Cleofás Rodríguez-Blanco

CHANGES IN PRESSURE PAIN THRESHOLDS OVER C5-C6 ZYGAPOPHYSEAL JOINT AFTER A CERVICOTHORACIC JUNCTION MANIPULATION IN HEALTHY SUBJECTS

OBJECTIVE This study examines if C7-T1 manipulation results in changes in pressure pain thresholds (PPT) over bilateral C5-C6 zygapophyseal joints in asymptomatic subjects. METHODS Thirty subjects, 13 men and 17 women, without a current history of neck, shoulder, or upper extremity pain participated. Participants were randomly divided into 3 groups: experimental dominant group, subjects who received the manipulative thrust directed at the right side of the C7-T1 joint; experimental nondominant group, those who received the thrust on the left side of the C7-T1 joint; and a placebo group, those who received a sham-manual procedure. The outcome measure was the PPT on both right and left C5-C5 zygapophyseal joints, which was assessed at preintervention and 5 minutes postintervention by an assessor blinded to the treatment allocation of the subject. A 3-way repeated measures analysis of covariance was used to evaluate changes in PPT. RESULTS The analysis of covariance revealed time x group (F = 32.3; P < .001), time x side (F = 4.9; P < .05), time x sex (F = 7.93; P < .01), and time x group x sex (F = 7.606; P < .001) interactions. Post hoc analyses found that (a) both experimental groups showed greater improvements in PPT than the placebo group (P < .05), without significant differences between them (P > .6); (b) the right side had greater increases in PPT in both experimental groups (P < .05), but not within the placebo group (P > .8); (c) men experienced greater increases in PPT levels than women, particularly in the experimental nondominant group (P < .01). Within-group effect sizes were large for both experimental groups (d > 1), but small for the placebo condition (d < 0.2). CONCLUSIONS These results suggest that a C7-T1 manipulation induced changes in PPT in both right and left C5-C6 zygapophyseal joints in healthy subjects.

Changes in masseter muscle trigger points following strain-counterstrain or neuro-muscular technique

The aim of this study was to compare the immediate effects, on pressure pain sensitivity and active mouth opening, following the application of neuromuscular or strain/counter-strain technique in latent myofascial trigger points (MTrPs) in the masseter muscle. Seventy-one subjects, 34 men and 37 women, aged 20-65 years old, participated in this study. Subjects underwent a screening process to establish the presence of MTrPs in the masseter muscle. Subjects were divided randomly into three groups: group A which was treated with a neuromuscular intervention, group B treated with the strain/counter-strain technique, and group C as control group. Each treatment group received a weekly treatment session during 3 consecutive weeks. Outcomes measures were pressure pain thresholds (PPTs), active mouth opening and local pain (visual analogue scale, VAS) elicited by the application of 2.5kg/cm(2) of pressure over the MTrP. They were captured at baseline and 1 week after discharge by an assessor blinded to the treatment allocation of the subject. The ANOVA found a significant groupxtime interaction (F=25.3; p<0.001) for changes in PPT, changes in active mouth opening (F=10.5; p<0.001), and local pain evoked by 2.5kg/cm(2) of pressure (F=10.1; p<0.001). Within-group effect sizes were large (d>1) for PPT and mouth opening, and moderate for local pain (d<0.7, 0.5) in both intervention groups; but small (d<0.2) for the control group in all outcomes. No significant differences between both intervention groups were found for any outcome (p>0.8). Our results suggest that neuromuscular or strain/counter-strain technique might be employed in the management of latent MTrPs in the masseter muscle.

Comparative short-term effects of two thoracic spinal manipulation techniques in subjects with chronic mechanical neck pain: A randomized controlled trial

