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Treating fallopian tube occlusion with a manual pelvic physical therapy

Authors:
  • Clear Passage Physical Therapy
  • Clear Passage Physical Therapy
  • HMD Research, Inc

Abstract

To determine the efficacy of a non-invasive, manual soft-tissue physical therapy in opening completely blocked fallopian tubes in infertile women with confirmed bilateral occlusion and a history indicative of abdominopelvic adhesions. Retrospective analysis. Clear Passage Therapies, Inc, clinic, Gainesville, Florida. 28 infertile women (mean age = 35.2) with diagnosed complete tubal occlusion (proximal, midtubal, distal, or combination). The patients were being treated for various types of abdominopelvic pain and dysfunction (eg, intercourse and/or pelvic pain, menstrual cramps, endometriosis pain). A 20-hour series of manual physical therapy treatments (mean duration = 1 week) designed to address pain and restricted soft tissue mobility due to adhesions and micro-adhesions. The therapists accessed some of the deeper structures (such as the fallopian tubes) indirectly by manipulating the peritoneum, uterine and ovarian ligaments, and neighboring structures. (1) Unilateral or bilateral tubal patency confirmed by diagnostic test or natural intrauterine pregnancy; (2) natural intrauterine pregnancy rate achieved by patent patients within the 2-year follow-up period. Of the 28 patients, 17 (61%, 95% exact CI 41%-78%) demonstrated post-treatment unilateral or bilateral patency, as measured by hysterosalpingography or natural intrauterine pregnancy. The median interval between the last treatment date and patency confirmation was 1 month. Nine of the 17 (53%) patent patients reported a subsequent natural intrauterine pregnancy. Since truly occluded tubes are not known to reopen spontaneously, the results suggest this non-invasive therapy might be considered as an adjuvant to standard gynecological procedures in treating tubal occlusion.
(1) FERTILITY
Wurn BF, Wurn LJ, King CR, Heuer MA, Roscow AS, Hornberger K, Scharf ES.
Treating fallopian tube occlusion with a manual pelvic physical therapy. Alternative
Therapies in Health and Medicine. 2008 Jan-Feb;14(1):18–23.
Wurn BF, Wurn LJ, King CR, Heuer MA, Roscow AS, Scharf ES, Shuster JJ. Treating
female infertility and improving IVF pregnancy rates with a manual physical therapy
technique. Medscape General Medicine. 2004;6(2):51.
(2) MENOPAUSE AND OSTEOPOROSIS
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2
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3
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Procter & Gamble Pharmaceuticals/TheraTech (Protocol 1998049). A 12-week,
Randomized, Parallel Group, Multicenter, Wear Study to Assess Skin Tolerance with a
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R.W. Johnson (Protocol ESTNRG-CHRT-104). A Multicenter, Double-Blind,
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Multicenter, Randomized, Double-Blind Exploratory Study Investigating the
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Sterling Winthrop Pharmaceuticals (Protocol SR41319B-004). A Phase III Study of
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Osteoporosis.
The Upjohn Company (Protocol M5410/0336). Evaluation of Endometrial Histology and
Bone Mineral Density (BMD) in Postmenopausal Women Receiving OGEN/PROVERA)
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Wyeth-Ayerst Research (Protocol 0802D1-324-US). A Randomized, Double-Blind,
Placebo- and Active-Controlled, Parallel, Multicenter Study to Assess the Safety and
Efficacy of 3 ½ Day Combinations of 17β-Estradiol/Norethindrone Acetate Transdermal
Delivery Systems for Relief of Menopausal Vasomotor Symptoms and Reduction of
Endometrial Hyperplasia.
4
Osteoporosis
Mead Johnson Laboratories: Evaluation of the Effect of the 0.5 mg Estrace Compared to
Placebo on Biochemical Markers of Bone Resorption in Postmenopausal Women, 1994.
Solvay Pharmaceuticals, Inc.: Investigation of Three Doses of Esterifield Estrogens
(Estratab®) on Bone Mineral Density and Parameters of Bone Metabolism in
Postmenopausal Women, 1992.
Osteoporosis Protocols
Boehringer Manheim Pharmaceuticals Corporation (Protocol MF4380). Double-Blind,
Placebo-Controlled, Randomized, Multicenter Study on the Efficacy and Safety of
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Postmenopausal Osteoporosis Using an Intermittent (every 3 months) I.V. Injection
Regimen of 1 mg.
Eli Lilly & Company (Protocol H3S-MC-GGGK). Comparison of Raloxifene HCl and
Placebo in the Treatment of Postmenopausal Women with Osteoporosis.
Eli Lilly & Company (Protocol H3S-MC-GGHF).Raloxifene HCl versus Placebo versus
Hormone Replacement Therapy: Histomorphologic Effects in Bone Loss.
Novo Nordisk Pharmaceuticals, Inc. (Protocol LEV/PD/15/USA). A Double-Blind,
Randomized Placebo-Controlled Trial of Three Doses of Levomeloxifene and Prempro®
for the Prevention of Postmenopausal Osteoporosis.
Novo Nordisk Pharmaceuticals, Inc. (Protocol LEV/PD/16/USA). A Double Blind,
Randomized, Multicenter, Placebo-Controlled Trial of 1.25 and 2.5 mg of
Levormeloxifene for the Treatment of Postmenopausal Osteoporosis.
Novo Nordisk Pharmaceuticals, Inc. (Protocol LEV/PD/17/USA). A Double-Blind,
Placebo-Controlled Trial to Study the Safety and Efficacy of 2.5, 10, and 40 mg of
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(Org OD 14) for Prevention of Osteoporosis in Postmenopausal Women.
Ostex International, Inc. (Protocol OST-C2). A Study of the Use of Osteomark in the
Quantitation of Cross-Linked N-telopeptides of a Type I Collagen as an Aid in
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Loss in Postmenopausal Women.
