Blog Arasys Perfector - Xanya Sofra Weiss

by Mannheimer, Jeffrey S., PhD,; 2005

The application of weak, low frequency electrical stimulation at the cellular level in animal, plant and E.Coli has been shown to stimulate the synthesis of adenosine triphosphate (ATP). In direct relationship, microamperage electrical nerve stimulation (MENS) has received anecdotal and clinical support as a pain reducing modality that has not been subjected to scientific study. The theoretical therapeutic effect of MENS is based upon the chemiosmotic theory of ATP synthesis by creating a proton gradient at the inner mitochondrial membrane. Magnetic resonance spectroscopy (MRS) represents the gold standard to quantify the metabolic effects of exercise and electrical stimulation on ATP synthesis as determined by fluctuation of Pi/PCr. An increase in Pi/PCr is indicative of an elevated rate of ATP production. 31P magnetic resonance spectroscopy (MRS) was used to examine the levels of inorganic phosphate (Pi), phosphocreatine (PCr) and intracellular pH (pHi) of the human masseter muscle. A cohort (n = 23) consisting of normal subjects and those with a temporomandibular disorder (TMD) were tested in a single application, randomized design with active and placebo comparison during a one hour exposure. Data in the form of phosphorus spectra were acquired at baseline, during the 20-32 and 48-60 minute time-points, with active stimulation and placebo protocols administered at a sub-sensory level via surface electrodes adjacent to the masseter muscle, thereby employing repeated measures. Pi/PCr values were calculated at each time-point and clinical measures consisting of visual analogue scale (VAS), active vertical mandibular range of motion (ROM) and pressure pain threshold (PPT) of the masseter were obtained at pre-and post-exposure for the TMD group. Exposure to MENS revealed a significant (p = .05) elevation of Pi/PCr in both normal and TMD subjects at the 48-60 minute time-point, which was not apparent with placebo exposure. Significant increases in ROM and PPT as well as a decrease in VAS, was apparent for the TMD group exposed to active stimulation. Due to the small sample size and limited statistical power, results should be considered with caution, pending replication and verification by further study.

Helena M[Photo]enp[Photo][Photo]; Riitta Jaakkola; Marita Sandstr[Photo]m; Lennart Von Wendt; 2004

Aim: To determine whether microcurrent stimulation (MENS) increases the range of motion (ROM) of the ankle joint in children with cerebral palsy.

Design: Twelve children with spastic hemiplegia (age range 4.5 to 16 years) with moderate myocontracture of the triceps surae, received MENS for 1 h five times a week for 4 weeks. An equally long baseline period was preceded. The assessments were: active and passive ROM of ankle dorsiflexion, popliteal flexion and ankle dorsiflexion in maximal flexion of knees in standing position while maintaining the heels in contact with the floor, one foot standing and hopping on one foot.

Results: After the treatment with MENS, the passive ROM of ankle dorsiflexion with both knees flexed and extended (p < 0.001) increased significantly. Increases were also observed in popliteal flexion (p < 0.001) and ankle dorsiflexion (p = 0.0012) during maximal flexion of the knees in a standing position. The ROM of active dorsiflexion with the knee flexed (p < 0.05) and one foot standing (p < 0.05) also improved. Children and parents found this treatment easy to carry out.

Conclusions: MENS relieves myocontracture and can enhance conventional rehabilitation programmes for children with cerebral palsy.

Xanya Sofra-Weiss, Ph.D

Bioimpendance Neuronal Microstimulation (BNM) was engineered to treat sports injury and muscle atrophy, as well as promote lipolysis and muscle hypertrophy. A clinical study with individuals presenting abnormally clumped RBCs was completed in February 2009 with the Ion Magnum. Results indicate that this technology rapidly and efficiently leads to normalized erythrocytes’ separation at the microscopic level. Red Blood Cells’ (RBCs) separation is crucial for the timely transport of hormones, antibodies, oxygen and nutrients to the cells and waste products to the kidneys. Therefore, blood separation is crucial in a number of biological processes including cellular cleansing, nourishment and oxygenation, endocrine and immune functioning.