Spinal Manipulation (SM) has been purported to decrease pain and improve function in subjects with non-specific neck pain. Previous research has investigated which individuals with non-specific neck pain will be more likely to benefit from SM. It has not yet been proven whether or not the effectiveness of thoracic SM depends on the specific technique being used. This double-blind randomized trial has compared the short-term effects of two thoracic SM maneuvers in subjects with chronic non-specific neck pain. Sixty participants were distributed randomly into two groups. One group received the Dog technique (n = 30), with the subject in supine position, and the other group underwent the Toggle-Recoil technique (n = 30), with the participant lying prone, T4 being the targeted area in both cases. Evaluations were made of self-reported neck pain (Visual Analogue Scale); neck mobility (Cervical Range of Motion); and pressure pain threshold at the cervical and thoracic levels (C4 and T4 spinous process) and over the site described for location of tense bands of the upper trapezius muscle. Measurements were taken before intervention, immediately afterward, and 20 min later. Both maneuvers improved neck mobility and mechanosensitivity and reduced pain in the short term. No major or clinical differences were found between the groups. In the between-groups comparison slightly better results were observed in the Toggle-Recoil group only for cervical extension (p = 0.009), right lateral flexion (p = 0.004) and left rotation (p < 0.05).

Changes in body balance and functional performance following whole-body vibration training in patients with fibromyalgia syndrome: a randomized controlled trial.

OBJECTIVE To determine whether an 8-week exercise programme supplemented with whole-body vibration improves body balance and dynamic strength in women with fibromyalgia. DESIGN Randomized controlled trial. PATIENTS Forty-six participants diagnosed with fibromyalgia. METHODS Participants were randomly assigned to: (i) an exercise training group with whole-body vibration (n = 15), which performed twice-weekly exercise sessions (aerobic exercise, strengthening and flexibility) combined with 3 whole-body vibration training sessions a week (bilateral squats: 6-9 sets of 30 s with 45-s recovery between sets; and unilateral squat: 4-7 sets of 30 s, 30 Hz-4 mm); (ii) an exercise group (n = 15) with the same combined exercise therapy; and (iii) a usual-care control group (n = 16). RESULTS Statistically significant improvements in the Medio-Lateral Stability Index and Medio-Lateral Mean Deflection with open eyes were found in the whole-body vibration exercise group compared with the control group. Non-significant effects were found for lower-limb physical function. CONCLUSION The results show that a traditional exercise programme, supplemented with whole-body vibration training, improved balance in women with fibromyalgia. This may represent a key factor for falls prevention in this patient group.

Effectiveness of a Treatment Involving Soft Tissue Techniques and/or Neural Mobilization Techniques in the Management of Tension-Type Headache: A Randomized Controlled Trial

OBJECTIVE To evaluate the effects of a protocol involving soft tissue techniques and/or neural mobilization techniques in the management of patients with frequent episodic tension-type headache (FETTH) and those with chronic tension-type headache (CTTH). DESIGN Randomized, double-blind, placebo-controlled before and after trial. SETTING Rehabilitation area of the local hospital and a private physiotherapy center. PARTICIPANTS Patients (N=97; 78 women, 19 men) diagnosed with FETTH or CTTH were randomly assigned to groups A, B, C, or D. INTERVENTIONS (A) Placebo superficial massage; (B) soft tissue techniques; (C) neural mobilization techniques; (D) a combination of soft tissue and neural mobilization techniques. MAIN OUTCOMES MEASURES The pressure pain threshold (PPT) in the temporal muscles (points 1 and 2) and supraorbital region (point 3), the frequency and maximal intensity of pain crisis, and the score in the Headache Impact Test-6 (HIT-6) were evaluated. All variables were assessed before the intervention, at the end of the intervention, and 15 and 30 days after the intervention. RESULTS Groups B, C, and D had an increase in PPT and a reduction in frequency, maximal intensity, and HIT-6 values in all time points after the intervention as compared with baseline and group A (P<.001 for all cases). Group D had the highest PPT values and the lowest frequency and HIT-6 values after the intervention. CONCLUSIONS The application of soft tissue and neural mobilization techniques to patients with FETTH or CTTH induces significant changes in PPT, the characteristics of pain crisis, and its effect on activities of daily living as compared with the application of these techniques as isolated interventions.