Pfizer, Inc. (Protocol 174-106). A Randomized, Double-Blind, Placebo-Controlled Study
of the Effects of Droloxifene 40 mg/d, 60 mg/d, and 80 mg/d on BMD in Osteopenic,
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5
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Preventing Bone Loss in Normal, Early Postmenopausal Women.
Pfizer, Inc. (Protocol A2181003-5045). A Study of the Safety and Efficacy of
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Procter & Gamble Pharmaceuticals/G.H. Besselaar Associates (Protocol RPE 002494). A
Randomized, Double-Blind, Placebo-Controlled, Multicenter, Parallel Group Study to
Compare the Efficacy and Safety of Risedronate (NE-58095) plus Estrogen versus
Estrogen Only in the Prevention of Bone Mineral Mass and No Vertebral Fractures.
Procter & Gamble Pharmaceuticals/G.H. Besselaar Associates (Protocol RVN008993). A
Randomized, Double-Blind, Placebo-Controlled, Multicenter, Parallel Group Study to
Determine the Efficacy and Safety of Risedronate (NE-58095) in the Treatment of
Postmenopausal Women with Established Osteoporosis-Related Vertebral Deformities.
Procter & Gamble Pharmaceuticals / Quintiles Inc. (Protocol RHN009193). A
Multicenter, Randomized, Double-Blind, Placebo-Controlled, Parallel Group Study to
Determine the Efficacy and Safety of Risedronate in the Treatment of Osteoporosis in
Elderly Women.
Procter & Gamble Pharmaceuticals (Protocol 1996023). A Randomized, Double-Blind,
Placebo-Controlled 24 Month, Dose Ranging , Multicenter Study Protocol Comparing
EMTDS to Placebo in the Prevention of Bone Loss in Hysterectomized Postmenopausal
Women.
Roche Pharmaceuticals (Protocol MF4492). Double-Blind, Placebo-Controlled,
Randomized, Multicenter Study on the Efficacy and Safety of Ibandronate During an
Extended Two Year Partial Crossover Study of Patients Enrolled in MF4380 Using an
Intermittent I.V. Injection Regimen of 0.5 mg and 1 mg Every 3 Months.
Sterling Winthrop Pharmaceuticals (Protocol SR 41319B-005). A Phase III Study of
Intermittent Cyclical Tiludronate in the Treatment of Post-Menopausal Women with Low
Bone Mineral Mass and no Vertebral Fractures.
Sterling Winthrop Pharmaceuticals (Protocol SR41319B-004). A Phase III Study of
Intermittent Cyclical Tiludronate in the Treatment of Established Post-Menopausal
Osteoporosis.
The Upjohn Company (Protocol M5410/0336). Evaluation of Endometrial Histology and
Bone Mineral Density (BMD) in Postmenopausal Women Receiving Ogen/Provera)
Hormone Replacement Therapy (HRT).
6
(3) GYNECOLOGICAL/UROLOGICAL CONDITIONS
Candidiasis
Bayer Corporation (Protocol S95-003). A Multicenter, Prospective, Randomized, Single-
Blind, Parallel-Group Comparison of the Clotrimazole 1-Day (One 500 mg Vaginal
Insert) and the Clotrimazole 3-Day Regimens (One 200 mg Vaginal Insert Daily for 3
Days) with Clotrimazole 7-Day Regimen (One 100 mg Vaginal Insert Daily for 7 Days)
for the Treatment of Vulvovaginal Candidiasis.
Advance Care Products, Ortho Pharmaceutical Corporaqtion (Protocol 94-007P). Phase
III Study Comparing Micanzole Nitrate (4%) Vaginal Cream and Mixanozole Nitrate
(2.8%) Vaginal Cream to Monistat® 7 (2%) Vaginal Cream in the Treatment of
Vulvovaginal Candidiasis.
Endometriosis
IBAH / Searle Research and Development (Protocol N65-97-02-001). Clinical Protocol
for a Dosing Optimization Study of Syneral® for Endometriosis: Safety and Efficacy of a
Single 400μG Daily Dose for 6 Months and a Step-Down Dose from 200μG BID for 2
Months to 200μG Daily for 4 Months: a double-blind, placebo-controlled, randomized
comparison to the currently recommended regimen of 200μG BID daily for 6 months,
IND # 18,138.
Oral Contraceptives
Organon, Inc./Pharmaco LSR (Protocol 086-001). An Open Label, Multicenter, Non-
Comparative Safety and Efficacy Study of the Desogestrel Containing Oral Contraceptive
CTR 25.
Organon, Inc./Pharmaco LSR (Protocol 092-001).An Open-Label, Randomized, Parallel,
Comparative, Multicenter, Safety and Efficacy Study of Triphasic Combination Oral
Contraceptives, CTR 99 and CTR 77, versus Ortho-Novum 777.
Organon, Inc./Quintiles, Inc. (Protocol 069-001). An Open-Label Noncomparative
Efficacy and Safety Study of Implanon, a one-Rod Contraceptive Implant Containing 3-
Ketodesogestrel in Healthy Female Volunteers, with Subsets for Pharmacokinetic
Measurements, Ophthalmological Assessments, Carbohydrate Metabolism, Lipid
Metabolism and Endometrial Morphology.
Organon, Inc. (Protocol 147-001). A Randomized, Open-Label, Comparative,
Multicenter Trial to Evaluate Contraceptive Efficacy, Cycle Control, Safety and
Acceptability of a Monophasic COC Containing 200μg EE, Compared to a COC
Containing 100μg Levonorgestrel and 20μg EE.
Ortho-McNeil Pharmaceutical (Protocol CAPSS022). A Comparison of Two Oral
Contraceptives: Oral Tri-Cyclen® vs. Loestrin® Fe 1/20.
