Boczkowski Fizjoterapia

11/12/2025

Just published in NEJM 🔥

Complex Regional Pain Syndrome

📘 Goebel (2025), https://www.nejm.org/doi/full/10.1056/NEJMcp2415752

👉 Complex regional pain syndrome (CRPS) is a rare post-traumatic chronic pain condition that affects a distal limb and is classified in the International Classification of Diseases, 11th Revision, as “chronic primary pain”; the condition may be autoimmune mediated.

👉 CRPS is diagnosed according to the Budapest criteria, which require the presence of objective limb abnormalities in two of four categories: sensory, vasomotor, edema or sudomotor, and motor or trophic.

👉 Approximately 80% of patients have substantial improvement within 18 months after disease onset;later improvement is rare.

👉Patient information should emphasize the nerve-function–related cause of CRPS that explains the relentless pain despite no or minor tissue change.

👉 Rehabilitative treatment with CRPS-specific physical and occupational therapy is key to improving function in the impaired limb.

👉 Treatment with simple analgesic drugs, tricyclic agents, and serotonin–norepinephrine reuptake inhibitors may improve quality of life but will typically incompletely reduce pain. Multidisciplinary pain-management treatment that follows the principles of cognitive behavioral therapy and spinal cord stimulator treatment — in persistent CRPS — can be offered at specialist centers.

📷 Illustration: . Pain Mechanisms. Shown are the mechanisms of nociceptive pain (Panel A), neuropathic pain (Panel B), and nociplastic pain (Panel C). CRPS itself is considered (mostly) nociplastic pain.

05/11/2025

Polecam

Understanding glucose. How your body manages energy.

Glucose metabolism is how your body turns food into energy, storing and releasing it as needed. Different organs and processes work together, influenced by hormones, to keep blood sugar steady and fuel your cells.

1️⃣ Blood Glucose Glucose from food enters the bloodstream, with levels kept between 0.8–10 mmol/L. The kidneys filter excess into urine if levels get too high.
🟢 Example: After a meal, blood glucose rises, prompting cells to take it up.
🟢 Example: Low levels trigger the liver to release stored glucose.

2️⃣ Liver The liver stores glucose as glycogen or makes new glucose (gluconeogenesis) from lactate, amino acids, or glycerol, releasing it when needed.
🟢 Example: During fasting, the liver breaks down glycogen (glycogenolysis) to maintain blood sugar.
🟢 Example: After exercise, it uses lactate to rebuild glucose.

3️⃣ Muscle Muscles take up glucose for energy or store it as glycogen, especially during exercise, and release lactate when oxygen is low. 🟢 Example: During a workout, muscles use glucose for quick energy via glycolysis.
🟢 Example: Resting muscles store glycogen for later use.

4️⃣ Central Nervous System (CNS) The brain relies on glucose for energy, using aerobic oxidation when oxygen is available, or switching to lactate if needed.
🟢 Example: A steady glucose supply keeps you alert and focused.
🟢 Example: In low oxygen, the brain uses lactate as a backup fuel.

5️⃣ Fat Tissue Fat cells store glucose as fat (lipogenesis) or break down fat (lipolysis) to release glycerol and fatty acids for energy during fasting.
🟢 Example: After a big meal, excess glucose turns into fat for long-term storage.
🟢 Example: During hunger, fat breakdown provides energy via ketogenesis.

Glucose metabolism involves the liver, muscles, brain, and fat tissue, balancing energy use and storage. Hormones like insulin (after meals) and glucagon (during hunger) control these processes, ensuring your body adapts to eating, exercise, or fasting.

18/10/2025

11/06/2025

🔍 WIĘZADŁA STAWU KRZYŻOWO-BIODROWEGO – CO MÓWI NAUKA O ICH UNERWIENIU I ROLI W BÓLU? 🔍

Czy wiesz, że więzadła SIJ (sacroiliac joint) nie są tylko pasywnym elementem podporowym, ale również bogato unerwioną strukturą czuciową? Najnowsze badanie opublikowane w Clinical Anatomy (2021) rzuca nowe światło na ich funkcję – i ma ogromne znaczenie dla terapii manualnej i fizjoterapii.

🧠 CO ZNALEZIONO POD MIKROSKOPEM?

✅ Więzadła międzykostne i tylne SI zawierają:
• Włókna mielinowe i niemielinowe
• Receptory Ruffiniego i Paciniego (mechanoreceptory)
• Liczne nocyceptory (przekaźniki bólu)

✅ Największe nagromadzenie nerwów stwierdzono w:
• Obszarach przyczepów więzadłowych
• Powierzchniach grzbietowych stawu SIJ

✅ Więzadła były bardziej unerwione niż sam staw!

💡 CO TO ZNACZY W PRAKTYCE?

👉 Jeśli pracujesz z pacjentami z bólem dolnego odcinka pleców, biodra, pośladków lub wzdłuż SIJ – twoim celem powinna być nie tylko mobilizacja stawu, ale przede wszystkim praca z więzadłami!

🔸 Terapia powięziowa
🔸 Neuromobilizacja więzadeł
🔸 Delikatne techniki manualne
🔸 Presury sensoryczne → mogą oddziaływać na mechanoreceptory i modulować ból

📌 Wniosek:
SIJ to nie tylko mechanika – to sensoryczny narząd ruchu, a jego więzadła są żywe, reaktywne i pełne zakończeń nerwowych. Praca z nimi to nie tylko ruch, ale neuromodulacja i świadome uwalnianie napięcia.

Źródło badania:
📖 Grob et al., “Sensory innervation of the human sacroiliac joint: A histological study”


Jeśli interesuje Cię anatomia funkcjonalna i chcesz, by fizjoterapia opierała się na naukowych podstawach – udostępnij ten post i daj znać w komentarzu, czy chcesz więcej takich materiałów! 💬👇

Pozdrawiam serdecznie
Marcin Absalon

16/04/2025