Ion Magnum’s (IM) dynamic, multi-sine, analogue waveform was originally tested at the cellular level by Dr. Donald Gilbert (1992), a molecular biologist, and was electronically composed by the Co-Inventor of the first Pacemaker (2008) to resonate at the motor nerve the signal of strenuous exercise normally emitted by the brain. Due to its resonance with the biological signal, the Ion Magnum signal spreads throughout the CNS ultimately triggering hormonal secretion such as Growth Hormone (GF), Thyroxine (T4) and Triiodothyronine (T3) for lipolysis and Insulin Growth Factor (IGF-1) for muscle hypertrophy. Power detox is an additional benefit of Ion Magnum’s induced effortless and painless isometric and isotonic muscle contractions. Several devices stimulate the muscles such asTENS Muscle Stimulators. However, TENS devices deplete ATP. Besides, muscle stimulation does not automatically release hormones. Neuronal synapses activated out of sync with the other inputs to the neuron stands out as odd and are eliminated. Neuronal synapses that are activated in sync with other inputs to the neuron are strengthened. The signal of a device must be in sync with the biological choreography in order to spread via the spinal cord and reach the brain. In sync, or resonance, has been touted by a number of approximate hit-or-miss techniques involving magnetic and electrical fields with dubious inconsistent results. But no technology has ever achieved nerve signaling that is biologically comparable to physical exercise. What the Co-Inventor of the first Pacemaker has accomplished, first in London University and then in the EU funded Research Center for Innovations Science, UK, is a full force, high-speed workout without actual movement, side effects or pain, that enhances hormonal secretion. Lipolysis and muscle hypertrophy following IM treatments has been reported by a number single subject design clinical studies.

IM neuronal microstimulation mobilizes the skeletal muscles into rhythmical pleasurable contractions the way the Pacemaker sets the heart rhythm by brief resonant signals. Intracellularly, this process involves neuronal signals traveling down the spinal cord, carrying the message to the brain via synapses strengthened by virtue of being activated in sync by IM’s resonant inputs. IM’s analogue multi- sine waveform signal has a history of 30 years of research in London University, UK. This bio-identical signal initially targets the motor neurons resulting in rhythmical muscle contractions equivalent to performing high resistance physical activity. The process is initiated at the peripheral motor neuron, then the circuit is completed by outgoing CNS neuron emission. This CNS emission causes the ultimate production of Free T3 and GH/IGF-1, which in turn cause lipolysis and muscular hypertrophy. Triggering hormonal secretion, however, is only part of the process. GF is transported via the blood to the liver to be transformed into IGF-1 which causes muscle hypertrophy. T3 and T4 are also released into the blood stream, being transported throughout the body where they control lipolysis and overall metabolism.

The present study involved 19 randomly selected subjects (17 females and 2 males) all of which received six 45 minute IM treatments every other day. All subjects completed a medical questionnaire. None of the subjects reported any medical disorders. None of the subjects was on a special diet or regular exercise regime. No special supplements or medications were offered during the study. The subjects were instructed to drink an average of 6 glasses of water daily. All subjects were given a 16.9 fluid oz bottle of water prior to the treatment and a second bottle of water after the treatment. METHOD: A drop of the subject’s blood was drawn from the fingertip of each subject and placed on a microscope slide. A special lens inside the microscope projected an intimate view of the living blood onto a computer screen by way of a video camera. The camera was hooked up to the microscope enabling the taking of photographs of a each subject’s blood sample before and after treatment. There were at least 5 pictures taken from different aspects of each sample to control for the possibility of contaminating the validity and reliability of the results by selecting a certain aspect of the sample over another. This was a blind study conducted by individuals that had not been given information as to how to interpret blood samples. VARIABLES:1. The presence of round, separated, freely moving erythrocytes.

2. Rouleau, in which the red blood cells are clumped together and stacked like coins. This suggests the presence of free radicals. Rouleau affects proper oxygenation and favors the growth of unhealthy organisms that can survive in a milieu that is less oxygen rich. Fungi, bacteria, and viruses require less oxygen than healthy tissue.

3. Erythrocyte aggregation, a condition one step worse than rouleau. This is often seen in people with degenerative diseases, degeneration of tissue, low oxygen and acidity. This condition can precede a blood clot which can cause a stroke or heart attack.

4. Poikilocytosis, a condition caused by free radicals. Usually, free radical damage signifies that there will also be damage to the nuclei of tissue cells.