7
RW Johnson Pharmaceutical Research Institute (Protocol NRGEEP-CONT-004). An
Open-Label Study to Evaluate Contraceptive Efficacy and Safety of the Transdermal
Contraceptive System of 17-Deacetylnorgestimate and Ethinyl Estradiol with the Oral
Contraceptive Triphasil.
Overactive Bladder and Urinary Incontinence
Eli Lilly & Company (Protocol H3S-MC-SAAL). Duloxetine versus Oxybutnin in
Patients with Urge Incontinence: A Multiple-Dose Study for Efficacy and Safety.
Pharmacia & Upjohn Pharmaceuticals (Protocol 97 OATA 039). Dose Escalation Study
with Tolterodine in Patients with Overactive Bladder: a single-blind study in patients
with symptoms of overactive bladder including urinary urgency and frequency with or
without urge incontinence.
Pharmacia & Upjohn Pharmaceuticals (Protocol 98-TOCR-007). Long-Term Safety and
Efficacy of Tolterodine Prolonged Release Capsules: an open-label, uncontrolled,
multinational study in patients with symptoms of overactive bladder.
Pharmacia & Upjohn Pharmaceuticals (Protocol 98-TOCR-007B). Long-Term Safety and
Efficacy of Tolterodine Prolonged Release Capsules: an open-label, uncontrolled,
multinational study in patients with symptoms of overactive bladder.
Urinary Tract Infection
Bayer (Protocol 100398). Prospective, Randomized, Double-Blind, Multicenter,
Comparative Trial to Evaluate the Efficacy and Safety of Ciprofloxacin Once Daily
Extended Release 500mg Tablets QD for 3 Days versus Conventional Ciprofloxacin
250mg Tablets BID for 3 Days in the Treatment of Patients with Uncomplicated Urinary
Tract Infections.
(4) MISCELLANEOUS SUBJECTS. Other areas of investigation include the
following:
Arthritis
GD Searle & Company (Protocol N49-98-02-102). Clinical Protocol for a Multicenter,
Double-Blind, Parallel Group Study Comparing the Incidence of Clinically Significant
Upper Gastrointestinal Adverse Events Associated with SC-58635 400 mg BID to that of
Diclofenac 75 mg BID in Patients with Osteoarthritis or Rheumatoid Arthritis, IND #
48,395.
Merck Industries (Protocol 088-001). A Double-Blind, Randomized, Stratified, Parallel-
Group Study to Assess the Incidence of PUB’s During Chronic Treatment with MK-0966
or Naproxen in Patients with Rheumatoid Arthritis.
8
Chronic Bronchitis
Abbott Laboratories, Inc. (Protocol M97-766). Comparative Study of the Efficacy of
Clarithromycin and Azithromycin for the Treatment of Patients with Acute Exacerbation
of Chronic Bronchitis.
Community Acquired Pneumonia
Abbott Laboratories, Inc. (Protocol M98-939). Comparison of the Safety of
Clarithromycin IR (250 mg) BID to Levofloxacin (500 mg OD) for the Treatment of
Community-Acquired Pneumonia.
TAP Holdings (Protocol CEF-97-002) A Comparative Study on the Safety and Efficacy
of Cefditoren Pivoxil and Cefpodoxime Proxetil in the Treatment of Community-
Acquired Pneumonia.
Diabetes
Bristol-Myers Squibb/US Pharmaceuticals (Protocol CV 138-002). Comparative
Outcomes Study of Metformin Intervention versus Conventional Approach: the cosmic
approach study.
Insmed Pharmaceuticals (Protocol INS1-DM-28). A Randomized, Multicenter, Double-
Blind, Parallel-Group Clinical Study to Compare the Effects of INS1 (D-Chiro-Inositol)
versus Placebo as Initial Oral Therapy in Subjects with Type 2 Diabetes Mellitus who
Fail to Achieve Adequate Glycemic Control with Diet and Exercise Alone.
Hypertension
ALLHAT National Trial on Hypertension Agents and Heart Disease. 5-year NIH trial.
GD Searle & Company (Protocol IE3-98-02-01). A Double-Blind, Placebo-Controlled,
Randomized Study to Evaluate the Safety and Efficacy of Ranging Doses of Eplernone
Relative to Placebo, Hydrochlorothiazide and Daily Dose Combinations of Eplernone
and Hydrochlorothiazide for the Treatment of Mild to Moderate Hypertension.
Lipid Lowering
Pharmacia Corporation (Protocol NB4-00-02-009). Clinical Protocol for a Randomized,
Double-blind, Placebo-controlled Study of SD-5613 as Monotherapy in Patients with
Primary Hypercholesterolemia (Monotherapy) Assessment of Reducing Cholesterol
[MONARCH]), IND #58,482.
9
Migraine
GlaxoWelcome. Imitrex Injection in the Treatment of Acute Migraine and Cluster
Migraine.
GlaxoWelcome. Imitrex Injection vs. Imitrex Tablets in Chronic Severe Migraine.
Wyeth-Ayerst. Inderol LA in Chronic Severe Migraine: Inderol LA 160mg vs. Inderol
40mg TID vs. Calcium Channel Blocker.
Sinusitis
Abbott Laboratories (Protocol M00-225). Comparative Study of the Safety and Efficacy
of ABT-773 150 mg QD vs. 150 mg BID for the Treatment of Acute Bacterial Sinusitis.
