Shiatsu-associated physical therapy on pain and fatigue on people with multiple sclerosis

Fillis, Michelle Moreira Abujamra; Nicio, Roseli; Nicio, Roberto Toshio; Santos, Gabriela Alves dos; Brandet, João Marcos; Ribeiro, Heloisa Galdino Gumieiro

doi:10.1590/fm.2022.35114

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ORIGINAL ARTICLE • Fisioter. mov. 35 • 2022 • https://doi.org/10.1590/fm.2022.35114 copy

Shiatsu-associated physical therapy on pain and fatigue on people with multiple sclerosis

Shiatsu associado à fisioterapia na dor e fadiga em pessoas com esclerose múltipla

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction:

Pain and fatigue are common symptoms in multiple sclerosis (MS). Shiatsu, a technique that uses the pressure of fingers, associated with manual therapy, exercises and stretching can be used to control these symptoms.

Objective:

To evaluate the effect of Shiatsu associated with physical therapy on pain and fatigue on people with MS.

Methods:

Randomized clinical trial with people diagnosed with MS divided into two groups: intervention group (IG) - Shiatsu-associated physical therapy (n = 9), and control group (CG, n = 8). Participants were assessed before and after treatment by the Expanded Disability Status Scale (EDSS), Neuropathic Pain Questionnaire (DN4), Visual Analog Scale (VAS) and Fatigue Impact Scale (MFIS), and description of sociodemographic.

Results:

Seventeen people with MS (9 men) aged 45.18 ± 3.06 years participated in this study. In the total sample, the average of DN4 was 1.65 ± 20.02, VAS was 2.29 ± 2.80, MFIS was 39.47 ± 29.67, and 52.9 % had a score > 38 in the MFIS that corresponds to presence of fatigue. The values pre/post-intervention/grade of p, respectively in the IG were DN4: 2.78 ± 2.16/2.0 ± 2.12/0.432, EVA: 3.22 ± 3.27/0.33 ± 1.00/0.023, total MFIS: 44.44 ± 35.91/35 ± 31.70/0.068. In the CG the values were DN4 : 0.38 ± 0.744/2.25 ± 2.71/0.054, EVA : 1.25 ± 1.83/3.63 ± 2.38/0.043, and MFIS : 33.88 ± 21.68/25.13 ± 24.22/0.379.

Conclusion:

Shiatsu associated with Physiotherapy was effective in improving pain and fatigue in individuals with MS.

Keywords:
Fatigue; Multiple sclerosis; Pain; Physical therapy; Shiatsu

Positioning	Therapy
Part 1 - Shiatsu points, manual techniques and passive mobilization²¹21 Namikoshi T. O livro completo da terapia Shiatsu. São Paulo: Manole; 1992. 272 p.
Patient in prone position with head resting on pillow and relaxed arms.	1) Sacral to cranial (cervical) sliding; 2) Transverse process adjustment; rotational pressure - circular over the shoulder blades; 3) Pressure applied by the therapist with both thumbs for 5 seconds and repeated three times at the following Shiatsu´s points: occipital region (GB20), oblong medulla (GV16), inter-scapular (BL14), suprascapular (VB-21), brachomedial (HT8), infra-scapular (BL-17), lumbar crest (BL23), sacral (BL25;BL 26), gluteal (GB29), Namikoshi point, femoral posterus (BL36, BL37), popliteal (BL40) posterior crural (BL57) BP6 (ankle), calcaneal tuberosity (BL60), plantar region (R1).
Right and left lateral decubitus: patient with extended lower limbs.	4) Passive upper trunk rotation exercise with hand stabilizing in pelvis and shoulder facilitation - 3 repetitions; 5) Passive lower trunk rotation exercise with hand stabilizing at shoulder and skin facilitation - 3 repetitions; 6) Passive mobilization of shoulder blade; 7) Sliding massage on triceps and buttocks; 8) Lumbar vertebrae rotation maneuver.
Supine: patient with extended lower limbs, arms at sides, relaxed, palms up.	9) Global pompage; 10) Upper trapezoid pompage; 11) Pressure applied by the therapist with both thumbs for 5 seconds and repeated three times at the following Shiatsu´s points: medial brachial region (CY1; CY3), ulnar fossa (HT3), antebrachial region (LU5, CY3, HT3), deltopectoral groove (LU1), lateral brachii (LI14), lateral forearm, dorsal region of the hand (LI4), dorsal finger region( HT7), palmar (CY8), femoral anterior (ST34), femoral medial (GB31), femoral lateral(ST-36),patellar (ST-35), tarsic region (ST-41) and dorsal crural region toes (ST-44) and digital (RL-3)*.
Part 2 - Active exercises and balance training²²22 Kisner C, Colby LA. Exercícios terapêuticos: fundamentos e técnicas. 6 ed. São Paulo: Manole; 2016. 1056 p.
Supine	1) Lumbar flexion: orthostatic position; feet farther than the shoulders; the trunk flexed forward until the hands touch the ground and return to the initial position, for 30 seconds, one repetition. 2) Active hip abduction exercise for 30 seconds, one repetition. 3) Active shoulder flexion exercise with extended elbows holding a ball, 3 sets of 10 repetitions. 4) Lying hip lift: dorsal decubitus on mat (ground); legs flexed at 90 degrees; patient extends hip keeping the shoulders and arms in the ground, contracting the glutes and abdomen; the movement goes up to the hip to align with the spine and then returns to the initial position, 3 sets of 10 repetitions. 5) Patient with flexed knees, with the aid of the ball, performs active trunk flexion exercise, contracting the abdomen. 3 sets of 10 repetitions.
Sitting on the chair	6) Active knee extension and flexion exercise, 3 sets of 10 repetitions. 7) Patient with crossed upper limbs in the chest performs the sitting and rising motion of the chair, 1 set of 10 repetitions. 8) Balancing exercises: standing balance will be worked, in which the patient will stay with only one foot fixed on the ground and another suspended, first with open eyes and then with closed eye.

