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Objective While fibromyalgia (FM) affects both men and women, differences exist in several factors including prevalence, symptoms and attitudes. Understanding these differences will help define the best approach to the clinical management of this still poorly-understood disease. This systematic review sought to identify gender differences in FM. Data sources The databases PubMed, Science Direct, Scielo, Scopus, Web of Science, and Pesquisa were searched using the terms “fibromyalgia”, “men” and “women” and the Boolean operators “AND” and “OR” for articles dealing with this topic published in any language in the past 20 years. The task force initially identified citations for 257 published articles. Study selection Of 257 records extracted, 28 articles were finally selected for inclusion. Data Extraction In the 28 studies, 2 studies were a clinical trial and the remaining studies were descriptive (10), observational studies (12), retrospective studies (2) and prospective studies (2). Articles were abstracted and quality of the studies determined using specific criteria. Data Synthesis The methodological quality of the studies reported in these articles was good (PEDro score 6.00±1.3328). Gender differences were detected in FM prevalence, symptoms and coping. Conclusions Overall, men with FM experienced more stress and worse sleep quality while women complained more of pain-related symptoms. Both sexes showed low physical activity levels. Both men and women responded well to manual treatment reporting substantial pain relief.

Rehabilitative ultrasound imaging (RUSI) is used by physical therapists as a feedback tool for measuring changes in muscle morphology during therapeutic interventions such as motor control exercises (MCE). However, a structured overview of its efficacy is lacking. We aimed to systematically review the efficacy of RUSI for improving MCE programs compared with no feedback and other feedback methods. MEDLINE, PubMed, SCOPUS and Web of Science databases were searched for studies evaluating efficacy data of RUSI to improve muscular morphology, quality, and/or function of skeletal muscles and MCE success. Eleven studies analyzing RUSI feedback during MCE were included. Most studies showed acceptable methodological quality. Seven studies assessed abdominal wall muscles, one assessed pelvic floor muscles, one serratus anterior muscle, and two lumbar multifidi. Eight studies involved healthy subjects and three studies clinical populations. Eight studies assessed muscle thickness and pressure differences during MCE, two assessed the number of trials needed to successfully perform MCE, three assessed the retain success, seven assessed the muscle activity with electromyography and one assessed clinical severity outcomes. Visual RUSI feedback seems to be more effective than tactile and/or verbal biofeedback for improving MCE performance and retention success, but no differences with pressure unit biofeedback were found.

Objective Dry needling is commonly used for the management of patients with musculoskeletal pain. However, the effects of patient expectations are uncertain. Our aim was to determine the effect of patient expectations on short-term clinical outcomes after the application of a single session of dry needling in individuals with neck pain. Methods We conducted a randomized, placebo-controlled clinical trial including 50 patients with mechanical neck pain. Participants received a single session of dry needling or sham needling in a blinded design. Predicted patient expectation was categorized as positive, neutral, or negative. Outcomes including neck pain intensity (visual analog scale, 0–100), pressure pain thresholds, and self-perceived improvement (Global Rating of Change, −7 to +7) were assessed at baseline, 1 day after the intervention (immediately after), and 7 days after the intervention (1 week after) by a blinded assessor. Repeated-measures analyses of covariance were conducted to assess the effects of real/sham needling adjusted by patient expectations. Results Individuals receiving dry needling exhibited better outcomes immediately and 1 week after the intervention than did those receiving sham needling (all P Conclusion This study did not find a significant effect of predicted patient expectations on the short-term effects of dry needling on pain intensity and pressure pain thresholds in people with mechanical neck pain.

Background: Although mostly common adverse events associated to dry needling can be considered minor, serious adverse events including induced pneumothorax cannot be excluded, and safety instructions for reducing the risk of pleura puncture are needed. Objective: To investigate if anthropometric features can predict the rhomboid major muscle and pleura depth in a sample of healthy subjects to avoid the risk of pneumothorax during dry needling. Methods: A diagnostic study was conducted on 59 healthy subjects (52.5 % male) involving a total of 236 measurements (both sides in maximum inspiration and expiration), to calculate the accuracy of a prediction model for both pleura and rhomboid depth, as assessed with ultrasound imaging, based on sex, age, height, weight, body mass index (BMI), breathing and chest circumference. A correlation matrix and a multiple linear regression analyses were used to detect those variables contributing significantly to the variance in both locations. Results: Men showed greater height, weight, BMI, thorax circumference and skin-to-rhomboid, rhomboid-to-pleura y skin-to-pleura distances (p

