Unraveling molecular determinants of manual therapy: an approach to integrative therapeutics for the treatment of fibromyalgia and CFS/ME

Application of protocols without parameter standardization and rigorous controls has led manual therapy (MT) and other physiotherapy approaches to controversial outcomes. Thus, there is an urgency to carefully define standard protocols that elevate physiotherapy treatments to rigorous scientific demands. One way this can be achieved is by studying gene expression and additional physiological changes that associate to particular, parameter-controlled, treatments in animal models and translating this knowledge to properly design objective, quantitatively-monitored clinical trials. Here, we propose a Molecular Physiotherapy Approach (MPTA), requiring multidisciplinary teams, to uncover the scientific reasons behind the numerous reports of MT that historically attribute benefits to these treatments. The review focuses in the identification of MT-induced physiological and molecular responses that could be used for the treatment of fibromyalgia (FM) and CFS/ME. The systemic effect associated to mechanical-load responses is considered of particular relevance as it suggests that defined, low-pain areas could be selected for treatments with overall benefits, an aspect that might result essential to treat FM. Additionally, MT can provide muscle conditioning to sedentary patients without demanding strenuous physical effort, detrimental for CFS/ME patients, placing MT as a real option for integrative medicine programs to treat FM and CFS/ME.

Dance as an Eccentric Form of Exercise: Practical Implications

The eccentric action is an integral part of the stretch-shortening (or eccentric-concentric) cycle of muscle movement, especially when repositioning of the centre of gravity is required. Jumps and landing tasks are examples of this cycle and are incorporated in most dance activities. However, unaccustomed eccentric muscle action can cause muscle damage, which is characterised by the development of delayed-onset muscle soreness and swelling, decline of pain-free range of motion, as well as sustained loss of muscle force and range of motion. Furthermore, unaccustomed eccentric muscle action can induce disturbances in movement economy and energy expenditure, so dancers spend more energy during a routine than usual. Such negative effects are gradually reduced and eventually disappear due to physiological adaptations to this form of muscular activity. Given that eccentric exercises also appear to induce greater muscle performance improvements than other forms of muscle conditioning, it is advised that they should be integrated into dancers’ weekly schedules. The purpose of the present review is to examine the possible effects of the eccentric component of dance on the performance and health status of dancers.