Table 1 Report on muscle stretching exercises used in concert with an educational approach
Each session was divided into two parts: (I) Educational/cognitive behavioral therapy (about 30–40 min) - Conditions offered by the physiotherapist: Talk about FM and difficulties in daily activities because of FM (positive perspectives). - Expected product of the activity: Adoption of body self-care resources to reduce pain and other symptoms (incorporation into daily life). - Actual product of the activity of the week: Verified in conversation with the patient. (II) Exercises (about 30–40 min), except for the first session. Session 1 • Conditions offered by the physiotherapist: Talk about FM and difficulties in daily activities because of FM. Delivery of the FM guidance booklet based on Marques et al. [43]. • Activities performed: Adding body self-care to the daily activities. Session 2 • Conditions offered by the physiotherapist: Perceptions of the body parts and movements: proprioception (body and movement) and adaptation to the difficulties presented by the patient. • Activities performed - Contact of the feet with the ground; recognition of foot pressure on the ground; differences and similarities in relation to both feet - Perceptions of the positioning of shoulders, trunk, and head with orientation for adopting good body posture - Foot sensitization exercises: massage with a tennis ball and a piece of bamboo, with the feet on the ground - Exercises in body weight transfer in the frontal and sagittal planes, as well as perceiving the body weight distributed in a similar way between the feet - These exercises were done with the eyes open, eyes closed, and in front of a mirror. Session 3 • Conditions offered by the physiotherapist: Guidance for body perception (proprioception) on a stretcher. • Activities performed: Perceptions of the body and its supports on the stretcher. In dorsal decubitus, the patients were instructed to keep their eyes closed, relax any tense muscles, and pay attention to their breathing (achieving a slow and constant rhythm between inhalation and exhalation). The physiotherapist helped guide their perceptions, calmly describing each body segment from toe to head. | |
Sessions 4–10 |  |
GLOBAL GROUP • Conditions offered by the physiotherapist: Preparatory maneuvers of manual therapy associated with breathing for the stretching exercises in muscle chains. In dorsal decubitus position with a relaxed body. Myofascial release of the shoulder and pelvic girdles, anterior chest, and paraspinal muscles associated with breathing. • Activities performed: During the session, care was taken to avoid postural compensation (due to increased tension in response to muscle shortening) in specific body segments and to restrict exercise to a minimum of discomfort. - First position of the global posture reeducation method, 15 min long: to stretch the posterior muscle chain, the participant remained in the dorsal decubitus position. The goal was to reach the final stretch position with the arms “adducted” and the lower limbs with a hip flexion to 90° supported in a specific band of the global posture reeducation stretcher. The knee extension was progressively performed (respecting the participant’s limit) with the ankle in dorsiflexion, keeping the occipital, lumbar region, and sacrum stabilized. - Second position of the global posture reeducation method, 15 min long: The anterior muscle chain was stretched with the participant in dorsal decubitus, arms abducted to about 30°, and the forearms in a supine position. The pelvis and lumbar segment remained stabilized. The hips were flexed, abducted, and rotated laterally with the plantar regions of the feet in contact. The lower limbs were progressively “extended” to the maximum extension of the knees, keeping the tibiotarsus at an angle of 90°; at the end of the posture, the arms reached approximately 140° of abduction. | SEGMENTAL GROUP • Conditions offered by the physiotherapist: Preparatory maneuvers of manual therapy associated with breathing for the stretching exercises. In dorsal decubitus position with a relaxed body. Myofascial release of the shoulder and pelvic girdles, anterior chest, and paraspinal muscles associated with breathing. • Activities performed: Three muscle stretching exercises, repeated three times each, gradually improved in the course of sessions according to participant tolerance, no more than five times each. The participants performed static segmental muscle stretching exercises with the therapist’s assistance. The exercise intensity was gently increased gradually to the point of minimum discomfort, and each position was held for 30 s, with the same time for rest between repetitions. Session 4 • Activities performed - Paravertebral: In dorsal decubitus, the patients flexed both hips and knees and brought them to the chest. - Gluteus: In dorsal decubitus, they flexed only one hip, brought their knee to the chest, and alternated limbs. They took care that the lumbar segment and head remained supported. - Ischiotibial: In dorsal decubitus, the patients flexed their hips and knees, with their feet resting on the mattress. They extended one knee and alternated their limbs. Session 5 • Activities performed - Repetition of the previous three exercises - Pectoralis: In dorsal decubitus, the patients flexed their hips and knees, with their feet resting on the mattress. They then positioned their arms at approximately 45° abduction and kept the shoulders away from the ears, with the medial epicondyles resting on the mattress and hands open. - Latissimus dorsi: In dorsal decubitus, they flexed their hips and knees, with feet supported on the mattress and lumbar segment in physiological lordosis. They flexed their arms to the maximum while keeping the elbows extended and palms opened. Session 6 • Activities performed - Repetition of the previous five exercises - Hip adductor: In dorsal decubitus, the patients flexed their hips and knees, joined the soles of their feet, and abducted their thighs. They ensured that the lumbar segment remained in physiological and relaxed lordosis. Sessions 7–10 Activities performed: All previous exercises |