F
UNDED RESEARCH SUPPORT
Miles, Inc.Clotrimazole 2% Vaginal Cream, 1993
Wyeth-Ayerst Laboratories. Trigonitis, 1992
SmithKline Beecham. Paxil, Carvedelol, Asthma, Arthritis, 1990-1991
3M/Bio: Pharm Estradiol Patch Study, 1990
Health & Sciences Research, Inc. Noven Patch Study, 1990
Organon, Inc. Desogestrel O.C. CTR-04 Study, 1990
Bartor. Estrapel and Effects of Estradiol Production Levels, 1989
Columbia Laboratories, Inc. Vaginal Moisturizing Gel Study, 1989
NIH (Co-Investigator with Dan Martin, Ph.D.). Walking and Bone Mass, 1988–1990
Ayerst. Estrogen, Exercise and Lipid Study, 1988–1990
Reid-Rowell. Estratab and Estratest and Effects on Lipids and Bone Mass, 1988–1990
Wallace Laboratories, 1987–1990
Felbamate Development Program for Lennox Gasteau Syndrome, Seizures
Organidin Reformulation Studies – cough /cold
10
Ciba-Geigy. Opthalmologics, Antihypertensives, 1983-1984
Nautilus, Inc. Exercise Physiology and Osteoporosis, 1982-1990
Ayerst Laboratories, 1982–1986
Altromid-S Protocols
Inderal – Product Line Extension Hypertension
Effexor – Antidepressant Study Program
Lodine Development RA, OA Protocols
PremPro Development Plan and Protocols
Premarin Osteoporosis Program Development
Prem Phase Development Plan and Protocols
Various Oral Contraceptive Studies
Ayerst Laboratories. Premarin, GNRH, 1982
SmithKline Beecham, 1981–1984
Diagnostic Bioequivalence Studies and Reformation
Monoacid Injectable Antibiotic Development Protocols
Paxil Antidepressant Studies UK and US
Obsessive Compulsive Studies US
Relafen Full Development Plan and All Protocols
RA and OA; Pain
Pharmacokinetic Studies
Ridawra – OA and RA Study Program
Topical Use Eczema Program
Tagamet – Ulcer Peptic and Gastric Studies
Various Ophthalmologics Topical – Antibiotics, Steroids
Schering Laboratories. Topical and Transdermal Delivery Systems, 1981-1982
Upjohn Laboratories. Depression, Hypertension, 1981-1983
Note: Additional sources of Funded Research Support include: Ayerst Laboratories, 1987;
Abbott Laboratories, 1986; Florida Department of Health and Rehabilitative Services III, 1986;
Lederle Laboratories, 1986; Nuclear Data, 1985-1986; Ayerst Laboratories, 1985; Wyeth
Laboratories, 1985; Bruner Foundation, 1983–1985; FL Dept. of Health & Rehabilitative
Services I, 1983; FL Dept. of Health & Rehabilitative Services II, 1983–1984; and Schering
Laboratories, 1983–1984.
... Adhesions have also been identified as a leading cause of secondary female infertility [9]. The Clear Passage Physical Therapy group has previously reported the successful use of this manual soft tissue physical therapy in the treatment of fallopian tube occlusion and treatment of dyspareunia and dysmenorrhea secondary to adhesions [10,11]. Following publication of those studies, the same manual soft tissue physical therapy was applied to patients with documented abdominal adhesions following recurrent abdominal surgeries, and to patients presenting with current or recurring partial and total SBOs as a non-surgical treatment option. ...
... The manual physical therapy protocols utilized by the therapists have been previously described in other studies where the primary focus of therapy was the manual decrease of adhesions, and the outcomes were a return of normal mobility and motility to previously adhered organs. [10,11,14] Thus, the therapy described in these studies and on those patients may be applied to adhered areas of any of the abdominal or pelvic organs, including the reproductive, digestive, urinary and other organs within and external to the peritoneum. ...
... Both patients presented in this case report had low BMIs allowing for easy palpation of the internal organs and adhesions, scars and restrictions. In clinical trials and published studies, these techniques increased mobility and decreased pain in patients with significant surgical histories indicating adhesion formation [10,[14][15][16]. ...
Method
Full-text available
Background: Adhesion formation is a widely acknowledged risk following abdominal or pelvic surgery. Adhesions in the abdomen or pelvis can cause or contribute to partial or total small bowel obstruction (SBO). These adhesions deter or prevent the passage of nutrients through the digestive tract, and may bind the bowel to the peritoneum, or other organs. Small bowel obstructions can quickly become life-threatening, requiring immediate surgery to resect the bowel, or lyse any adhesions the surgeon can safely access. Bowel repair is an invasive surgery, with risks including bowel rupture, infection, and peritonitis. An additional risk includes the formation of new adhesions during the healing process, creating the potential for subsequent adhesiolysis or SBO surgeries. Objective: Report the use of manual soft tissue physical therapy for the reversal of adhesion-related partial SBOs, and create an initial inquiry into the possibility of nonsurgical lysis of adhesions. Case Reports: Two patients presenting with SBO symptoms due to abdominal adhesions secondary to abdominal and pelvic surgery were treated with manual soft tissue physical therapy focused on decreasing adhesions. Conclusions: Successful treatment with resolution of symptom presentation of partial SBO and sustained results were observed in both patients treated. OPEN ACCESS J. Clin. Med. 2013, 2 2
... Manual physical therapy (mPT), a method of physiotherapy and rehabilitation, is used to treat patients with a wide variety of adhesive conditions including burns, adhesive capsulitis, radiculopathy, pain, infertility, and lessening of scars [20][21][22][23][24][25][26][27][28][29][30] . This therapy has shown promise in preventing adhesion formation in animal models [31,32] . ...
... Manual physical therapy can provide adjunct therapy for known adhesions where there is no other available therapy proven to decrease recurrent SBO or to treat pain associated with adhesive disease. Unlike surgical procedures, adhesions do not appear to occur after treatment with the CPA [28] . Because treatment group participants had more complex histories and symptoms, their improvements likely had more of an impact on daily function than subjects in the control group. ...
