Impaired Range of Motion of Limbs and Spine in Chronic Fatigue Syndrome.

[Firestormm]

J Pediatr. 2014 Jun 11.
Impaired Range of Motion of Limbs and Spine in Chronic Fatigue Syndrome.

Rowe PC1, Marden CL2, Flaherty MA2, Jasion SE2, Cranston EM2, Johns AS2, Fan J2, Fontaine KR3, Violand RL4.

Abstract
OBJECTIVE:
To determine whether adolescents and young adults with chronic fatigue syndrome (CFS) have a greater prevalence of impaired range of motion (ROM) of the limbs and spine than healthy control patients.

STUDY DESIGN:
Case-control study comparing rates of abnormal ROM in 48 consecutive adolescents and young adults with CFS and 48 healthy control patients matched by sex and joint hypermobility. We examined range of ankle dorsiflexion, passive straight-leg raise, seated slump, upper-limb neurodynamic test, prone knee bend, and prone press-up. Abnormal ROM was defined before the study began. The number of abnormal responses ranged from 0 (normal ROM throughout) to 11 (impaired ROM in all areas tested).

RESULTS:
The median number of areas with impaired ROM was greater in patients with CFS at the onset of stretch in the involved limb (5 vs 2, P < .001) and at end-range (2 vs 0, P < .001). Patients with CFS were more likely to have greater than 3 areas of impaired ROM (OR 6.0, 95% CI 2.1-17.3; P < .001) and were more likely to develop abnormal symptomatic responses to the individual tests and to the overall assessment (40% vs 4%; P < .001).

CONCLUSIONS:
Impaired ROM is more common in subjects with CFS than in healthy adolescents and young adults matched by sex and joint hypermobility. Adding a longitudinal strain to the nerves and soft tissues provoked symptoms in some subjects with CFS. The causes, functional impact, and optimal treatment of these abnormalities warrant further study.

Copyright © 2014 Elsevier Inc. All rights reserved.

 

[heapsreal]

i wonder if the general increase in inflammation we have from the immune system may increase or speed up arthirtis type conditions. I have alot of arthritic changes in the lumbar spine and cervical spine with bone spurs and facet joint arthritis. recently told my spine is alot older then me??

Maybe this shows that increased inflammation speeds up the aging process in general in many cfsme people??

 

[WillowJ]

Adding a longitudinal strain to the nerves and soft tissues provoked symptoms in some subjects with CFS.

A PT always thinks this should help, but I can't handle traction.

 

[alex3619]

This was in adolescents and young adults ... I don't think its about aging, that is a separate issue (and probably right). My guess is that its about loss of tissue stretch, probably due to alternations of protein composition. One factor might be elevated elastase, which destroys elastin, but I do not think all of us have this. Another might be the autoantibody to HSP60. If our proteins are badly folded then this might result in problems with muscle in particular.

This is also consistent with much older research showing blood vessel stiffness in ME/CFS.

The younger patients might not be appreciably physically older, but they do seem to be prematurely ossified.

 

[Firestormm]

This paper was presented btw at the IACFS/ME conference. There's a summary of it in Charles Shepherd's booklet if anyone would like to find it. I am off back to bed: https://www.facebook.com/permalink...._id=666487920098210&offset=0&total_comments=1

 

[Dolphin]

(Not too important)
I wonder whether a reviewer encouraged them to talk about CBT and GET or whether they decided this themselves:

Chronic fatigue syndrome (CFS) is a relatively common disorder in adolescence, with an estimated prevalence of 1 per 1000.1-4 It is a prominent cause of prolonged school absence.5-7 Cognitive behavioral therapy and graded exercise are the treatments best supported by the evidence in both adolescents and adults,8,9 but treatment effect sizes are modest.9,10 Moreover, concerns have been raised about the potential for harm if exercise is pursued too aggressively.11 Better understanding of the pathophysiology of symptoms is needed to identify more effective treatments.

 

[Dolphin]

The CFS patients were quite a flexible group:

More subjects with CFS could place their palms on the floor (44% vs 17%;P< .01), but the groups had a similar prevalence of abnormalities on the other 8 items of the Beighton score.

Generally they were matched well:

Eleven in each group had a Beighton score of 0-1, 16 had a score of 2-3, 13 had a score of 4-5, and 8 had a score of 6-9. The median Beighton score was 3 in both groups (P= .20), confirming that the matching on this variable was successful.

