Cristina Alonso-Blanco

Myofascial trigger points and their relationship to headache clinical parameters in chronic tension-type headache.

Objective.—To assess the presence of trigger points (TrPs) in several head and neck muscles in subjects with chronic tension‐type headache (CTTH) and in healthy subjects; and to evaluate the relationship of these TrPs with forward head posture (FHP), headache intensity, duration, and frequency.

Trigger points in the suboccipital muscles and forward head posture in tension-type headache.

Objective.—To assess the presence of trigger points (TrPs) in the suboccipital muscles and forward head posture (FHP) in subjects with chronic tension‐type headache (CTTH) and in healthy subjects, and to evaluate the relationship of TrPs and FHP with headache intensity, duration, and frequency.

Forward head posture and neck mobility in chronic tension‐type headache: a blinded, controlled study

Forward head posture (FHP) and neck mobility were objectively assessed in 25 patients with chronic tension-type headache (CTTH) and 25 healthy controls. Side-view pictures were taken in a sitting position to measure the craniovertebral angle. A cervical goniometer was employed to measure the range of all cervical motions. Patients with CTTH showed a smaller cranio-vertebral angle (45.3° ± 7.6°) than controls (54.1° ± 6.3°), thus presenting a greater FHP (P < 0.001). Patients also had lesser neck mobility for all cervical movements, except for right lateral flexion (P < 0.01). There was a positive correlation between the craniovertebral angle and neck mobility. Within the CTTH group, a negative correlation was found between the cranio-vertebral angle and headache frequency, but neck mobility did not correlate with headache parameters. Further research is needed to define a potential role of FHP and restricted neck mobility in the origin or maintenance of TTH.

Two exercise interventions for the management of patients with ankylosing spondylitis: a randomized controlled trial.

Fernández-de-las-Peñas C, Alonso-Blanco C, Morales-Cabezas M, Miangolarra-Page JC: Two exercise interventions for the management of patients with ankylosing spondylitis: A randomized controlled trial. Am J Phys Med Rehabil 2005;84:407–419. Objective:The purpose of this clinical trial was to evaluate the impact of a 4-month comprehensive protocol of strengthening and flexibility exercises developed by our research group versus conventional exercises for patients with Ankylosing Spondylitis (AS) on functional and mobility outcomes. Design:Randomized controlled trial. Forty-five patients diagnosed with AS according to the modified criteria of New York were allocated to control or experimental groups using a random numbers table. The control group was treated with a conventional protocol of physical therapy in AS, whereas the experimental group was treated with the protocol suggested by our research group. The conventional intervention consisted of 20 exercises: motion and flexibility exercises of the cervical, thoracic, and lumbar spine; stretching of the shortened muscles; and chest expansion exercises. The experimental protocol is based on the postural affectation of the AS and the treatment of the shortened muscle chains in these patients according to the Global Posture Reeducation (GPR) method. This intervention employs specific strengthening and flexibility exercises in which the shortened muscle chains are stretched and strengthened. The study lasted 4 mos. During this period, patients received a weekly group session managed by an experienced physiotherapist. Each session lasted an hour, and there were 15 total sessions. Changes in activity, mobility, and functional capacity were evaluated by an assessor blinded to the intervention, using the following previously validated scores from the Bath group: BASMI (tragus to wall distance, modified Schöber test, cervical rotation, lumbar side flexion, and intermalleolar distance), BASDAI (The Bath Ankylosing Spondylitis Disease Activity Index), and BASFI (The Bath Ankylosing Spondylitis Functional Index). Results:Both groups showed an improvement (prepost scores) in all the outcome measures, mobility measures of the BASMI index, as well as in BASFI and BASDAI indexes. In the control group, the improvement in tragus to wall distance (P = 0.009) and in lumbar side flexion (P = 0.02) was statistically significant. Although the rest of the outcomes also improved, they did not reach a significant level (P > 0.05). In the experimental group, the improvement in all the clinical measures of the BASMI index (P < 0.01) and in the BASFI index (P = 0.003) was statistically significant. The intergroup comparison between the improvement (prepost scores) in both groups showed that the experimental group obtained a greater improvement than the control group in all the clinical measures of the BASMI index, except in tragus to wall distance, as well as in the BASFI index. Conclusions:The experimental protocol developed by our research group, based on the GPR method and specific strengthening and flexibility exercises of the muscle chains, offers promising results in the management of patients suffering from AS. Further trials on this topic are required.

Prevalence of neck and low back pain in community-dwelling adults in Spain: a population-based national study.