Variable	Sample total (Average/Frequencies%)	Control group (n = 8)	Intervetion group (n = 9)	p-value
Gender (men/women)	9/8 (52.9/47.1)	5/3(62.5/37.5)	4/5 (44.4/55.6)	0.63
Age (years)	45.18 ± 12.63	46.88 ± 15.60	43.67 ± 10.03	0.33
Time of diagnosis (years)	8.00 ± 4.52	7.25 ± 5.23	8.67 ± 4.00	0.34
EDSS	2.91 ± 1.20	3.06 ± 0.97	2.77 ± 1.41	0.44
MS type (RR/others)	15/2 (88.2/11.8)	6/2 (75/25)	9/0 (100/0)	0.20
Physical therapy (Yes/No)	4/13 (23.5/76.5)	2/6 (25/75)	2/7 (28.5/71.6)	0.66
Physical activity (Yes/No)	4/13 (23.5/76.5)	3/5 (37.5/62.5)	1/8 (11.1/99.9)	0.24
ND4	1.65 ± 2.02	0.38 ± 0.74	2.78 ± 2.16	0.006*
VAS	2.29 ± 2.80	1.25 ±1.83	3.22 ± 3.27	0.009*
MFIStotal	39.47 ± 29.67	33.88 ± 21.68	44.44 ± 35.91	0.07
MFIS >38	52.9% (9)	50.0% (4)	55.6% (5)	0.60

Variables	Intervention group (n = 9)				Control group (n = 8)
Variables	Pre- intervention	Post- intervention	(95% CI)	p-value	Pre- assement	Post- assement	(95% CI)	p-value
ND4 (0-10)	2.78 ± 2.16	2.0± 2.12	[-1.3;2.9]	0.43	0.38 ± 0.744	2.25 ± 2.71	[-3.7;0.04]	0.05
ND4	4 (44.44%)	2 (22.22%)	-	0.72	0	2 (25%)	-	0.03
VAS (0-10)	3.22 ± 3.27	0.33 ± 1.00	[0.50;5.27]	0.02^* * p < 0.05.	1.25 ± 1.83	3.63 ± 2.38	[-4.65;-0.09]	0.04^* * p < 0.05.
MFIS total (0-84)	44.44 ± 35.91	35 ± 31.70	[-8.98;19.78]	0.068	33.88 ± 21.68	25.13±24.22	[-9.98;19.78]	0.37
MFIS cognitive (0-40)	18.56 ± 14.03	15.00±14.85	[-0.87;7.99]	0.10	11.13±11.49	9.38±10.92	[-7.40;10.9]	0.665
MFIS physicist (0-36)	23.22 ± 18.80	17.00 ±14.28	[-0.93;13.37]	0.080	19.25±10.75	13.25±13.17	[-5.55;17.55]	0.25
MFIS psychosocial (0-8)	3.33 ± 3.35	3.00 ± 3.53	[-0.75;1.42]	0.500	3.88 ± 3.18	2.50 ± 2.50	[-1.44;4.19]	0.28
Fatigue (MFIS > 38)	5 (55.6%)	4 (44.4%)	-	0.040^* * p < 0.05.	4 (50%)	3 (37.5)	-	0.11

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[1] * Correspondence: micmoreira@gmail.com