• breathing
• cardio rehabilitation
• diaphragm
• fascia
• manual therapy
• osteopathic
• osteopathy
• physiotherapy

• adherence
• fascia
• myofascial
• osteopathic manipulation
• osteopathy
• pain
• peritoneum
• scar

• Back pain
• failed back surgery syndrome
• spine surgery

• Degenerative lumbar disease
• Failed back surgery syndrome
• Lumbar spine surgery
• Patient satisfaction
• Risk factors

• Complications
• High cholesterol
• High triglycerides
• Hyperlipidemia
• Lumbar fusion
• Lumbar surgery

• Humans
• Hyperlipidemias/complications
• Hyperlipidemias/epidemiology
• Lumbar Vertebrae/surgery
• Myocardial Infarction/etiology
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Propensity Score
• Renal Insufficiency/complications
• Retrospective Studies
• Spinal Fusion/adverse effects
• Surgical Wound Infection/etiology
• Urinary Tract Infections

• Chronic pain
• FBSS
• Failed back surgery syndrome

• failed back surgery syndrome
• sympathetic nervous system
• pulsed radiofrequency
• numeric rating scale
• oswestry disability index
• back pain
• autonomic nervous system
• genetic factors

• Autonomic Nervous System
• Failed Back Surgery Syndrome/therapy
• Humans
• Low Back Pain/therapy
• Pulsed Radiofrequency Treatment
• Treatment Outcome

• Neuroplasticity
• Spinal cord stimulation
• Structural brain alterations
• Structural imaging
• Supraspinal mechanism
• Voxel-based morphometry

• complementary therapies
• intervertebral disc displacement
• low back pain
• lumber intervertebral disc herniation
• prospective study
• protocol
• registry

• Acupuncture Therapy/methods
• Adult
• Aged
• Humans
• Integrative Medicine/methods
• Intervertebral Disc Displacement/complications
• Intervertebral Disc Displacement/therapy
• Medicine, Korean Traditional/methods
• Middle Aged
• Observational Studies as Topic
• Prospective Studies
• Registries
• Republic of Korea
• Sciatica/etiology
• Sciatica/therapy
• Treatment Outcome
• Young Adult

Evidence-based practice (EBP) arises from evidence-based medicine (EBM). The latter represents a movement of thought born in the second half of the 19th century, while the EBP is born since the new millennium, represented by different scientific figures and professional associations. The EBP is the research for the best practical and clinical strategies, with the ultimate goal of determining guidelines. The improvement of manual osteopathic practice derives from the balanced mix of scientific research, operator experience and patient experience. The text reviews the benefits and limitations of EBP in the osteopathic field. We must remember that knowledge, both theoretical and practical, is always evolving and we must not stop at what appears to be a dogma. Science and knowledge are always evolving, and hence, we must always study and update ourselves.

• cochrane
• evidence-based medicine
• evidence-based practice
• fascia
• oteopathic

• cardiac transplantation
• case report
• diaphragm
• fascia
• heart
• osteopathic
• pain

The word diaphragm comes from the Greek (διάϕραγμα), which meant something that divides, but also expressed a concept related to emotions and intellect. Breath is part of a concept of symmorphosis, that is the maximum ability to adapt to multiple functional questions in a defined biological context. The act of breathing determines and defines our holobiont: how we react and who we are. The article reviews the fascial structure that involves and forms the diaphragm muscle with the aim of changing the vision of this complex muscle: from an anatomical and mechanistic form to a fractal and asynchronous form. Another step forward for understanding the diaphragm muscle is that it is not only covered, penetrated and made up of connective tissue, but the contractile tissue itself is a fascial tissue with the same embryological derivation. All the diaphragm muscle is fascia.

• breathing
• diaphragm
• fascia
• myofascial
• osteopathic
• physiotherapy

• fMRI
• frequency
• spinal cord stimulation
• subthreshold
• suprathreshold

• chronic headache
• diaphragm
• irritable bowel syndrome
• low back pain
• pain

The incidence of chronic postoperative pain following lumbar spinal surgery has increased with the overall increase in the prevalence of lumbar surgery. This study was conducted to evaluate the analgesic effectiveness of pulsed electromagnetic field (PEMF) therapy in subjects with persistent pain following lumbar surgery.