Study Design. Cross-sectional epidemiological study. Objective. To determine the 1-year prevalence of neck pain and low back pain in the Spanish population and their association with sociodemographic and lifestyle habits, self-reported health status and comorbidity with other chronic disorders. Summary of Background Data. No recent population-based epidemiological studies have estimated the prevalence of neck and low back pain in Spain. Methods. We analyzed data obtained from adults aged 16 years or older (n = 29,478) who participated in the 2006 Spanish National Health Survey, an ongoing, home-based personal interview which examines a nation-wide representative sample of civilian noninstitutionalized population residing in main family dwellings (household) of Spain. We analyzed prevalence data of neck and low back pain and their relationship with socio-demographic characteristics (sex, age, marital status, educational level, occupational status, or monetary income), self-perceived health status, lifestyle habits (smoking habit, alcohol consumption, sleep habit, physical exercise, or obesity), and the presence of concomitant chronic diseases or symptoms. Results. The 1-year prevalence was 19.5% (95% CI: 18.9–20.1) for neck pain and 19.9% (95% CI: 19.3–20.5) for low back pain. Both neck pain and low back pain were higher among female (26.4% and 24.5%) than male (12.3% and 15.1%). Subjects in the 31 to 50 years group were 1.5 times (95% CI: 1.3–1.8) more likely to report low back pain than participants in the 16 to 30 years group. Individuals reporting neck or low back pain showed worse self-reported health status (OR: 4.9, 95% CI: 4.5–5.3 for neck pain; OR: 4.7, 95% CI: 4.3–5.1 for low back pain) and were more likely to complain of depression (OR: 4.3, 95% CI: 3.9–4.7 or OR: 3.6, 95% CI: 3.3–3.9, respectively). Further, a strong association between neck and low back pain was found (OR: 15.6, 95% CI: 14.2–17.1). Finally, neck pain and low back pain were also associated with several other chronic conditions, particularly arthrosis (OR: 6.5, 95% CI: 6.0–7.0), and headaches (OR: 4.3, 95% CI: 3.9–4.8) for neck pain, and both arthrosis (OR: 5.7, 95% CI: 5.3–6.2), and osteoporosis (OR: 6.3, 95% CI: 5.6–7.2), for low back pain. Conclusion. This Spanish population-based survey showed that neck and low back pain are prevalent and highly associated between them, more frequent in female (particularly neck pain) and associated to worse self-reported health status. Individuals with neck and low back pain were more likely than those without pain to have depression and other painful conditions, including headache and osteoporosis.

One-year follow-up of two exercise interventions for the management of patients with ankylosing spondylitis: a randomized controlled trial.

Fernández-de-las-Peñas C, Alonso-Blanco C, Alguacil-Diego IM, Miangolarra-Page JC: One-year follow-up of two exercise interventions for the management of patients with ankylosing spondylitis: A randomized controlled trial. Am J Phys Med Rehabil 2006;85:559–567. Objective:To assess the long-term effects on functional and mobility outcomes of two exercise interventions for the management of patients with ankylosing spondylitis. Design:In an extended 12-mo follow-up of a randomized controlled trial, 40 patients who were diagnosed with ankylosing spondylitis according to the modified criteria of New York, allocated to control or experimental groups using a random numbers table, and who performed their respective exercise program at least three times per month, were included in this long-term study. The control group was treated during 15 sessions with a conventional exercise regimen in ankylosing spondylitis, whereas the experimental group received 15 sessions of exercises based on the treatment of the shortened muscle chains following the guidelines described by the Global Posture Reeducation method. These patients were followed up and assessed again 1 yr after entering the study, reapplying the same validated indexes: BASMI (Bath Ankylosing Spondylitis Metrology Index [tragus to wall distance, modified Schober test, cervical rotation, lumbar side flexion, and intermalleolar distance]), BASDAI (Bath Ankylosing Spondylitis Disease Activity Index), and BASFI (Bath Ankylosing Spondylitis Functional Index). Results:The intragroup comparison between follow-up and postintervention data showed that both groups decrease their clinical and functional measures during the follow-up period. This decrease was only significant for lumbar side flexion and intermalleolar distance measurements, being more significant in the control group (P = 0.001 and P = 0.002, respectively). Intragroup differences between follow-up and preintervention assessments revealed that improvements in all mobility measures of the BASMI index and in the BASFI index were partially maintained at the 12-mo follow-up in the experimental group but not in the control group. The intergroup comparison (unpaired t test analysis) between changes on each outcome during the long-term follow-up (post–follow-up; and pre–follow-up) showed no significant differences in the decrease between postintervention and follow-up data between the study groups. On the other hand, the intergroup comparison between preintervention and follow-up data revealed significant differences in almost all mobility measures of the BASMI index (except for cervical rotation) and in the BASFI index, in favor of the experimental group. Conclusions:An exercise regimen based on the Global Posture Reeducation method and focusing on specific strengthening and flexibility exercises of the shortened muscle chains offers promising short- and long-term results in the management of patients who have ankylosing spondylitis.

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.

