripheral pain receptors activate nociceptor impulses aggravating sensitization. There is no evidence of muscular alterations in FM, but reports do exist of a dysfunction in connective tissue or fascia that triggers a peripheral nociceptor stimulus. Biochemical studies in fascial tissue have shown an increase in collagen and inflammatory substances in the connective tissue around muscle cells [3, 5, 8]. The roles of the fascial system include protection, body compartmentalization, lining and hemodynamic coordination, sending blood and lymph towards the heart and glands from the periphery. Any alteration in fascial tissue mobility can cause imbalance between body fluids leading to tissue hardening and the build-up of toxins. By stimulating lymph vessels, metabolic waste products can be eliminated, reducing excess fluid, freeing blockages and regulating the immunologic system [9, 10]. Through single-photon emission computerized tomography (SPECT), the presence of blood flow abnormalities has been confirmed in patients with FM including increased blood flow in brain cortex regions related to pain [9].
During the lymphatic drainage procedure, touch receptors which are close to pain stimuli, are also sensitive to pressure exerted on the skin. The impulse is transmitted to the spinal cord whe
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