Abstract.[Purpose] The purpose of this study was to identify which manual therapy technique was effective against muscle tenderness and stiffness of myofascial pain syndrome and then, based on the result, to determine the cause of myofascial pain syndrome.[Subjects] The subjects were 23 men and 67 women who had an average age of 65.5 ± 19.0 years. All subjects had normal results in imaging and neurological examinations but complained of chronic pain along with muscle tenderness and stiffness.[Methods] Using a muscle hardness meter, the muscle hardness of the tender, stiff muscles was measured before, immediately after, and 1 week after manual therapy. The subjects were divided into two groups according to the therapy given myotherapy/massage, to provide direct stimulus to the muscle, or joint facilitation/joint mobilization, to improve functional joint disorders. Statistical analysis was conducted using repeated measures ANOVA, and multiple comparisons were performed.[Results] A significant difference in muscle hardness was seen between pre-treatment and post-treatment. A significant difference in muscle hardness was seen between before and 1 week after manual therapy, but not between post-treatment and 1 week after. A significant difference was seen between the direct stimulus to muscle technique and the functional joint disorder technique. Post-treatment muscle hardness decreased more with direct muscle stimulus than with the functional joint disorder technique, and muscle stiffness was decreased even 1 week after treatment.[Conclusion] Manual therapy for muscle tenderness and stiffness of myofascial pain syndrome was effective at reducing muscle stiffness. Moreover, techniques that provide direct stimulus to the muscle are better at reducing voluntary muscle stiffness than techniques that improve functional joint disorders.

This study examined the validity of a practical evaluation method for pitting edema by comparing it to other methods, including circumference measurements and ultrasound image measurements. Fifty-one patients (102 legs) from a convalescent ward in Maruyama Hospital were recruited for study 1, and 47 patients (94 legs) from a convalescent ward in Morinaga Hospital were recruited for study 2. The relationship between the depth of the surface imprint and circumferential measurements, as well as the relationship between the depth of the surface imprint and the thickness of the subcutaneous soft tissue on an ultrasonogram, were analyzed using a Spearman correlation coefficient by rank. There was no significant relationship between the surface imprint depth and circumferential measurements. However, there was a significant relationship between the depth of the surface imprint and the thickness of the subcutaneous soft tissue as measured on an ultrasonogram (correlation coefficient 0.736). Our findings suggest that our novel evaluation method for pitting edema, based on a measurement of the surface imprint depth, is both valid and useful.

[Purpose] To develop and verify the reliability of a new practical evaluation method for pitting edema, which uses the depth of the surface imprint as an indicator. [Subjects] We included 26 inpatients (52 legs). [Methods] The subjects were diagnosed with edema, and we verified the inter- and intra-rater reliabilities of the edema gauge using intraclass correlation coefficients. [Results] For the first and second measurement values and the measured values between the examiners, the intraclass correlation coefficients were high. [Conclusion] Therefore, our findings suggest that the edema gauge, which measures the depth of the surface imprint, has sufficient intra- and inter-rater reliabilities.

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The relationship between occlusal force and fall risk was studied in order to verify the usefulness of occlusal force measurements as a fall risk assessment. [Subjects] Fifty-five frail elderly persons (average age, 83.0 ± 5.7 years) receiving day-care services participated in this study. [Methods] Fall risk was assessed using the Fall Risk Index-21 (FRI-21). The occlusal force of the participants was measured using a commercial occlusal force meter, GM10. The number of residual teeth, leg strength, grip strength, one-leg standing time with the eyes open, Timed Up and Go test (TUG), and Functional Reach Test (FRT) were also assessed as fall-related factors. Items independently associated with FRI-21 were extracted in stepwise multiple regression analysis. [Results] TUG and occlusal force were found to be independently associated with FRI-21. [Conclusion] These results suggest that occlusal force is a useful assessment of the fall risk of the frail elderly.

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[Purpose] To clarify how a novel dynamic cushion affects the leg edema evoked by wheelchair sitting, we measured the changes in leg volume induced during wheelchair sitting with the dynamic air cushion or a static cushion. [Subjects and Methods] Nine healthy male subjects participated in this study. Leg edema during wheelchair sitting was evaluated with strain gauge plethysmography (the gauge was placed around the middle portion of the lower thigh). Following a period of rest, each subject was asked to sit on a wheelchair containing the dynamic cushion for 15 min. Then, the protocol was repeated with a static cushion. The angles of the knee and ankle joints were set to 90 degrees, and no footrests were used. [Results] The change in leg volume observed during sitting on the dynamic cushion (0.00 ± 0.03 mL/100 mL) was smaller than that observed during sitting on the static cushion (0.02 ± 0.02 mL/100 mL). [Conclusion] These results suggested that the dynamic cushion relieved leg edema during wheelchair sitting.

In the first part of the study (S1), we quantified muscle stiffness and gender differences in healthy persons. In the second part (S2), we clarified the relationship between muscle stiffness and pain in myofascial pain syndrome (MPS) which has muscle knots. [Subjects] The subjects of S1 were 52 healthy adults in their twenties. The subjects of S2 were 44 patients complaining of chronic lumbago, who showed no imaging or neurological findings and had muscle knots in the longissimus thoracis. [Methods] In S1, we measured the stiffness of the longissimus thoracis, and the trapezius and major rhomboid muscles with a muscle hardness meter; gender differences were verified with the t test. In S2, muscle stiffness was measured with the muscle hardness meter, and pain was evaluated using a numerical rating scale. The relationship between muscle stiffness and pain was investigated using Pearson's correlation coefficient. [Results] In S1, for the trapezius muscle, females showed significantly higher values, but no significant differences were seen for the other two muscles. In S2, the correlation between muscle stiffness and pain in muscle knots was weak. [Conclusion] We revealed that females have comparatively higher muscle stiffness in the trapezius muscle than males; however, the level of pain had no influence on muscle stiffness in MPS which has muscle knots.