Fibromyalgia syndrome (FMS) is a condition that courses with chronic pain, fatigue, sleep disturbance, impaired quality of life and daily function. Due to the lack of blood, imaging or histological confirmatory tests, the diagnosis of FMS is based on the presence of widespread pain and presence of tender points (TPs). Our aim was to assess the pain pressure thresholds (PPTs) and subjective pain perception (SPP) of all 18 TPs while applying a normalized pressure in female patients with fibromyalgia. An exploratory descriptive pilot study was conducted in 30 female patients with FMS. Sociodemographic data (e.g., age, height, weight, and body mass index), clinical characteristics (e.g., years with diagnosis and severity of FMS), PPTs (assessed with an algometer), and SPP (assessed with a visual analogue scale) of all 18 TPs were collected. A comparative analysis side-to-side (same TP, left and right sides) and between TPs was conducted. No side-to-side differences were found (p &lt, 0.05). Significant differences between all 18 TPs were found for PPTs (p &lt, 0.0001), and SPP (p &lt, 0.005) scores were found. The most mechanosensitive points were located in the second costochondral junction, the occiput, the trochanteric prominence, the most painful while applying a normalized pressure considering the TP and side were those located in the gluteus, trochanteric prominence, and supraspinatus. The current study describes PPTs and SPP, as assessed with algometry and visual analogue scale, respectively, of all 18 TPs in female patients with FMS. TPs exhibited significant PPTs and SPP differences between TP locations with no side-to-side differences.

It has been suggested that Percutaneous Electrical Nerve Stimulation (PENS) can increase muscle strength. No previous study has investigated changes in performance in semiprofessional soccer players. This study compares the effects of adding two sessions of PENS to a training program versus the single training program over sport performance attributes (e.g., jump height and squat speed) in healthy soccer players. A cluster-randomized controlled trial was conducted on twenty-three semiprofessional soccer players who were randomized into an experimental (PENS + training program) or control (single training program) group. The training program consisted of endurance and strength exercises separated by 15-min recovery period, three times/week. The experimental group received two single sessions of PENS one-week apart. Flight time and vertical jump height during the countermovement jump and squat performance speed were assessed before and after each session, and 30 days after the last session. Male soccer players receiving the PENS intervention before the training session experienced greater increases in the flight time, and therefore, in vertical jump height, after both sessions, but not one month after than those who did not receive the PENS intervention (F = 4.289, p = 0.003, η 2 p: 0.170). Similarly, soccer players receiving the PENS intervention experienced a greater increase in the squat performance speed after the second session, but not after the first session or one month after (F = 7.947, p &lt, 0.001, η 2 p: 0.275). Adding two sessions of ultrasound-guided PENS before a training strength program improves countermovement jump and squat performance speed in soccer players.

Temporomandibular disorders (TMD) are the most common orofacial impairment, but the relevance of certain clinical features in TMD is not clear.The main objective of this study was to analyse if temporomandibular disorders (TMD) are associated with sociodemographic (eg age, height, weight, body mass index and gender), psychological (eg anxiety and depression) and clinical features (eg use of dental splints, orthodontics, retainers, bruxism, sleep disturbance, familiar prior history of TMD and dental occlusion).An observational study was conducted to calculate the correlation of TMD, as assessed with DC/TMD criteria, with sociodemographic, psychological and clinical features on 59 voluntary subjects with TMD (n = 45) and without TMD (n = 14). Sex, height, weight, body mass index, age, use of dental splint, orthodontics, retainers, parafunctional disorders, sleep disturbance, familiar history of TMD, bruxism, anxiety, stress and dental occlusion class data were included in a multivariable correlation analysis to determine which variables are associated with TMD and bruxism.TMD was found to be correlated with none of the features assessed (P .05), but a negative correlation with the use of dental splint (P .05). Dental occlusion class showed no statistically significant correlation with any assessed feature (P .05).The etiology of TMD is not clear and considering certain clinical features including dental occlusion are not justified in the evidence-based TMD practice for making irreversible occlusal treatment decisions.

