Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
J Altern Complement Med. 2011 Oct;17(10):891-9. doi: 10.1089/acm.2010.0258. Epub 2011 Oct 12.
The objectives of this report are to review the clinical practice of Structural Integration (SI), an alternative method of soft-tissue manipulation and sensorimotor education, and to summarize the evidence to date for mechanism and clinical efficacy.
The author's personal knowledge of SI literature, theory, and practice was supplemented by a database search, consultation with other senior SI practitioners, and examination of published bibliographies and websites that archive SI literature.
SI purports to improve biomechanical functioning as a whole by progressively approximating specific ideals of posture and movement, rather than to treat particular symptoms. Hypothesized mechanisms at the level of local tissue change include increases in soft-tissue pliability, release of adhesions between adjacent soft-tissue structures, and increased interstitial fluid flow with consequently improved clearance of nociceptive potentiators. Hypothesized mechanisms for more global changes include improved biomechanical organization leading to reductions in mechanical stress and nociceptive irritation, a perception of improved biomechanical efficiency and coordination that generalizes to the self, and improvements in sensory processing and vagal tone. Emotional catharsis is also thought to contribute to psychologic changes. Limited preliminary evidence exists for improvements in neuromotor coordination, sensory processing, self-concept and vagal tone, and for reductions in state anxiety. Preliminary, small sample clinical studies with cerebral palsy, chronic musculoskeletal pain, impaired balance, and chronic fatigue syndrome have reported improvements in gait, pain and range-of-motion, impaired balance, functional status, and well-being. Adverse events are thought to be mild and transient, although survey data are not available. Contraindications are thought to be the same as for massage.
Evidence for clinical effectiveness and hypothesized mechanisms is severely limited by small sample sizes and absence of control arms. In view of the rapidly increasing availability of SI and its use for treatment of musculoskeletal pain and dysfunction, more adequate research in warranted.
本报告旨在回顾结构整合（SI）的临床实践，这是一种软组织操作和感觉运动教育的替代方法，并总结迄今为止关于其机制和临床疗效的证据。
作者个人对 SI 文献、理论和实践的了解，辅以数据库搜索、与其他资深 SI 从业者的咨询，以及对存档 SI 文献的已发表文献目录和网站的检查。
SI 旨在通过逐渐接近特定的姿势和运动理想来整体改善生物力学功能，而不是治疗特定的症状。局部组织变化的假设机制包括软组织柔韧性增加、相邻软组织结构之间粘连的释放，以及间质液流动增加，从而改善疼痛增强剂的清除。更广泛的变化的假设机制包括改善生物力学组织，从而减少机械应激和疼痛刺激，感知到的生物力学效率和协调性改善，并扩展到自我，以及感觉处理和迷走神经张力的改善。情感宣泄也被认为有助于心理变化。初步证据表明，在神经运动协调、感觉处理、自我概念和迷走神经张力方面有所改善，并且状态焦虑有所降低。初步的、小规模的临床研究表明，脑瘫、慢性肌肉骨骼疼痛、平衡障碍和慢性疲劳综合征患者的步态、疼痛和活动范围、平衡受损、功能状态和幸福感有所改善。虽然没有调查数据，但认为不良事件是轻微和短暂的。禁忌症被认为与按摩相同。
由于样本量小且缺乏对照组，临床有效性和假设机制的证据受到严重限制。鉴于 SI 的可用性迅速增加及其在治疗肌肉骨骼疼痛和功能障碍方面的应用，需要进行更充分的研究。