Spinal manipulative therapy in the management of cervicogenic headache

Patients suffering from cervicogenic headache (CeH) are commonly treated with spinal manipulative therapy. We have analyzed the quality and the outcomes of published, randomized, controlled trials assessing the effectiveness of spinal manipulation in CeH. Among 121 relevant articles, only two met all the inclusion criteria. Methodological quality scores were 8/10 and 7/10 points. Only one of the trials made use of a headache diary. Both the trials reported positive (+) results on headache intensity, headache duration, and medication intake, so that spinal manipulative therapy obtained strong evidence of effectiveness (level 1) with regard to these outcomes. Conversely, spinal manipulation obtained no more than limited evidence (level 3) in reducing headache frequency, as it was analyzed only in one study with positive (+) results. A greater number of well‐designed, randomized, controlled trials are required to confirm or refute the effectiveness of spinal manipulation in the management of CeH.

Sexual Behaviors among Older Adults in Spain: Results from a Population-Based National Sexual Health Survey

INTRODUCTION The Spanish National Sexual Health Survey (SNSHS) is designed to examine sexual activity, sexual behaviors, and sexual health among the Spanish population. AIM To describe sexual activity and behaviors of Spaniards aged ≥ 65 years old focusing on gender differences. METHODS A population-based descriptive study was conducted using individual data from the SNSHS. The number of subjects aged ≥ 65 years included was 1,939 (1,118 women, 821 men). MAIN OUTCOME MEASURES Sexual activity, frequency, sexual behaviors, sexual practices, and reasons for lack of sexual activity were assessed from questions included in the survey. Subjects who reported having any sexual practice including giving or receiving kissing and hugging, vaginal intercourse, oral sex, or masturbation, with at least one partner in the previous 12 months were considered as sexually active. We analyzed sociodemographic characteristics, self-rated physical and sexual health, comorbid conditions, and medications using multivariate logistic regression models. RESULTS Overall, 62.3% of men and 37.4% of elderly women were sexually active (P < 0.01). The prevalence of sexual inactivity significantly increased with age (P < 0.01, odds ratio [OR] 5.8, 95% confidence interval 3.8-9.05 men; 6.37, 3.9-10.4 women). Not having a partner was a predictor of sexual inactivity (OR 5.79, 3.98-8.42 men; OR 12.0, 8.4-17.2 women). Worse self-rated sexual health, suffering ≥ 2 comorbid conditions, and taking ≥ 2 medications were associated with higher probability of reporting no sexual activity in both men and women. The most common sexual practices were kissing, hugging, and vaginal intercourse. The most common reasons for sexual inactivity were: partner was physically ill (23%), lack of interest (21%), and the man was a widower (23%). CONCLUSIONS This study provided data on sexual activity in older Spanish adults and has identified potential factors that appear to influence sexuality in the elderly with some gender differences. Current results can have implications for healthcare providers for addressing these concerns in an effective manner.

Has the Prevalence of Disability Increased Over the Past Decade (2000–2007) in Elderly People? A Spanish Population-based Survey

OBJECTIVES The main objectives of the current study were (1) to describe the prevalence of disability according to sociodemographic features, self-perceived health status, comorbidity, and lifestyle habits; (2) to determine factors associated with disability in men and women; and (3) to study the time trends prevalence of disability in the period 2000 to 2007. METHODS We analyzed data taken from the Spanish National Health Surveys conducted in 2001 (n = 21,058), 2003 (n = 21,650), and 2006 (n = 29,478). For the current study, we included answers from adults aged 65 years and older. The main variable was disability including basic activities of daily living (ADLs), instrumental ADLs (IADLs), and mobility disability. We stratified the adjusted models by the main variables. We analyzed sociodemographic characteristics, self-perceived health status, lifestyle habits, and comorbid conditions using multivariate logistic regression models. RESULTS The total number of individuals aged 65 years and older was 18,325 (11,346 women, 6,979 men). Women were significantly older than men in all the surveys (P < .001). Women showed higher prevalence of disability (ADL, IADL, and mobility) as compared with men in all surveys. Time trends in the total disability prevalence and whole age range showed a significant increase from 2000 to 2007 in both men and women (OR 1.13, 95% CI 1.1-1.7), particularly in individuals with older age. The variables significantly associated with a higher likelihood of reporting ADL and IADL disability were age older than 84, lower educational level, 2 or more comorbid chronic conditions, obesity (only in women), sleeping more than 8 hours per day, and not practicing physical exercise. Finally, variables that increased the probability of having mobility disability were age older than 84 years, lower educational level, 2 or more comorbid chronic conditions, and not practicing physical exercise. In addition, subjects with disability had a worse self-reported health status. CONCLUSIONS The current study revealed an increase in disability from 2000 to 2007 in the older Spanish population. We found that age older than 84 years, lower education levels, obesity, not practicing physical activity and sleeping more than 8 hours per day were associated with higher disability. Individuals with disability reported a worse self-perceived health status and a greater number of comorbid conditions.