A randomized, double-blind, sham-controlled, multicenter study in 36 subjects with persistent low-back and/or radiating leg pain after lumbar surgery was conducted. Eligible subjects were randomized (1:1:1) to receive one of two doses of therapy (42-μs or 38-μs pulse width) or treatment with a sham device. Subjects self-treated twice daily for 60 days. The primary end point was change in pain intensity (∆PI) using the Numerical Pain Rating Scale between average baseline (Days −5 to −1) and end of treatment (Days 56–60) for lumbar and radiating leg pain. Secondary outcome measures included the Oswestry Disability Index, Beck Depression Inventory-II, Patient Global Impression of Change, and consumption of analgesics.

Low-back pain scores for the 42-μs group decreased by 40.2% (p = 0.028), compared to 18.6% for the 38-μs pulse width group (p = 0.037) and 25.6% for the sham group (p = 0.013 per protocol population). Average leg pain scores decreased by 45.0% (42 μs, p = 0.009), 17.0% (38 μs, p = 0.293), and 24.5% (sham, p = 0.065). The proportion of subjects responding to therapy, time to 30% reduction in pain scores, and Patient Global Impression of Change were improved with the PEMF 42-μs device over the sham control, although results were associated with p-values >0.05.

PEMF therapy (42-μs pulse width) was associated with trends for a reduction in pain, compared to sham treatment. Secondary endpoints were consistent with an overall beneficial effect of the PEMF 42-μs pulse width device.

• chronic pain
• failed back surgery syndrome
• lumbar surgery
• neuromodulation
• neuropathic pain
• nociceptive pathways
• pulsed electromagnetic field therapy

The functions of the diaphragm do not stop locally in its anatomy but affect the whole body system. The respiratory rhythm, directly and indirectly, affects the central nervous system (CNS). This article describes and reviews these influences, containing, for the first time, information on this subject in a single text. The ability of breath to move the brain mass and determine patterns of neural oscillation will be discussed. The role of the diaphragm in influencing motor expression and its effect on intracranial blood shifts in respiratory activity will also be discussed. It is known that the diaphragm can have multiple uses in improving the symptomatological picture of chronic diseases, but there is no current, concrete data on the effects that the rehabilitative training or manual approaches could have on the patient; in particular, on his/her cognitive and cerebral aspects in general.

• breathing
• diaphragm
• neural oscillation
• phrenic nerve
• vagus nerve

• COPD
• diaphragm
• fascia
• muscle pain
• thoracic pain

• Animals
• Chest Pain/etiology
• Chest Pain/metabolism
• Chest Pain/pathology
• Chest Pain/physiopathology
• Fascia/diagnostic imaging
• Fascia/metabolism
• Fascia/pathology
• Fascia/physiopathology
• Humans
• Lung/physiopathology
• Myalgia/etiology
• Myalgia/metabolism
• Myalgia/pathology
• Myalgia/physiopathology
• Pain Measurement
• Prognosis
• Pulmonary Disease, Chronic Obstructive/complications
• Pulmonary Disease, Chronic Obstructive/metabolism
• Pulmonary Disease, Chronic Obstructive/pathology
• Pulmonary Disease, Chronic Obstructive/physiopathology
• Risk Factors
• Tomography, X-Ray Computed

COPD is a worsening condition that leads to a pathologic degeneration of the respiratory system. It represents one of the most important causes of mortality and morbidity in the world, and it is characterized by the presence of associated comorbidity. This article analyzes gastroesophageal reflux disease (GERD) and low back pain (LBP) in patients with COPD and tries to produce anatomo-clinical considerations on the reasons of the presence of these comorbidities. The considerations of the authors are based on the anatomic functions and characteristics of the respiratory diaphragm that are not always considered, from which elements useful to comprehend the symptomatic status of the patient can be deduced, finally improving the therapeutic approach. The information contained in the article can be of help to the clinician and for physiotherapy, and to all health professionals who gravitate around the patient’s care, improving the approach to the diaphragm muscle.