5. Fungal forms: a sign of poor assimilation of nutrients and an acidic condition in the body fluids 6. Bacteria.

7. Thrombocyte Aggregation: when the throbocytes (platelets) aggregate can form a clot which can block an artery. RESULTS:

97% of the subjects had an immediate improvement after the first treatment. However the improvement was on the average limited to going from Erythrocyte Aggregation to mostly Rouleau plus some round, separated, freely moving erythrocytes. Before the 6th treatment, 60% of the subjects had 70% rouleau and 30% normal RBCs separation. 40% of the subjects had mostly round, separated, freely moving erythrocytes before the 6th treatment. After the end of the 6th treatment, 85% of the subjects had mostly round, separated, freely moving erythrocytes. 20% of the subjects had about 30% rouleau and 70% RBCs separation after the 6th treatment. 5% of the subjects had rouleau and minimal RBG’s separation after the 6th treatment. 92% of the subjects had reduced fungal forms, poikilocytosis, thrombocyte aggregation and bacteria. 45% out of that

92% of the subjects with fungal forms, poikilocytosis, thrombocyte aggregation and bacteria present in their blood prior to the first treatment showed none of these forms in the after blood sample after the 6th treatment. 100% of the subjects showed a significant improvement in terms of Poikiloacytosis. These highly significant results may reflect the device’s potential in acting as a mega antioxidant by replenishing the missing electrons of free radicals, thus turning them into stable molecules. CONCLUSION: The results of this clinical microscopy study can be summarized as follows:

1. IM treatments result in an overall improvement in terms of normalized erythrocyte separation.

2. On the average, RBCs separation appears to linearly improve with increased number of treatments.

3. IM treatments appear to have a negative correlation with the number of fungal forms, poikilocytosis, thrombocyte aggregation and bacteria present in the blood prior to the IM treatments, demonstrating a significant reduction of all of the above mentioned variables after the 6th treatment.

4. The enhanced erythrocyte separation as well as the reduction of fungal forms, poikilocytosis, thrombocyte aggregation and bacteria persisted during the intervals between treatments. A longitudinal study is necessary to investigate the total length of time during which such normalization effects continue to be present. So far, two subjects that have been followed up over a period of three months have sustained the Ion Mangum’s positive effects on RBCs separation. This technology that was initially based on research associated with the Pacemaker and gained its popularity in the field of body building and cosmetic procedures is now coming full circle by offering benefits that can be potentially used in Medicine to reduce the incidence or progression of cardiac disorders as a result of erythrocyte aggregation. IM treatments effortlessly exercise the body without lactic acid production while enhancing RBCs separation. This process of exercis ing without actually exercising could solve the dilemma caused by intolerance to Statins which is associated with intolerance to exercise, possibly due to lactic acid formation. Statins are widely prescribed to lower high blood cholesterol and thus reduce the risk for heart disease.

CHAPMAN-JONES David ; HILL D; 2002

Background: The healing processes of tendon tissue are not well understood and the difficulty in clinical management of its pathology reflects this. Previous in vitro studies have demonstrated that application of microcurrent can promote protein production (collagen) in fibroblasts and tenocytes. In vivo studies, using animal models, have demonstrated that tendon and ligament tissue responds particularly well to this application. Thus the purpose of this study was to evaluate functional outcome in patients presenting with chronic pathology in the Achilles tendon, following application of microcurrent compared with conservative management.Method: A prospective comparative study was undertaken using a blocked randomisation method. Subjects were allocated either to group A and exposed to current clinical management or to group B, the experimental microcurrent regime. Classification and subsequent evaluation of pathology were assessed employing clinical assessment tests, self-assessment and assessment by diagnostic ultrasound. Baseline characteristics were similar in both groups. Subjects were assessed at three, six and 12 months after entry into the study. Forty-eight subjects, 24 in each group, completed the study. A statistical analysis was performed, calculating the differences between the two groups and between each interval assessment. Categorical variables were compared between the two groups using the chi-squared test. The Mann-Whitney test was performed to assess changes in ordinal variables. Results Statistically significant differences were found in favour of group B, the experimental group, in four out of the five clinical markers used at the 0.1% level of significance. Conclusion: The application of microcurrent treatment to patients presenting with chronic Achilles tendon pathology can make a significant contribution to improvement of the condition.( vol. 88, no8, pp. 471-480 )

Chronic low back pain associated with myofascial trigger point activity has been historically refractory to conventional treatment (Pain Research and Management 7 (2002) 81). In this case series study, an analysis of 22 patients with chronic low back pain, of 8.8 years average duration, is presented. Following treatment with frequency-specific microcurrent, a statistically significant 3.8-fold reduction in pain intensity was observed using a visual analog scale. This outcome was achieved over an average treatment period of 5.6 weeks and a visit frequency of one treatment per week. When pain chronicity exceeded 5 years, there was a trend toward increasing frequency of treatment required to achieve the same magnitude of pain relief.In 90% of these patients, other treatment modalities including drug therapy, chiropractic manipulation, physical therapy, naturopathic treatment and acupuncture had failed to produce equivalent benefits. The microcurrent treatment was the single factor contributing the most consistent difference in patient-reported pain relief.These results support the observation that rigorously designed clinical investigations are warranted.