Method
Full-text available
AIM To compare (1) quality of life and (2) rate of recurrent small bowel obstructions (SBO) for patients treated with novel manual physiotherapy vs no treatment. METHODS One hundred and three subjects (age 19-89) with a history of recurrent adhesive SBO were treated with a manual physiotherapy called the Clear Passage Approach (CPA) which focused on decreasing adhesive crosslinking in abdominopelvic viscera. Pre- and post-therapy data measured recurring obstructions and quality of life, using a validated test sent 90 d after therapy. Results were compared to 136 untreated control subjects who underwent the same measurements for subjects who did not receive any therapy, which is the normal course for patients with recurring SBO. Comparison of the groups allowed us to assess changes when physiotherapy was added as an adjunct treatment for patients with recurring SBO. RESULTS Despite histories of more prior hospitalizations, obstructions, surgeries, and years impacted by bowel issues, the 103 CPA-treated subjects reported a significantly lower rate of repeat SBO than 136 untreated controls (total obstructions P = 0.0003; partial obstructions P =0.0076). Subjects treated with the therapy demonstrated significant improvements in five of six total domains in the validated Small Bowel Obstruction Questionnaire (SBO-Q). Domains of diet, pain, gastrointestinal symptoms, quality of life (QOL), and pain severity, when compared to post-CPA treatment, were significantly improved (P < 0.0001). The medication domain was not changed in the CPA-treated group (P = 0.176). CONCLUSION CPA physical therapy was effective for patients with adhesive SBO with significantly lower recurrence rate, improvement in reported symptoms, and overall quality of life of subjects.
... A subset of the patients included in the 10-year analysis had also been included in small, multiple case reports or reports of phase I studies; a total of 76 of the 1392 patients had been included in those previous reports. [17][18][19][20][21] ...
... The techniques that the therapy used had been examined previously, with results published by the research group and others. 15,[17][18][19][20][22][23][24][25][26][27][28][29][30][31] Based on each patient's goals and subjective complaints and on findings from the initial evaluation, the CPA protocol was individualized to treat sites that presented with restricted mobility within each patient's body. 32 The therapy used various site-specific pressures across the restrictive bands of adhered tissues and structures, working progressively deeper from the most superficial tissues, to restore mobility via myofascial release. ...
Method
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Background • Female infertility is a complex issue encompassing a wide variety of diagnoses, many of which are caused or affected by adhesions. Objectives • The study intended to examine the rates of successful treatment of infertile women using a protocol of manual physical therapy to address underlying adhesive disease leading to infertility. Methods • The research team designed a retrospective chart review. Setting • The study took place in a private physical therapy clinic. Participants • Participants were 1392 female patients who were treated at the clinic between the years of 2002 and 2011. They had varying diagnoses of infertility, including occluded fallopian tubes, hormonal dysfunction, and endometriosis, and some women were undergoing in vitro fertilization (IVF). Intervention • All patients underwent whole-body, patient-centered treatments that used a protocol of manual physical therapy, which focused on restoring mobility and motility to structures affecting reproductive function. Outcome Measures • Improvements demonstrated in the condition(s) causing infertility were measured by improvements in tubal patency and/or improved hormone levels or by pregnancy. Results • The results included a 60.85% rate of clearing occluded fallopian tubes, with a 56.64% rate of pregnancy in those patients. Patients with endometriosis experienced a 42.81% pregnancy rate. The success rate was 49.18% for lowering elevated levels of follicle stimulating hormone (FSH), with a 39.34% pregnancy rate in that group, and 53.57% of the women with polycystic ovarian syndrome (PCOS) achieved pregnancy. The reported pregnancy rate for patients who underwent IVF after the therapy was 56.16%. The results also suggested that the treatment was effective for patients with premature ovarian failure (POF). Conclusion • The manual physical therapy represented an effective, conservative treatment for women diagnosed as infertile due to mechanical causes, independent of the specific etiology. (Altern Ther Health Med. 2015;21(3):32-40.) Amanda D. Rice, PhD, is the director of clinical studies; Kelseanne P. Breder, BA, is an intern. Both are in the research department at Clear Passage Physical Therapy in Gainesville, Florida. Kimberley Patterson, PTA, is a therapist; Leslie B. Wakefield, DPT, is a physical therapist; Evette D. Reed, PT, is a physical therapist; and Belinda F. Wurn, PT, is a clinical director. All are located in the clinical department at Clear Passage Physical Therapy. C. Richard King, III, MD, is the medical director of Clear Passage Physical Therapy. Lawrence J. Wurn, LMT, is a therapist in the clinical department and the research director in the research department at Clear Passage Physical Therapy.
... [21] The time and force applied to each structure vary according to patient tolerance. [22]The frequency and duration of treatment sessions vary from a 1-hour session/ week to intensive sessions of 2 to 4 hours of daily treatment. ...
... [5] Indirect manipulation of the fallopian tubes is performed through manipulating adjacent soft tissue structures such as broad ligament and peritoneum targeting restrictions and adhesions. [22] CPA for endometriosis: pregnancy rates following CPA are equivalent to surgical interventions with a 42.8% pregnancy rate. [5] CPA also has long-term positive effects regarding dyspareunia, sexual dysfunction, and dysmenorrhea associated with endometriosis. ...
Article
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Background: Infertility is a disease that affects millions of reproductive-aged couples worldwide with current management options that tend to carry different long-term and short-term health hazards. Manual therapy is widely used as a regular treatment for a variety of diseases and it can be applied to all body areas. Currently different manual therapy approaches are used in treating infertility. Main body of the abstract: The current literature supports the positive effects of manual therapy in treating female infertility associated with blocked fallopian tubes, endometriosis, hormonal disturbance, and unexplained infertility. Literature includes four approaches; (1) Clear Passage Approach (CPA), (2) Mojzisova Method, (3) Mercier therapy, and (4) osteopathy. The present narrative review discusses the potential effects of different manual therapy approaches and the available evidence supporting their value. Conclusions: Although current available studies are limited in number with limitations in studies design, manual therapy is considered as a promising, effective, and safe option for treating infertility. Further studies with different study designs and systematic reporting of side effects are highly recommended. Key words: Infertility, Adhesion, Manual therapy, visceral manipulation.
