The 12th Invest in ME Research Conference June, 2017, Part 2
MEMum presents the second article in a series of three about the recent 12th Invest In ME International Conference (IIMEC12) in London.
Discuss the article on the Forums.

Neuromuscular Strain Increases Symptom Intensity in Chronic Fatigue Syndrome

Discussion in 'Latest ME/CFS Research' started by Kati, Jul 18, 2016.

  1. Kati

    Kati Patient in training

    Messages:
    5,462
    Likes:
    19,550
    Neuromuscular Strain Increases Symptom Intensity in Chronic Fatigue Syndrome
    http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0159386
    By Rowe and colleagues

    Abstract

    Chronic fatigue syndrome (CFS) is a complex, multisystem disorder that can be disabling. CFS symptoms can be provoked by increased physical or cognitive activity, and by orthostatic stress.

    In preliminary work, we noted that CFS symptoms also could be provoked by application of longitudinal neural and soft tissue strain to the limbs and spine of affected individuals.

    In this study we measured the responses to a straight leg raise neuromuscular strain maneuver in individuals with CFS and healthy controls.

    We randomly assigned 60 individuals with CFS and 20 healthy controls to either a 15 minute period of passive supine straight leg raise (true neuromuscular strain) or a sham straight leg raise.

    The primary outcome measure was the symptom intensity difference between the scores during and 24 hours after the study maneuver compared to baseline.

    Fatigue, body pain, lightheadedness, concentration difficulties, and headache scores were measured individually on a 0–10 scale, and summed to create a composite symptom score.

    Compared to individuals with CFS in the sham strain group, those with CFS in the true strain group reported significantly increased body pain (P = 0.04) and concentration difficulties (P = 0.02) as well as increased composite symptom scores (all P = 0.03) during the maneuver.

    After 24 hours, the symptom intensity differences were significantly greater for the CFS true strain group for the individual symptom of lightheadedness (P = 0.001) and for the composite symptom score (P = 0.005).

    During and 24 hours after the exposure to the true strain maneuver, those with CFS had significantly higher individual and composite symptom intensity changes compared to the healthy controls.

    We conclude that a longitudinal strain applied to the nerves and soft tissues of the lower limb is capable of increasing symptom intensity in individuals with CFS for up to 24 hours.

    These findings support our preliminary observations that increased mechanical sensitivity may be a contributor to the provocation of symptoms in this disorder.
     
    actup, barbc56, Daisymay and 12 others like this.
  2. Denise

    Denise Senior Member

    Messages:
    1,095
    Likes:
    3,447
    I think it is important to note that the authors say one of the study limitations is that assessments beyond 24 hours were not done, nor were biomarkers measured though both would be important in future studies.

    Anecdotally some study participants experienced symptom exacerbation for much more than 24 hours.
    Also some patients find symptom exacerbation to be greater sitting with legs stretched straight out in front of them (at right angle to the torso) but amelioration (to some degree) if a rolled up towel or pillow is placed under their knees.
     
    MeSci, panckage, Valentijn and 3 others like this.
  3. M Paine

    M Paine Senior Member

    Messages:
    296
    Likes:
    816
    Auckland, New Zealand
    I wonder what a "15 minute period of passive supine straight leg raise" involves, and how it differs from a "sham straight leg raise". And if either of those two procedures would invoke aerobic respiration?
     
  4. Denise

    Denise Senior Member

    Messages:
    1,095
    Likes:
    3,447

    upload_2016-7-18_15-46-58.png

    (I don't think aerobic respiration is likely to be involved in either procedure.)
     
    barbc56, Daisymay, Valentijn and 2 others like this.
  5. Jill

    Jill Senior Member

    Messages:
    207
    Likes:
    708
    Auckland, NZ
    So thy are saying that the stretch felt , that no doubt sends signals up the spinal cord, is contributing to the symptoms, . In a sense i could understand this as i find sitting up in bed, legs out in front difficult.It seems to aggravate my neck and that aggravates everything else..

    Edit - just read the discussion and this is exactly what he is talking about. I am hypermobile , as diagnosed by Peter Rowe at a sydney conference in 1998. He is such a neat out of box thinker . Other drs I've seen back here , even a geneticist decided I don't have it because I miss one of the breighton criteria. A cardiologist even without examing me "divined "I didn't have it. Peter said my skin, stetched scars and ability to easily do yoga moves without stretching clinched it for him. Ive since realsied my mother has many aspects ( shes healthy at 79) and sadly so does my nephew. I'm just crosssing fingers that he doesnt come down with this - he is soooooo much like me. He already gets some of the gut issues. Atleast I'll be watching and can help out in getting him help if he needs it.

    Uuum need to watch this work
     
  6. Kati

    Kati Patient in training

    Messages:
    5,462
    Likes:
    19,550
    Accompanying article published here in 'Consumer Affairs'

    https://www.consumeraffairs.com/new...nding-of-chronic-fatigue-syndrome-071916.html

    Exerpt:
    Read more at the link
     
    mango, Snow Leopard and Comet like this.
  7. M Paine

    M Paine Senior Member

    Messages:
    296
    Likes:
    816
    Auckland, New Zealand
    I couldn't find heart rate measurements in the data for this paper, but I'm sure it did mention they were measured. Odd. I need to have a better read. I'm still wondering in a 15 minute leg raise could get the heart going in a CFS patient. I do a lot of yoga, and I can get the heart racing, and subsequently go into PEM from activity which a healthy person may find simple.
     