Changes in Pain Perception after Pelvis Manipulation in Women with Primary Dysmenorrhea: A Randomized Controlled Trial

OBJECTIVE This study aims to evaluate the immediate effect of a global pelvic manipulation (GPM) technique, bilaterally applied, on low back pelvic pain in women with primary dysmenorrhea (PD). DESIGN A prospective, randomized, double-blind, controlled trial. SETTING Faculty of Nursing, Physiotherapy and Podiatry. University of Sevilla, Spain. METHODS The sample group included 40 women (30 ± 6.10 years) that were divided into an experimental group (EG) (N = 20) who underwent a bilateral GPM technique and a control group (CG) (N = 20) who underwent a sham (placebo) intervention. Evaluations were made of self-reported low back pelvic pain (visual analog scale), pressure pain threshold (PPT) in sacroiliac joints (SIJs), and the endogenous response of the organism to pain following catecholamines and serotonin release in blood levels. RESULTS The intragroup comparison showed a significant improvement in the EG in the self-perceived low back pelvic pain (P = 0.003) and in the mechanosensitivity in both SIJs (P = 0.001). In the between-group comparison, there was a decrease in pain perception (P = 0.004; F(1,38) = 9.62; R(2) = 0.20) and an increase in the PPT of both SIJs, in the right side (P = 0.001; F(1,38) = 21.29; R(2) = 0.35) and in the left side (P = 0.001; F(1,38) = 20.63; R(2) = 0.35). There were no intergroup differences for catecholamines plasma levels (adrenaline P = 0.123; noradrenaline P = 0.281; dopamine P = 0.173), but there were for serotonin levels (P = 0.045; F(1,38) = 4.296; R(2) = 0.10). CONCLUSION The bilateral GPM technique improves in a short term the self-perceived low back pelvic pain, the PPT in both SIJs, and the serotonin levels in women with PD. It shows no significant differences with a sham intervention in catecholamines plasma levels.

Immediate Changes in Masticatory Mechanosensitivity, Mouth Opening, and Head Posture After Myofascial Techniques in Pain-Free Healthy Participants: A Randomized Controlled Trial

OBJECTIVE This study aimed to assess the immediate effects on masticatory muscle mechanosensitivity, maximal vertical mouth opening (VMO), and head posture in pain-free healthy participants after intervention with myofascial treatment in the temporalis and masseter muscles. METHODS A randomized, double-blind study was conducted. The sample group included 48 participants (n=48), with a mean age of 21±2.47 years (18-29). Two subgroups were defined: an intervention group (n=24), who underwent a fascial induction protocol in the masseter and temporalis muscles, and a control group (n=24), who underwent a sham (placebo) intervention. The pressure pain threshold in 2 locations in the masseter (M1, M2) and temporalis (T1, T2) muscles, maximal VMO, and head posture, by means of the craniovertebral angle, were all measured. RESULTS Significant improvements were observed in the intragroup comparison in the intervention group for the craniovertebral angle with the participant in seated (P<.001; F1,23=16.45, R2=0.41) and standing positions (P=.012, F1,23=7.49, R2=0.24) and for the pressure pain threshold in the masticatory muscles, except for M2 (P=.151; M1: P=.003; F1,23=11.34, R2=0.33; T1: P=.013, F1,23=7.25, R2=0.23; T2: P=.019, F1,23=6.41, R2=0.21). There were no intragroup differences for the VMO (P=.542). Nevertheless, no significant differences were observed in the intergroup analysis in any of the studied variables (P>.05). CONCLUSION Myofascial induction techniques in the masseter and temporalis muscles show no significant differences in maximal VMO, in the mechanical sensitivity of the masticatory muscles, and in head posture in comparison with a placebo intervention in which the therapists hands are placed in the temporomandibular joint region without exerting any therapeutic pressure.

Craniocervical Posture and Trigeminal Nerve Mechanosensitivity in Subjects with a History of Orthodontic Use: A Cross-Sectional Study

Abstract The purpose of the study was to evaluate whether, in asymptomatic subjects, there are differences in: (i) head posture while sitting and standing still and (ii) trigeminal nerve mechanosensitivity, between those who have a history of using orthodontics and those who do not. The sample consisted of 72 subjects (21±2.14 years): one group who had used orthodontics in the past (n=37), and another group who had not had previous orthodontic treatment (n=35). The authors measured the CranioVertebral Angle (CVA) while the subject was sitting and standing still by means of lateral photographs, and the pressure pain threshold (PPT) of the trigeminal nerve. The orthodontics group showed a more upright position of the head when sitting compared to the non-orthodontics group, with the difference being statistically significant (ANOVA test; p<0.001; F1,70=16.705; R2=0.19), but not for the standing position (p=0.538). The values of the PPT in the trigeminal nerve (supraorbital-V1, infraorbital-V2 and mandibular- V3) were lower on both sides (dominant and nondominant) in the non-orthodontics group. The between-group comparison (ANOVA test) showed statistically significant differences for the trigeminal nerve PPT in its different branches (V1 p=0.001; F1,70=13.012; R2=0.15) (V2 p=0.004; F1,70=9.103; R2=0.11) (V3 p=0.005; F1,70=8.228; R2=0.10). Based on these observations, it was concluded that subjects with a history of orthodontic use show a better sitting craniocervical posture and mechanosensitivity of the trigeminal nerve branches compared to the group that had not used orthodontics in the past.