... In previously published clinical trials and studies, these techniques increased range of motion, reversed infertility, prevented SBO and decreased pain in patients with histories indicating significant adhesion formation. [12][13][14][15] Therapy focused on decreasing adhesions in order to decrease pain, and to increase function and range of motion. The patient's response to treatment was significant and readily apparent to him, the therapists and his physicians. ...
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In this case study, we report the use of manual physical therapy in a pediatric patient experiencing complications from a life-threatening motor vehicle accident that necessitated 19 surgeries over the course of 12 months. Post-surgical adhesions decreased the patient's quality of life. He developed multiple medical conditions including recurrent partial bowel obstructions and an ascending testicle. In an effort to avoid further surgery for bowel obstruction and the ascending testicle, the patient was effectively treated with a manual physical therapy regimen focused on decreasing adhesions. The therapy allowed return to an improved quality of life, significant decrease in subjective reports of pain and dys-function, and apparent decreases in adhesive processes without further surgery, which are important goals for all patients, but especially for pediatric patients.
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Decreasing pain and improving function and quality of life are important topics for patients that refuse or are not candidates for traditional medical interventions and those at the end stages of the disease. Patients with inoperable, metastatic bowel carcinoma that experience pain and small bowel obstruction (SBO) as a result of adhesions are a subset of these patients. The standard treatment, adhesion and/or resection surgery followed by post-surgical medications to prevent infection and decrease pain, may not be ideal in end-stage cancer patients. We treated such a patient using manual soft tissue physical therapy with the goal of decreasing her pain and alleviating symptoms of bowel obstruction secondary to adhesions successfully, using a protocol we developed initially to open fallopian tubes that were blocked by adhesions. The patient was a 61-year-old married woman with a history of multiple abdominopelvic surgeries over the last 12 years including hysterectomy, ileostomy, and ileostomy reversal with chemotherapy and radiation for treatment of stage IIIB ovarian/peritoneal carcinoma. She experienced SBO episodes every 2-3 months and had five adhesiolysis and/or resection surgeries to attempt to repair the bowel. Because she had undergone a recent exploratory laparoscopy that revealed metastasis to the omentum, her physicians were reluctant to perform any further surgeries, and the patient requested no more surgical interventions. She was unable to eat or drink, so a peripherally inserted central catheter (PICC line) was placed, and she received total parenteral nutrition (TPN) daily. She experienced chronic pain associated with the SBOs at a level of 4-5/10 that increased throughout the day with movement. The patient was undergoing chemotherapy and medicated with Nexium 40mg qd, Compazine 10mg prn, Zofran 4mg prn, Ativan 1mg qd, multivitamin bid, Vitamin D 2000mg qd, Co-Enzyme Q10 qd, and Dilaudid prn for pain. Her goals were to relieve the abdominal pain, decrease SBO incidents, eat a normal diet, and travel.
Chapter
Energy field therapies build on two different disciplines—a spiritual discipline which involves faith in the existence of a universal life-force or energy, and a system based in the principles of physics. The fundamental nature of humanity is to express itself through touch, and historically, touch therapies have been used within traditional medicine/healing systems almost universally. This chapter covers a range of biofield and manipulative therapies to promote fertility and to support holistic wellbeing during pregnancy, including Reiki, therapeutic touch, osteopathy, chiropractic, and others.
Article
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We present a comparative analysis the impact of the different types of medicine that exist today on the planet. We conclude that while the classical, holistic mind-body medicine is sustainable as it only uses talk and touch therapy, the modern pharmaceutical medicine has a large destructive impact on the planets environment and is not sustainable. When we compare the cost-effectiveness of the drugs and the holistic medicine, we find that holistic medicine is far cheaper and far more effective than pharmaceutical drugs; therefore, there is no reason to use drugs as the main medicine in the future. To save the global environment from a massive destructive impact we need to use holistic, consciousness based medicine. The simplest way to document the destructive effect of the pharmaceutical drugs is to look at the 1.4 trillion dollars they cost yearly, which reflects a direct, negative effect on the global environment. The use of pharmaceutical drugs is also teaching people a materialistic way of thinking that make people behave more like active consumers and thus less sustainable. Holistic medicine on the other hand helps raising the patient's consciousness and inspire "spiritual values" that motivates sustainable behavior. We encourage further research in the philosophical impact of the different types of medicine, to elucidate the consequences for the global environment of personal, national, and super-national health strategies.
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Non-venous pelvic pain is a dilemma that can frustrate even the most patient of providers. Managing these conditions can be even more bewildering as they require a multidisciplinary approach in most cases. Diet and lifestyle modifications in addition to physical therapy, biofeedback, medications, surgery, and integrative medicine modalities can be used alone or in combination to relieve symptoms and should be individualized after proper evaluation and diagnosis. Because most of these conditions are located in the area of pudendal nerve distribution, pudendal nerve blocks have been very successful in helping to control the pain symptoms and should be used judiciously. Here we discuss the common conditions and how physical therapy and pudendal nerve blocks play a significant role in treatment.
Article
The linear everting (LE) catheter has been developed to safely guide a Falloposcope into the entire length of Fallopian tube in order to observe the tubal lumen. It may also be useful therapeutically for the recanalization of occluded tubes. Fifty infertility patients who had been diagnosed with proximal, mid and distal tubal occlusion by hysterosalpingogram, Rubin test and hysteroscopic selective hydrotubation, were selected to undergo Falloposcopic tuboplasty (FT). Patients having hydrosalpinges were excluded from the study group. The total number of tubes treated was 102 during 53 FT procedures. On the basis of tubes attempted, the LE catheter successfully accessed 85.3% (87/102). A follow-up hysterosalpingogram was completed 1-3 months following the FT procedure, which revealed an overall patency rate of 79.4% (81/102). During FT, a high incidence of multiple adhesions was observed in the entire length of tubal lumen in patients having bilateral occlusions. To date, the total number of pregnancies following FT treatment is 11 over a follow-up period of 2 months to 3 years. FT has been established as a highly useful, less invasive and novel treatment for tubal infertility. This technique may be useful in selected patients with tubal infertility.
