Some systematic reviews (Green et al 2003, Faber et al 2006) have supported a combination of manual therapy and exercise for patients with impingement for improvements in pain and function. Manual therapy interventions may be appropriate for restrictions in the glenohumeral joint, shoulder girdle, cervical and thoracic spine, and ribs and are discussed in more detail in Chapters 11, 12, 15 and 20.
Bang & Deyle (2000) showed significant between-group differences on function, pain, and isometric strength of the shoulder in patients with impingement for the group that received thrust and non-thrust techniques to the glenohumeral joint, shoulder girdle, cervical and thoracic spine, and ribs and also manual muscle stretching, massage, and supervised exercise over the group receiving only the exercise intervention. Boyles et al (2009) showed significant within-group improvements at 48 hours for pain with provocative shoulder and resisted tests and functional scores in patients with impingement after only receiving mid-thoracic, cervico-thoracic, and rib thrust manipulation.
NASA (National Aeronautical and Space Administration) also saw the need to develop a means of preventing and treating bone and muscle loss of their astronauts as they explored the moon and other regions of the galaxy. Methods were developed to enhance bone retention, prevent or alleviate muscle atrophy, and enhance natural healing and regeneration whilst in a space environment with little access to conventional treatments.
Bergman et al (2004) compared medical care (consisting of oral analgesics or NSAID, education, advice, corticosteroid infiltrations and physical therapy referral for exercise, modalities, massage after 6 weeks) to medical care with up to 6 treatments of thrust and non-thrust manipulative interventions to the ribs and cervical-thoracic spine over 12 weeks in patients with shoulder symptoms and dysfunction of cervico-thoracic spine and adjacent ribs. At 12 weeks, 43% of the manipulation group and 21% of the medical care group reported full recovery. A 17-percentage point difference favouring manipulation still existed at 52 weeks. During intervention and follow-up a consistent between-group difference in severity of the main complaint, shoulder pain and disability, and general health favoured the manual therapy group.
Sensations extrêmes en perspectives avec ce livre dont la beauté évocatrice des photographies coupe le souffle-d'ailleurs on s'attendrait presque à expirer de la vapeur tant on se sent happé par les paysages... Parce que ces lieux froids sont fascinants et qu'il est toujours fructueux de sortir de sa zone de confort, ce livre vient à point nommé nous rappeler que le réchauffement climatique n'est pas un simple inconvénient du développement mais bien une agression commise à l'encontre de l'équilibre du monde.