Effectiveness of Myofascial Release in Patients With Chronic Post Sternotomy Pain Syndrome

Cairo University (CU)

Status: Not yet enrolling

Conditions: Chronic Postsurgical Pain

Treatments: Other: Myofascial release; Other: Breathing exercises; Drug: Pharmacological treatment

Study type: Interventional

Funder types: Other

Identifiers

NCT06630208

P.T.REC/012/005235

Details and patient eligibility

About

The main aim of this study is to investigate the effectiveness of Myofascial release in patients with chronic sternotomy pain.

Full description

Post-sternotomy pain syndrome (PSPS) is a prevalent disorder affecting a substantial proportion of patients who have undergone sternotomy surgery, with incidence rates ranging from 10% to 40%. Several mechanisms have been proposed to be responsible for the development of PSPS; for example, intercostal neuralgia from scar-entrapped neuroma, brachial plexus injury, ribs or costal fractures with incomplete healing, sternal wound infections and even hypersensitivity reaction to sternal wire. chronic post sternotomy pain (CPSP) can compromise quality of life, affecting their sleep patterns and impairing their working ability.

During the first week after coronary artery bypass grafting (CABG) surgery, vital capacity (VC) decreases by 30-60% and even up to 1 year this remains reduced by 12%. Reduced VC has a negative effect on exercise tolerance (Vo2max) and therefore it is important to optimize pulmonary function after CABG surgery. The decreased thoracic mobility after CABG still presents 12 months after surgery. Thoracic mobility and vital capacity were affected more when the left internal thoracic artery (LITA)-retractor was used and reduced thoracic mobility is related to diminished pulmonary function.

New therapeutic-rehabilitative proposals have been tried in cardiac patients. After cardiac surgery, it was found that the responses of the cardiovascular, and respiratory systems get better after neuromuscular manual therapy. The strong correlation between manual therapy and its effects, suggests that a central control mechanism could be activated by manual therapy.

Using Myofascial release (MFR) techniques may be beneficial for patients post-CABG and off-pump coronary artery bypass grafting (OPCAB) surgery. The advantages of MFR techniques are gentleness and non-invasiveness. During therapy one works with fascia structures, thus, not influencing bone structures directly, These techniques are comfortable and safe, they may be applied in acute conditions.

Enrollment: 60 estimated patients

Sex: All

Ages: 55 to 65 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Chronic Post-sternotomy pain (CPSP), defined as discomfort at the thorax after cardiac surgery, persisting for at least 2 months, and without apparent cause (I.e., such as infection or the underlying disease that motivated the surgery).
• Age between 55 to 65 years old.
• All patients will be under full medical supervision.
• Adherence to informed consent.
• Cardiac sternotomy intervention

Exclusion criteria

• Neuromuscular disorders.
• Any Active hemorrhage.
• The presence of an unstable cardiac, pulmonary or cerebral pathology.
• Poor cognition and mentality.
• Patients with active contagious skin conditions
• Any Cardiopulmonary problems (eg. Uncontrolled hypertension, Heart Failure, Arrhythmia)
• Patients with malignancy.
• Any acute viral infection.
• Patients with ascites or end-stage liver or kidney failure.
• Patients will participate in other physiotherapy programs rather than the prescribed protocol.
• Chest infection in last 3 months.
• Patients with musculoskeletal problems like any bone fracture
• Osteoporotic patients.
• Any recent open wound in the chest are.
• Hemodynamic instability.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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60 participants in 2 patient groups

Myofascial release + Breathing exercises + Pharmacological treatment

Experimental group

Description:

It will include 30 patients, who will receive myofascial release for 5 days, with breathing exercises in addition to pharmacological treatment.

Treatment:

Drug: Pharmacological treatment

Other: Breathing exercises

Other: Myofascial release

Pharmacological treatment

Active Comparator group

Description:

It will include 30 patients, who will receive pharmacological treatment only.

Treatment:

Drug: Pharmacological treatment