BACKGROUND: Obesity has been reported to be associated with coronary artery disease and other atherosclerotic diseases. Recently, evidence has accumulated indicating that intra-abdominal visceral fat accumulation contributes to atherogenesis; however, the mechanism underlying this remains to be determined. This study was undertaken to elucidate whether intra-abdominal visceral fat accumulation impairs vascular endothelial function in obese men.

METHODS AND RESULTS: Thirty-eight obese men (body mass index (BMI)26.0), aged 19-64 y (mean age 37.6±1.8 y) and 23 age-matched non-obese subjects were examined. According to the ratio of the maximum thickness of preperitoneal fat to the minimum thickness of subcutaneous fat (Pmax/Smin) obtained by longitudinal ultrasound scanning in the subxiphoid region in obese men, we divided obese subjects into two categories; visceral (Pmax/Smin1; n=23) and subcutaneous type (Pmax/Smin<1; n=15). To investigate endothelial function, we performed ultrasound measurement of the brachial artery diameter non-invasively both at rest and during reactive hyperaemia in the muscle distal to the brachial artery which causes endothelium-dependent vasodilatation. The brachial diameter change was also measured after sublingual administration of nitroglycerin, which causes endothelium-independent vasodilatation. Flow-mediated diameter (D) increase (%FMD; D/D´100), in the subjects with visceral type obesity (3.09±0.43%) was significantly lower than those of the subjects with subcutaneous type obesity and non-obese subjects (7.90±0.51%, 8.91±0.44%, respectively, P<0.01). The magnitude of endothelium-independent vasodilatation by nitroglycerin was similar in all groups. On multiple regression analysis, the Pmax/Smin showed a significant inverse correlation with %FMD.

CONCLUSIONS: The subjects with visceral type obesity, rather than those with the subcutaneous type, are associated with impaired flow-mediated endothelium-dependent vasodilatation of the brachial artery.

INTRODUCTION

As aggressive therapy with combination surgery, chemotherapy, and radiotherapy (RT) increases tumor control in head-and-neck neoplasms, posttreatment quality-of-life issues remain problematic (1). One area of concern is progressive fibrosis of soft tissue in the head, neck, and supraclavicular area. For many patients, palpation of the treated areas reveals hard, unyielding tissue that limits range of motion and/or leads to pain associated with movement. The concept of investigating microcurrent therapy to treat radiation-induced fibrosis arose from the observation of a salivary gland patient who was receiving microcurrent therapy for the surgical scar at a family physician’s office while receiving neutron therapy at Fermilab. The patient experienced significantly milder erythema and mucositis than would historically be expected for radical RT in the neck area. This serendipitous observation led to a hypothesis that microcurrent therapy could be beneficial in managing the effects of RT.