Article
Ninety-three infertile women with distal tubal occlusion were subjected to salpingostomy in 1982-1984. In 78 of them follow-up data were available for 2-5 years. Second look laparoscopy was performed in 47 patients at a median of 4 months postoperatively. It showed one or both tubes patent in 45 (96%). In the total series of 93 patients, 13% had live births, 7.5% spontaneous abortions, and 13% ectopic pregnancies. Severe adnexal adhesions and the extent of fimbrial damage found at operation or at second look laparoscopy were the most significant factors related to the poor outcome of microsurgery. Our experience suggests that cases with severe adhesions and poor tubal status should be primarily directed to in vitro fertilization program rather than to microsurgery.
Article
A total of 66 patients with proximal Fallopian tube (113 tubes) obstruction, as diagnosed by both laparoscopy and hysterosalpingogram, were each subjected to a transcervical recanalization procedure sequentially using selective salpingography followed, if necessary, by tubal catheterization with a soft Teflon 2-French catheter and finally, if needed, wire-guide cannulation. Each procedure were terminated once patency had been achieved without recourse to the next technique. Bilateral obstruction was present in 47 patients and unilateral in 19 patients. Patency was achieved in 39 (34.5%) Fallopian tubes by selective salpingography alone, in 52 (46.0%) by tubal catheterization and in 10 (8.9%) by wire guide, with 12 (10.6%) tubes remaining obstructed. Pregnancy occurred in 24 (36.4%) patients without recourse to other treatment (mean follow-up, 17 months). Where patency was achieved (59 patients), 19 out of 43 (44.1%) of those treated for bilateral obstruction and five out of 16 (31.3%) of those treated for unilateral obstruction achieved a pregnancy. Pregnancy occurred in six out of 22 patients (27.3%) where selective salpingography was used to produce tubal patency, in 17 out of 30 patients (56.7%) where tubal catheterization was used and in one out of seven (14.3%) where a wire guide was used, which was an ectopic pregnancy. The difference between the ongoing pregnancy rates following tubal catheterization (50.0%) and wire-guide cannulation (0.0%) was significant (P = 0.033). While wire-guide cannulation is the most effective method used to achieve tubal patency, these results indicate that when it is truly necessary, as opposed to electively used by clinicians, the prognosis with regard to pregnancy is poor and alternative therapy such as microsurgery or in-vitro fertilization should be considered early.
Article
A study was initiated to identify background factors, clinical features and pre-operative scoring systems of importance for future selection of patients suitable for fertility surgery. Surgical procedures, background factors and scoring systems for tubal lesions and adnexal adhesions and risk factors for ectopic pregnancy were analyzed with respect to possible correlation to subsequent fertility in a retrospective study of 246 patients undergoing fertility surgery (adhesiolysis, salpingostomy, tubal anastomoses, implantation and myomectomy) between 1986 and 1990. Follow-up periods varied between one to six years. In 94% of cases a second look laparoscopy was performed. Adhesiolysis was done in 62%. The conception rate was 41.1%, the ectopic pregnancy rate was 14.6% and the delivery rate was 22.0%. Myomectomy procedures were most successful, with a delivery rate of 44.0% and no ectopic pregnancy. Previous ectopic pregnancy indicated a higher risk for recurrence, as did a high risk score for ectopic pregnancy. The extent of tubal damage was most relevant to subsequent fertility. Salpingostomies in women with mild or moderate tubal damage resulted in a delivery rate of 25.4% compared with those with severe damage (5.6%). No deliveries were seen after lysis of extensive adnexal adhesions. Adhesion formation is not negligible and a second look laparoscopy is recommended. Women with fibroids should always be considered for fertility surgery, not only because of high success rates, but also as an adjuvant to subsequent in vitro fertilization. Patients with previous ectopic pregnancy, extensive adhesions and unfavorable tubal scores should not be considered for surgery but referred for in vitro fertilization.
Article
Fifty-two patients with 84 proximal Fallopian tube obstructions underwent Fallopian tube recanalization (FTR). The successful catheterization rate for Fallopian tubal ostia was 100%, and the successful recanalization rate was 64%. After FTR, hysterosalpingography or selective tubography showed no evidence of adhesion (without adhesion) in 31 tubes, perifimbrial adhesion in 17 tubes, hydrosalpinx in six tubes, and intratubal adhesion in 30 tubes (unsuccessful recanalization). Six patients (11%) achieved intrauterine pregnancies and two had extrauterine pregnancies. Follow-up studies in seven patients without adhesion showed patency in one patient and reocclusion in six patients who obtained repatency after a second FTR. Fallopian tube catheterization was useful for the exact diagnosis of Fallopian tube occlusion. The higher incidence of adhesion in patients' background caused the low incidence of pregnancy.