  8. Kati

    Kati Patient in training

    Messages:
    5,462
    Likes:
    19,550
  9. shannah

    shannah Senior Member

    Messages:
    1,357
    Likes:
    1,622
    The latest article published has a different focus. I must admit I didn't see this one coming!

    http://www.medicalnewstoday.com/articles/311813.php

    Lead author Dr. Peter Rowe, of Johns Hopkins University School of Medicine in Baltimore, MD, and colleagues believe their findings point to certain forms of physical therapy as an effective treatment for chronic fatigue syndrome (CFS).

    "We have shown in earlier studies that neuromuscular strain and restricted range of motion can be present in other areas of the body, and these areas of restricted movement might need to be treated with specific forms of physical therapy before people can tolerate more regular exercise.

    This needs to be studied more formally, but suggests a very practical avenue for addressing symptoms."
    Dr. Peter Rowe
     
  10. Denise

    Denise Senior Member

    Messages:
    1,095
    Likes:
    3,447

    I'm guessing that Dr. Rowe described the specifics of the physical therapy (passive therapy to increase range of motion and decrease neuromuscular strain) but the information didn't get included in the article.

    And not including it perpetuates the public's (and healthcare professional's) view that patients can be more active after undergoing physical therapy....
     
    mango likes this.
  11. mango

    mango Senior Member

    Messages:
    905
    Likes:
    4,975
    I was very surprised and disappointed when I read the full-text of the study, and at the very end found those suggestions :(

     
    Valentijn, Chezboo and shannah like this.
  12. dreampop

    dreampop Senior Member

    Messages:
    202
    Likes:
    503
    I have seen Rowe and had this done, he does it on all his patients, and may be able to answer some questions.

    1) Can it increase HR? My understanding is that it can exacerbate autonomic problems and I would believe it could. It may also release mast cells during the strain iirc.
    2) The physical therapy is neural tension work and he suggests two avenues: an osteopath and/or tai chi work - which is like yoga for the neural tissue. There are other forms of neural tension work you can find online, that are more like PT but derived from tai chi.
    3) The leg raise is literally lying down, and the physician raises one of your legs until it reaches tension, holding it there and seeing if symptoms worsen.

    Unfortunately, I have had both done and saw no improvements in my exercise tolerance from either. My belief is that CFS may very well lay in the neural tissue, or the brain contracting the neural tissue. It sounds simple, but when you can see the profound impact it has on your symptoms, even stuff like making a nose stuffier or a tension headache work, you could buy into it. Rowe believes, I think, that during growth the neural tissue gets clumped and this is the problem but I find that would only explain a pediatric patient base (which is who he sees to be fair).

    I'm unaware of any drugs that work to loosen neural tissue in a way we loosen muscles and Rowe certainly doesn't advocate one. I'm not sure where I would place Rowe amongst CFS doctors - his focus is largely on the ANS, removing problems like migraines and sinusitis, and long term, recumbent exercise or walking to tackle deconditioing.
     
    Last edited: Jul 25, 2016
    Snow Leopard, actup, Jill and 2 others like this.
  13. dreampop

    dreampop Senior Member

    Messages:
    202
    Likes:
    503
    Of course the question remains, do people who are really fatigued get neural tissue tension, do MS people get neural tension? And of, course, will treating it improve symptoms - I did osteopath work for like 7 months and got nothing, and it was too expensive for me to justify continuing. The osteopathic practice is a bit of "fringe" practice to put it lightly, where gentle movements on your skin are supposed to be rearranging tissue correctly. IDK about it.
     
  14. shannah

    shannah Senior Member

    Messages:
    1,357
    Likes:
    1,622
    I'm glad you posted @dreampop

    I was about to ask if anyone had neural mobilization treatments and the outcome.

    I did tai chi a very long time ago and it actually made me worse.

    I agree with the study findings that it takes so very little indeed to exacerbate symptoms; however, I question the study conclusions that he's made and I find them to be rather simplistic, disappointing and missing the mark.

    What is causing such ongoing injury to the tissues to begin with?
     
    ScottTriGuy and mango like this.
  15. dreampop

    dreampop Senior Member

    Messages:
    202
    Likes:
    503
    Its tricky with neural mobilization - you have to go very gently or it will make it worse as per this study. I don't think Rowe thinks the tissue is injured, he sees a "mechanically sensitized nervous system" but admits that could be due to any number of causes. Anyway, I think he was more interested in getting the evidence of neural hypersensitivity out there in a paper, so other researchers could use it as brain food, and clinicians could check for it in a suspect cfs case. Also, because he believes its treatable at least some of the time. I think hypothesizing as to why wasn't his focus.
     
  16. Jill

    Jill Senior Member

    Messages:
    207
    Likes:
    708
    Auckland, NZ
    @dreampop
    How does one do, or rather how do the therapists release the neural tension. Do they massage or stretch? I wouldn't imagine stretchimg would be any use and i'm also thinking massage might not be.

    This is someone holding your leg, straight out and pushing it up for twenty mins. Is that right? Did it feel at the time that it was stretchingthe back of your legs?
     

See more popular forum discussions.

Share This Page