METHODS AND MATERIALS

Twenty-six head-and-neck cancer patients who had completed RT and were experiencing tissue discomfort or limitations caused by fibrosis participated in the study. Because this was a pilot study to determine the efficacy of a new use of a standard therapeutic technique, it was important that all participants have quantifiable symptoms with no expectation of resolution without intervention. Hence, patients experiencing documented progressive fibrosis were targeted. The staff made objective range-of-motion measurements, and subjective complaints were solicited from the patients. The procedure and its possible lack of benefit were explained to the patients before they signed a document indicating informed consent. The Provena Saint Joseph Hospital Institutional Review Board approved the protocol. Selection of study subjects Eligible patients had finished either photon or neutron therapy at least 6 months before entering the study and had no evidence of disease. They had mental alertness sufficient to understand, evaluate, and consent to the protocol, which included the availability for b.i.d. treatments daily for 1 week and the ability to return for scheduled follow-up visits. Exclusion criteria included the use of a pacemaker, use of calcium-channel blocker drugs, pregnancy, and a life expectancy of 6 months. Individuals who were unable to abstain from physical therapy to the affected area, routine use of antiinflammatory steroids, or nonsteroidal antiinflammatory drugs during the treatment and follow-up period were also excluded. Table 1 summarizes the baseline characteristics of the participants. Choice of microcurrent technique and schedule The use of electrical stimulation for pain relief is well established in physical therapy centers. Many commercial electrical stimulation devices are available, most of which are commonly referred to as transcutaneous electrical nerve stimulation units. Typical units emit electrical pulses with alternating positive and negative polarities in the 10–500- kHz range and currents in the milliampere range. Microcurrent units are often incorrectly referred to as transcutaneous electrical nerve stimulation units, but microcurrent units deliver lower currents (microampere range) and lower frequencies (0.5 to several hundred hertz). In general, units using higher current and frequencies are more effective at blocking acute pain, but the pain relief is not lasting. Microcurrent therapy using lower frequencies requires longer treatment times to achieve pain relief, but the relief can endure for many hours after the treatment has terminated (5). Because the patients targeted for this study were experiencing chronic rather than acute symptoms, a microcurrent device was selected. The costs of microcurrent devices range from several hundred to thousands of dollars. Some fraction of the cost is related to packaging, but most of it is associated with the degree of sophistication of the electronic circuits. It is well known that the body’s impedance changes when electrical current passes through it. The more sophisticated devices contain circuitry that monitors impedance and adjusts the output current to compensate for changes. These devices also deliver fast rise time pulses that can affect voltagesensitive sodium and calcium ion channels (6). The Electro- Myopulse and Electro-Acuscope instruments (Biomedical Design Instruments, Burbank, CA) chosen for this study deliver impedance-controlled, fast rise time pulses. Their retail price is about $8500 each. Electrotherapy treatments are reimbursable under established billing codes. Typical charges to a patient are $40–50 per 15-min treatment. However, patients in this study were not charged for the therapy. Physical therapists use microcurrent therapy in a variety of ways, often in combination with massage, heat, and physical manipulation. Treatment schedules are not standardized, but are driven by insurance payment schedules and the patients’ personal schedules. The treatment schedule for this study was established after informal discussions with a few physical therapists who had extensive experience using the Electro-Myopulse and Electro-Acuscope instruments for treating a variety of physical complaints. All agreed that noticeable improvement could be obtained most quickly if the patient were treated b.i.d. for 3 days. All agreed that lasting improvement tended to require several treatments per month for about 6 months and that some conditions could resolve completely if this long-term treatment schedule were followed, particularly if therapy started soon after the injury or symptom occurred. Given the advanced fibrosis of many of the study patients, it was decided to administer microcurrent treatments b.i.d. for 5 days and simply observe whether this therapy had any effect on severely fibrotic tissue. Any observed improvements were not expected to be lasting, because no follow-up treatments at more spread-out intervals were scheduled. Until measurable evidence of the treatment’s effectiveness was observed, it did not seem reasonable to commit resources to a longterm treatment schedule. Objective measurement techniques As shown in Fig. 1, cervical rotation, extension/flexion, and lateral flexion were measured using two large protractors mounted in perpendicular planes. An elastic band with Velcro attachments was secured to the patient’s head to permit the placement of a small laser that pointed to degree markings on circular scales used to measure range of motion in degrees. This laser was positioned relative to the points about which the patient’s head pivots during rotation, ex- Fig. 1. Patient positioned at vertex of two mutually perpendicular protractors used to measure cervical range of motion. Fig. 2. Laser affixed to the patient’s head measures left–right cervical rotation. Impedance-controlled microcurrent therapy for RT-induced fibrosis in head-and-neck cancer ● A. J. LENNOX et al. 25 tension/flexion, and lateral flexion. Stationary lasers were used to position the patient so that the movable laser was on a line that intersected the vertex of the large protractors. Figures 2 through 4 illustrate the setup for each angular measurement. Day-to-day patient positioning accuracy was 0.25 cm, which is small compared with the protractors’ 112-cm radius. This choice of scale minimized the effect of day-to-day errors in positioning the patient’s center of rotation at the vertex of the scale. For each patient, the pretreatment data were used to classify each range of motion as asymptomatic or mildly, moderately, or severely limiting. If a patient’s range was within 90% of the optimal range for a healthy young person, that patient was classified as asymptomatic for that measurement. Ranges between 70% and 90% of optimum were designated mildly limiting, and those of 50–70% were moderately limiting. Ranges 50% of optimum were considered severely limiting.