Article
Transvaginal tubal catheterization procedures have been suggested as an alternative to microsurgery and in-vitro fertilization (IVF) in the treatment of women with proximal tubal occlusion. A transcervical balloon tuboplasty (TBT) catheter was specifically developed and tested in a prospective multicentre trial. A total of 151 women with confirmed bilateral or unilateral tubal occlusion were studied. The primary study population included 106 women who, after exclusion of patients for protocol violations, represented those females who were treated for complete tubal occlusion with TBT. TBT is an ambulatory, minimally invasive catheter procedure, performed under paracervical block or mild sedation, which utilizes a co-axial balloon catheter under fluoroscopic guidance. Re-canalization, pregnancy and reocclusion rates following the procedure were documented. A total of 28 patients demonstrating uni- or bilateral tubal patency after either hysterosalpingography and/or selective salpingography represented the control population. TBT established tubal patency of at least one Fallopian tube in 95/106 patients (90%) and in 167/205 obstructed oviducts (82%). Clinical pregnancies occurred in 37/106 females (35%), with a life table adjusted rate of 37%. Patients without distal disease had significantly higher pregnancy rates than those with bipolar tubal disease (49% versus 12%, life table adjusted rate; P = 0.0002) but pregnancy rates were independent of underlying aetiology for tubal disease. Pregnancy rates in control patients who did not reach TBT because of tubal patency after hysterosalpingography and/or selective salpingography were significantly lower than in those successful treated with TBT (P = 0.027), and occurred only for four cycles after hysterosalpingography and with approximately a 1 year delay after selective salpingography.(ABSTRACT TRUNCATED AT 250 WORDS)
Article
Proximal tube occlusion (PTO) accounts for 20% of tubal factor cases. The classification into nodular (salpingitis isthmica nodosa or endometriosis), non-nodular (true fibrotic occlusion) and so-called pseudo occlusion (detritus, polyps, hypoplastic tubes) is essential. Using falloposcopy, PTO that is already diagnosed by laparoscopy and hysterosalpingography (HSG) can be confirmed or bypassed (false PTO); patients with false PTO were placed on a temporary waiting period. Nodular and pseudo occlusion patients were pre-treated with gonadotrophin-releasing hormone analogue (GnRH-a) for at least 6 weeks to shrink the underlying pathology, after which tubal re-catheterization was performed. In a prospective study starting in July 1993, 53 patients prediagnosed as having PTO were examined by falloposcopy. Three of these patients had non-nodular occlusion and were directed to microsurgical repair (conservative treatment not possible). A total of 19 cases revealed patent tubes with healthy mucosa and no underlying pathology (false PTO). Of the remaining 31 patients, 18 were classified as nodular and 13 as pseudo occlusion. In all of these patients at least one tube was patent after GnRH-a treatment. After a 6 month period, 37% of the false PTO patients achieved a spontaneous pregnancy (6% per cycle). The spontaneous pregnancy rate in the true PTO group was significantly lower (10% per patient, 1.6% per month; P < 0.05). Using assisted reproduction techniques, in particular gamete intra-Fallopian transfer (GIFT), as a subsequent treatment for the true PTO group, a pregnancy rate of 50% per cycle was achieved. A retrospective analysis of our entire PTO population (n = 109) showed a spontaneous pregnancy rate after achieving tubal patency (using falloposcopy and GnRH-a) that was dramatically low (1.8%), with no difference between the nodular and pseudo groups. The chance for pregnancy can be enhanced significantly (P < 0.001) using assisted reproduction techniques (GIFT) following tubal re-catheterization and GnRH-a treatment.
Article
There is still controversy about the question of which approach is best to treat tubal infertility: microsurgery, laparoscopic treatment, or in vitro fertilization. Our study comprised 161 patients with distal tubal occlusion. Various instruments (argon laser, CO2 laser, Nd:YAG laser, monopolar electrical needle, scissors) were used for laparoscopic salpingostomy, and a variety of techniques applied for tubal wall eversion (flowering technique according to Bruhat with and without suturing, suturing alone, or no eversion at all). Thirty-seven women with a total of 63 laparoscopically treated tubes were followed over a period of 2-72 months. Tubal patency was 38.9%. The reocclusion rate correlated with severity of tubal wall pathology and state of reduction of the tubal mucosa. After laser treatment tubal patency proved to be higher (41.1%) compared with treatment with conventional instruments. The Argon laser scored best results. The majority of patent tubes in the follow-up were found in the cohort with "perfect" and "good" eversion (95.8%), whereas none of the tubes where eversion was classed "insufficient" remained patent. The technique according to Bruhat without the use of additional suturing yielded better results regarding tubal patency (66.6%) than the other eversion methods described (33.4%). The pregnancy rate could be assessed in 81 out of 161 laparoscopically treated cases. A total of 19 patients (23.3%) became pregnant. In 9.8% pregnancy was intrauterine and in 13.5% extrauterine. The highest intrauterine and lowest extrauterine pregnancy rate was seen in the group with "mild" distal tubal occlusion (according to AFS classification). In 84.2% of women who had conceived postoperatively, tubal wall eversion had been done by the Bruhat technique without suturing. Taking into account tubal wall pathology, tubal patency, eversion techniques, and rate of intrauterine pregnancies, it can be concluded that patients with thin-walled tubes allowing "perfect" or "good" eversion will benefit most from laparoscopic salpingostomy.
Article
Fertility outcome following microsurgical tubocornual anastomosis by laparotomy was evaluated. A total of 131 women presenting pure proximal occlusion, whether bilateral or in one tube only, were treated between January 1978 and December 1993. Subsequent fertility was studied in 120 patients, 11 being patients lost to follow-up. Cumulative intrauterine pregnancy (IUP) rate, evaluated by life-table analysis, was 68% at 24 months. The overall IUP rate, calculated from a group of 120 women with follow-up > or = 2 years, and including births and miscarriages, was 70% after 2 years. Comparisons of the cumulative IUP rates show that the fertility outcome is significantly better if the woman is aged < or = 36 years and if tubocornual anastomosis is carried out bilaterally. These results from our personal series confirm that microsurgical tubocornual anastomosis is still of prime importance in the treatment of pure proximal occlusions. Nevertheless, considerable progress in the fields of tubal catheterization, Falloposcopy and in-vitro fertilization techniques raises the question of the management of patients presenting with a proximal tubal occlusion. Here we define the indications for microsurgical tubocornual anastomosis.