• COPD
• GERD
• diaphragm
• fascia
• low back pain

Neuropathic pain after spinal surgery, the so-called failed back surgery syndrome (FBSS), is a frequently observed troublesome disease entity. Although medications may be effective to some degree, many patients continue experiencing intolerable pain and functional disability. Only gabapentin has been proven effective in patients with FBSS. No relevant studies regarding manipulation or physiotherapy for FBSS have been published. Spinal cord stimulation (SCS) has been widely investigated as a treatment option for chronic neuropathic pain, including FBSS. SCS was generally accepted to improve chronic back and leg pain, physical function, and sleep quality. Although the cost effectiveness of SCS has been proved in many studies, its routine application is limited considering that it is invasive and is associated with safety issues. Percutaneous epidural adhesiolysis has also shown good clinical outcomes; however, its effects persisted for only a short period. Because none of the current methods provide absolute superiority in terms of clinical outcomes, a multidisciplinary approach is required to manage this complex disease. Further studies concerning the etiology, diagnosis, treatment, and cost effectiveness of FBSS are warranted to deepen our understanding of this condition.

• Failed back surgery syndrome
• Neuralgia
• Percutaneous adhesiolysis
• Spinal cord stimulation

• depression
• failed back surgery syndrome
• insomnia
• pain catastrophizing.
• pain severity
• risk factors

The respiratory diaphragm is the most important muscle for breathing. It contributes to various processes such as expectoration, vomiting, swallowing, urination, and defecation. It facilitates the venous and lymphatic return and helps viscera located above and below the diaphragm to work properly. Its activity is fundamental in the maintenance of posture and body position changes. It can affect the pain perception and emotional state. Many authors reported on diaphragmatic training by using special instruments, whereas only a few studies focused on manual therapy approaches. To the knowledge of the authors, the existing scientific literature does not exhaustively examines the manual evaluation of the diaphragm in its different portions. A complete evaluation of the diaphragm is mandatory for several professional subjects, such as physiotherapists, osteopaths, and chiropractors not only to elaborate a treatment strategy but also to obtain information on the validity of the training performed on the patient. This article aims to describe a strategy of manual evaluation of the diaphragm, with particular attention to anatomical fundamentals, in order to stimulate further research on this less explored field.

• chiropractic
• diaphragm
• manual therapy
• osteopathic evaluation
• physiotherapy

Fifteen percent to forty percent of patients present with persistent disabling neck pain or radicular pain after cervical spine surgery. Persistent pain after cervical surgery is called cervical post-surgery syndrome (CPSS). This review investigates the literature about interventional pain therapy for these patients. Because different interventions with different anatomical targets exist, it is important to find the possible pain source. There has to be a distinction between radicular symptoms (radicular pain or radiculopathy) or axial pain (neck pain) and between persistent pain and a new onset of pain after surgery. In the case of radicular symptoms, inadequate decompression or nerve root adherence because of perineural scarring are possible pain causes. Multiple structures in the cervical spine are able to cause neck pain. Hereby, the type of surgery and also the number of segments treated is relevant. After fusion surgery, the so-called adjacent level syndrome is a possible pain source. After arthroplasty, the load of the facet joints in the index segment increases and can cause pain. Further, degenerative alterations progress. In general, two fundamentally different therapeutic approaches for interventional pain therapy for the cervical spine exist: Treatment of facet joint pain with radiofrequency denervation or facet nerve blocks, and epidural injections either via a transforaminal or via an interlaminar approach. The literature about interventions in CPSS is limited to single studies with a small number of patients. However, some evidence exists for these procedures. Interventional pain therapies are eligible as a target-specific therapy option. However, the risk of theses procedures (especially transforaminal epidural injections) must be weighed against the benefit.

• Post-surgery syndrome
• Neck pain
• Cervical epidural injections
• Cervical interlaminar injections
• Cervical transforaminal injections
• Cervical facet joint pain
• Cervical radiofrequency neurotomy
• Facet joint nerve block
• Epidural steroids
• Local anesthetics