DISCUSSION

In head-and-neck cancer patients, radiation-induced fibrosis can lead to many different complaints, depending on the size and placement of the treatment fields, the total dose, and whether the patient also underwent surgery. Limitations in neck range of motion are common and are quantifiable. Because this study was looking for objectively measured changes associated with microcurrent therapy, the protocol was designed to achieve improvement in the range of motion. Measurements were made on all patients in the study regardless of whether the patient considered range-of-motion limitations to be a problem. Most of the patients in the mildly and moderately limited groups had learned to compensate for the limitations and were surprised when the measurements showed how much capability they had lost. The patients who were most severely limited received the greatest degree of benefit. Patients also received relief from a number of complaints not directly targeted in the treatment protocol, the most significant of which were trismus and xerostomia. When the study was completed, some case studies were done using a different microcurrent protocol along with physical therapy for the relief of trismus. The results were encouraging and suggest that additional studies on the role of microcurrent therapy in treating trismus are warranted. Our xerostomia data are currently being analyzed and will be published separately. Perhaps the most encouraging outcome of this study was that many of the benefits observed at the end of the treatment week were sustained. In some cases, continued improvement occurred during the 3-month follow-up period, suggesting that the treatment had initiated tissue repair. The beneficial effects of electric current for soft tissue repair have been described by Polk (8). The exact mechanisms for tissue repair are not completely understood, but one theory indicates that microcurrent stimulation influences the migration of extracellular calcium ions to penetrate the cell membrane. The higher level of intracellular calcium encourages increased synthesis of adenosine triphosphate. Protein synthesis is encouraged by affecting mechanisms that control DNA, thus encouraging cellular repair and replication (9). It is also believed that microvoltage may affect the cascade of reactions involved in a variety of inflammatory responses. Our data support the view that microcurrent therapy can initiate long-term benefit for patients with fibrosis. At the onset of the study, it was expected that any improvement in symptoms would be transient, because no follow-up treatment was offered. The data indicate that this assumption was incorrect. Although the group size was small, the data shown in Figs. 6 through 8 suggest that improvement continued during the first and second months after microcurrent therapy. The treatment schedule needs to be optimized, perhaps delivering fewer treatments the first week followed by weekly and then monthly treatments to determine the maximal achievable benefit. For patients who are just beginning RT, it is possible that an optimal treatment schedule would include administering impedance-controlled microcurrent treatment concurrent with RT. In designing the study, we deliberately excluded the use of any agent or activity that could contribute to the relief of symptoms associated with fibrosis. Because this study has shown benefits attributable to microcurrent therapy alone, it is appropriate to consider combining this therapy with other physical therapy techniques or medications such as pentoxifylline/ vitamin E (10). Seven of the patients who benefited from microcurrent therapy indicated that they had received no benefit from previous physical therapy, but it is possible that the combination might be more effective than either modality alone.

CONCLUSION

Impedance-controlled microcurrent therapy shows promise in improving the range of motion and alleviating other symptoms associated with radiation-induced fibrosis. Studies should be done to validate our preliminary results and to optimize the treatment schedule to achieve longer lasting benefit. Protocols combining microcurrent therapy with physical therapy and/or promising medications could prove to be very beneficial in improving the quality of life for RT patients.

M . Lewis , M . Johnson; 2003

Objectives: To determine the effectiveness of therapeutic massage (TM) for the symptomatic relief of musculoskeletal pain, and to analyse TM intervention protocols used in studies.

Design: Systematic review of randomised controlled clinical trials and experimental studies on healthy human participants.

Participants: Patients with musculoskeletal pain and healthy participants with post-exercise pain and soreness. Main outcome measures Comparisons of TM with: (i) no treatment; (ii) sham interventions; and (iii) active (standard) treatment. Outcome was dichotomised as effective (TM>comparison group) or not effective (TM≤comparison group).

Results: Twenty studies (1341 participants) met the criteria for review. TM was superior to no treatment in five out of 10 comparisons, superior to sham (laser) treatment in one out of two comparisons, and superior to active treatment in seven out of 22 comparisons. TM was superior to comparison groups in six out of 11 studies using patients with musculoskeletal pain, and in three out of seven studies using patients with low back pain. TM was superior to comparison groups in four out of nine studies using healthy participants experiencing post-exercise pain and soreness. There were no relationships between study outcome and the TM regimen used.

Conclusions: The available evidence is inconclusive. A combination of inadequate sample sizes, low,methodological quality and insufficient TM dosing is likely to have contributed to the confused evidence base