Efficacy of Physiotherapy Techniques on Irritable Bowel Syndrome (IBS). Pilot Study.
Condition: Irritable Bowel Syndrome
MeSH terms: Irritable Bowel Syndrome; Syndrome
Study type: Interventional

Summary: 
      Introduction and State of Question Irritable Bowel Syndrome can be classified as a functional
      digestive disorder characterized by abdominal pain, bloating, and changes in the frequency
      and consistency of bowel movements. Recent studies endorse the use of physical therapies for
      its symptomatic treatment. With the present study investigators wanted to verify the
      effectiveness of physiotherapy techniques in order to alleviate or eliminate the symptoms of
      Irritable Bowel Syndrome.

      Material and Methods Investigators have carried out an uncontrolled pilot clinical trial in a
      sample of 24 patients diagnosed with Irritable Bowel Syndrome in two hospitals in the Region
      of Murcia. Among the measurement tools used, we highlight the use of the IBS-Severity Scale,
      IBS-QoL, STAI and spirometry tests.
    

Detailed description: 
      Scope of treatment: From the Digestive System Services, patients who meet the criteria
      described above, will be referred to the Rehabilitation Services of the Virgin of Arrixaca
      and Reina Sofía University Hospital, and then, to the physiotherapy unit. At the same time,
      the researcher will contact these patients to manage the appointments proposed in
      physiotherapy. The physical treatment to be applied individually has a duration of 40 min per
      session, establishing a maximum of 8 sessions and a minimum of 3 sessions. This treatment is
      described below: the first three weeks: (3 days / week)

        1. Performing direct physical treatment on the diaphragm, using stretching, followed by
           teaching exercises for re-education of the abdomen and diaphragm. (20 min):

           A) Direct physical treatment on the diaphragm. It refers to the stretching of the
           xiphoid and costal portions. With the patient in the supine position and the hips flexed
           90º, investigator take advantage of the abdominal-diaphragmatic respiration in its
           expiratory component to stretch these portions, trying to penetrate with fingertips over
           the xiphoid and costal edge and maintaining the position with each gain, performing a
           maximum of 3 winnings.

           B) Abdomino-diaphragmatic reeducation: With the patient in the supine position and the
           hips flexed 90º, investigator will place the hands in the abdominal area and ask pacient
           to try to push the hands upwards taking air with the belly. Once the patient have become
           aware investigator will put up some resistance to the movement. Investigator will avoid
           possible compensations by controlling the expansion of the rib cage if necessary. Next
           investigator will ask patient to associate movements of the pelvic scale during
           breathing. In inspiration, investigator will ask patient to slightly push the sacrum on
           the stretcher and in ESP, then investigator will ask patient to bring the pelvis back
           tightening the buttocks as trying to retain defecation. (10min)

        2. Transcutaneous retrograde electrostimulation: L1-L4 (2hz-10hz) rectangular asymmetric
           biphasic at the level of the dermatome. From the anterior inferior iliac spine to a
           pubic symphysis. Second canal from the greater trochanter to the saphenous veins. (30
           min). For this, investigator use the TENS STIM-PRO T-800 device. European Certificate of
           Conformity (CE 2460). The investigator use program of acupuncture TENS according to the
           Sjound and Erikson theory of endorphin release, with a neuromodulating objective.
           Parameters of this program: 2 Hz and 180ms, for 30 min. Investigator should increase the
           intensity measured in Milli-Amps until it produces contraction for a few seconds, then
           lower it until the contraction is no longer visible. This therapy can be applied during
           manual therapy treatment, be it diaphragmatic stretching, abdominal massage and
           diaphragmatic reeducation.

        3. Connective Tissue Massage or Dicke (10 min): Investigator place the patient sitting on
           the table and ask that the lumbar area and gluteal and sacral area be discovered.
           Without the help of oils or creams, investigator have to make three strokes with the
           help of the ulnar edge of the hand and the 3rd and 5th finger. This therapy may arise
           that the patient has to go to the bathroom before, during or after treatment due to the
           activation of the renal system through stimulation of the cuti-visceral reflex.

        4. Massage with direct maneuvers on the abdomen: It is a massage specially indicated to
           facilitate intestinal mobility and transit in the large intestine. For its realization
           investigator can apply creams or oils. The direction of the maneuvers will be clockwise.
           It is important to apply the not pain rule. Investigator will start with a superficial
           friction, followed by a spiral massage in the intestinal area. Next, perform 6 very slow
           strokes adding small pressures on the ascending, transverse and descending colon
           respectively and repeating this maneuver 3 times. (10min)
    

Intervention name(s): Physical Therapy Group
Intervention type(s): Other
Intervention description(s): Performing direct physical treatment on the diaphragm, using stretching, followed by teaching exercises for re-education of the abdomen and diaphragm.
Transcutaneous retrograde electrostimulation: L1-L4 (2hz-10hz) rectangular asymmetric biphasic at the level of the dermatome. From the anterior inferior iliac spine to a pubic symphysis. Second canal from the greater trochanter to the saphenous veins. (30 min). Parameters of this program: 2 Hz and 180ms.
Connective Tissue Massage or Dicke
Massage with direct maneuvers on the abdomen: The direction of the maneuvers will be clockwise. We will perform 6 very slow strokes adding small pressures on the ascending, transverse and descending colon respectively and repeating this maneuver 3 times. (10 minutes)
Intervention model: Single Group Assignment
Intervention model description: 24 patients diagnosed with Irritable Bowel Syndrome
Masking: None (Open Label)
Primary purpose: Treatment