 

[Dolphin]

This is from the results section:

To explore whether the ROM impairments were more likely to have a component of neurodynamic dysfunction/ adverse neural tension, we assessed whether abnormal slump test symptoms were made better or worse by returning the neck to the neutral (nonflexed) position while the leg remained extended. Similarly, during the ULNT1, we evaluated the symptomatic response to cervical lateral flexion while the elbow of the upper limb remained extended. Among those with CFS whose slump symptoms (predominantly pain in the back, neck, and head) were provoked by either right or left knee extension while maintained in neck and upper trunk flexion, all 7 reported improvements in those symptoms once the neck was returned to the neutral position, consistent with a neurodynamic component. Of those whose symptoms were provoked by the ULNT1 maneuver, 4 of 6 had improvement in symptoms with ipsilateral cervical lateral flexion (neck side bend toward the tested limb) and 5 of 6 had increased symptoms with contralateral cervical lateral extension (side bend away from the tested limb), which also is consistent with a neurodynamic component.

 

[Dolphin]

They looked at some indirect measures of activity for possible effects:

To explore whether the ROM impairments could be explained by reductions in activity, we examined whether subjects with CFS with a score of #3 on the composite ROM score differed from those with a score of >3. There were no differences in the SF-36 physical function normed score (39.4 vs 41.3; P= .48), the SF-36 vitality normed score (32.2 vs 35.6;P= .19), or the Functional Disability Inventory score (21.8 vs 19.8;P= .53). Similarly, there was no difference in the median composite ROM score whether subjects with CFS remained in full-time school or had changed to parttime or home schooling (ROM score = 5 for both groups; P= .41).

Although activity levels and stamina in those with CFS are lower by definition, our data are not strongly supportive of the hypothesis that movement restrictions can be attributed simply to reduced physical activity. The physical activity of those with a greater number of ROM limitations was similar to those with fewer restrictions, as measured by questionnaire scores and rates of full-time school attendance. Objective measures of activity, such as comparative records of the number of steps per day, would help address this question in future studies.

 

[Dolphin]

They discuss how the abnormalities could be explored further:

Although the mechanisms for the impaired movement and increased mechanosensitivity in those with CFS are not known, unless treated, these abnormalities would be expected to contribute to symptoms and to impair function. Treatment of neuromuscular strain with the use of manual techniques, including neural mobilization, has proven beneficial for carpal tunnel syndrome and other conditions. 53-58 The optimal method of treatment for the abnormalities we describe in this report has not been studied. Testable hypotheses suggested by our results would be that if the physical examination abnormalities we report have a role in the pathophysiology of symptoms, then those who experience improvements in activity levels and CFS symptoms over time will also show improved performance on repeat ROM testing. A second testable hypothesis is that compared with standard therapy, addressing the movement restrictions with manual therapy would lead to more rapid rehabilitation and tolerance of graded increases in exercise.

 

[xchocoholic]

Any chance this is from flouroquinolones ? Frozen shoulders can be a side effect. My ROM was getting better until my last reaction to quinolones.

Tc .. x

 

[Sasha]

Treatment of neuromuscular strain with the use of manual techniques, including neural mobilization, has proven beneficial for carpal tunnel syndrome and other conditions.

So is this some sort of physical therapy that we could try? What sort of practitioner would know how to do that? A physio?

I don't really get what the mechanism for causing ME symptoms is supposed to be here. Can someone sum it up in a layperson's sentence or two?

 

[WillowJ]

Any chance this is from flouroquinolones ? Frozen shoulders can be a side effect. My ROM was getting better until my last reaction to quinolones.

Tc .. x

unlikely in the entire patient group, to have been using this specific type of antibiotic. However as you say, such injury is possible in particular cases.
http://www.merckmanuals.com/profess...and_antibacterial_drugs/fluoroquinolones.html
in case anyone else wanted to see.

 

[WillowJ]

So is this some sort of physical therapy that we could try? What sort of practitioner would know how to do that? A physio?

I don't really get what the mechanism for causing ME symptoms is supposed to be here. Can someone sum it up in a layperson's sentence or two?

This is what I found:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2565076/?report=classic
I read only the abstract, though the whole paper is there, and it said the quality of papers on neural mobilization is, on the whole, poor.

and a rant, basically, by a PhD PT (physical therapist, which is think is a physiotherapist to those of you who use the other version of English), which explains what they are doing (and why he thinks it's illogical):
http://www.jospt.org/doi/pdf/10.2519/jospt.2001.31.5.224
It looks to me like he's saying the model is that there is inappropriate tension in the nerves causing them to lack normal motion and the PT should try to move them about a bit, to loosen them. But he thinks the posture and mobility tests used can't prove the problem is in the nerves in particular, and he also thinks the nerves in particular cannot be targeted for mobility therapy.

fwiw, I found that if you want to see a PT, the more education the better. I won't see anyone who doesn't have a Master degree. If they have or are working on a PhD, even better.