Short-term changes in median nerve neural tension after a suboccipital muscle inhibition technique in subjects with cervical whiplash: a randomised controlled trial

OBJECTIVES To assess the immediate effect of a suboccipital muscle inhibition (SMI) technique on: (a) neck pain, (b) elbow extension range of motion during the upper limb neurodynamic test of the median nerve (ULNT-1), and (c) grip strength in subjects with cervical whiplash; and determine the relationships between key variables. DESIGN Randomised, single-blind, controlled clinical trial. SETTING Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Spain. PARTICIPANTS Forty subjects {mean age 34 years [standard deviation (SD) 3.6]} with Grade I or II cervical whiplash and a positive response to the ULNT-1 were recruited and distributed into two study groups: intervention group (IG) (n=20) and control group (CG) (n=20). INTERVENTIONS The IG underwent the SMI technique for 4minutes and the CG received a sham (placebo) intervention. Measures were collected immediately after the intervention. MAIN OUTCOME MEASURES The primary outcome was elbow range of motion during the ULNT-1, measured with a goniometer. The secondary outcomes were self-perceived neck pain (visual analogue scale) and free-pain grip strength, measured with a digital dynamometer. RESULTS The mean baseline elbow range of motion was 116.0° (SD 10.2) for the CG and 130.1° (SD 7.8) for the IG. The within-group comparison found a significant difference in elbow range of motion for the IG [mean difference -15.4°, 95% confidence interval (CI) -20.1 to -10.6; P=0.01], but not for the CG (mean difference -4.9°, 95% CI -11.8 to 2.0; P=0.15). In the between-group comparison, the difference in elbow range of motion was significant (mean difference -10.5°, 95% CI -18.6 to -2.3; P=0.013), but the differences in grip strength (P=0.06) and neck pain (P=0.38) were not significant. CONCLUSION The SMI technique has an immediate positive effect on elbow extension in the ULNT-1. No immediate effects on self-perceived cervical pain or grip strength were observed.

A Systematic Review of the Soft-Tissue Connections Between Neck Muscles and Dura Mater: The Myodural Bridge.

Study Design. Systematic review. Objective. To elucidate the existence of soft tissue connections between the neck muscles and cervical dura mater. Summary of Background Data. Several studies discuss the existence of a cervical myodural bridge; however, conflicting data have been reported. Methods. Searches were conducted in the PubMed, Web of Science, Cochrane Library, and PEDro databases. Studies reporting original data regarding the continuity of non–post-surgical soft tissue between the cervical muscles and dura mater were reviewed. Two reviewers independently selected articles, and a third one resolved disagreements. Another two researchers extracted the methodology of the study, the anatomical findings, and evaluated the quality of the studies using Quality Appraisal for Cadaveric Studies Scale. A different third researcher resolved disagreements. Results. Twenty-six studies were included. A soft tissue connection between the rectus capitis posterior minor, the rectus capitis posterior major, and the obliquus capitis inferior muscles seems to be proved with a strong level of evidence for each one of them. Controversy exists about the possible communication between the dura mater and the upper trapezius, rhomboideus minor, serratus posterior superior, and splenius capitis by means of the ligamentum nuchae. Finally, there is limited evidence about the existence of a soft tissue connection between rectus capitis anterior muscle and the dura mater. Conclusion. There is a continuity of soft tissue between the cervical musculature and the cervical dura mater; this might have physiological, pathophysiological, and therapeutic implications, and going some way to explaining the effect of some therapies in craniocervical disorders. Level of Evidence: N/A