Objective A correct examination is essential during a differential diagnosis of neck pain patients. Therefore, the objective of this study was to provide an update on the properties considered most important by physical therapists (PTs) when conducting accessory and physiological movement tests during the cervical spine physical examination. Methods A total of 84 private physiotherapy centres participated in this online cross-sectional survey including 415 active physiotherapists and members of one autonomous Spanish Physiotherapists School. This survey included information about the characteristics of the respondents (eg, weekly patient care, highest qualification and specific training in osteopathy and manual therapy), their opinion about the accuracy and reliability of accessory and physiological movement tests, the frequency and importance of mobility and pain responses, and the most commonly reference used to make a judgement. Results Pain responses are most frequently used by physiotherapists at a rate of 79.8% and also rated as important by 42.65% respondents mobility aspects such as quality of end-feel (17.3%), quantity of translation (16.4%) and quality of resistance (13.3%) during passive accessory intervertebral movement tests. During passive and active physiological movement tests, the most frequent properties assessed were the quality of motion path (80.5% and 84.3%, respectively) and quantity of angle bending (81.7% and 77.6%, respectively). Pain responses are used as reference by 54.7% to make a clinical judgement during passive accessory intervertebral movement tests. Conclusion Physical therapists face validity in relation to passive accessory intervertebral movement test for assessing spinal segmental motion aspects has been decreasing with more attention devoted to pain responses. The current scepticism regarding the motion properties assessed with these tests is associated with utility aspects such as validity, sensitivity, accuracy and specificity.

This systematic review and meta-analysis sought to gain further insight into the relationship between cortisol reactivity and chronic widespread pain in patients with fibromyalgia. The studies selected were those conducted in adults with fibromyalgia that were random controlled, non-controlled or observational. Studies were excluded if they examined diseases other than fibromyalgia or if they did not report on pain or cortisol. Twelve studies met inclusion criteria. Data were extracted into tabular format using predefined data fields by two reviewers and assessed for accuracy by a third reviewer. The methodological quality of the studies was assessed using the PEDro scale. Data Synthesis: Of 263 studies identified, 12 were selected for our review and 10 were finally included as their methodological quality was good. In the meta-analysis, we calculated effect sizes of interventions on pain indicators and cortisol levels in patients with fibromyalgia. A small overall effect of all the interventions was observed on pain tolerance and pressure pain thresholds, yet this effect lacked significance (ES = 0.150; 95%CI 0.932–1.550; p > 0.05). Conclusions: While some effects of individual nonpharmacological therapeutic interventions were observed on both cortisol levels and measures of pain, our results suggest much further work is needed to elucidate the true relationship between chronic widespread pain and cortisol levels in patients with fibromyalgia.

Objective: Chronic mechanical neck pain is associated with musculoskeletal tissue alterations. Active trigger points in the trapezius and levator scapulae muscles are common in patients with chronic mechanical neck pain. In this study, we compared the effect of dry needling (DN) combined with manual therapy (MT) to sham dry needling (SDN) combined with MT on pain, pain pressure threshold, cervical range of motion and neck disability in patients with chronic mechanical neck pain. Methods: A randomised, single-blind clinical trial was carried out involving 101 participants with chronic mechanical neck pain, divided into an intervention group (DN+MT, n=47) and a control group (SDN+MT, n=54). Participants received two treatment sessions. The intervention group received MT in conjunction with DN of the most mechano-sensitive myofascial trigger point (MTrP). The control group received MT plus SDN. Outcomes measures were: pain intensity (numeric pain rating scale, NPRS), pressure pain threshold (PPT), cervical range of motion (ROM) and neck disability (neck disability index, NDI). Results: This study found that between-group differences in pain intensity were statistically significant (P2) was observed. Cervical ROM also showed highly statistically significant differences. After 4 weeks, a statistically significant reduction (PConclusion: Our results show that DN+MT is efficacious and significantly better than SDN+MT at reducing pain intensity, PPT, neck disability and cervical ROM in patients with chronic mechanical neck pain. Level of evidence: 1b.

Since manual palpation is a subjective procedure for identifying and differentiate Myofascial Trigger Points -MTrPs-, the use of Shear Wave Elastography -SWE- as an objective alternative is increasing. This study aimed to analyze pain pressure thresholds -PPTs- and SWE differences between active MTrPs, latent MTrPs and control points located in the upper trapezius to analyze the association of SWE features with clinical severity indicators (e.g., pain extension area, PPTs, neck pain and neck disability). An observational study was conducted to calculate the correlation and to analyze the differences of sociodemographic, clinical and SWE features on 34 asymptomatic subjects with latent MTrPs and 19 patients with neck pain and active MTrPs. Significant PPT differences between active with latent MTrPs (p &lt, 0.001) and control points (p &lt, 0.001) were found, but no differences between latent MTrPs and control points (p &gt, 0.05). No stiffness differences were found between active MTrPs with latent MTrPs or control points (p &gt, 0.05). However, significant control point stiffness differences between-samples were found (p &lt, 0.05). SWE showed no significant correlation with clinical severity indicators (p &gt, 0.05). No stiffness differences between active and latent MTrPs were found. Neck pain patients showed increased control point stiffness compared with asymptomatic subjects. SWE showed no association with clinical severity indicators.

Background In addition to muscle morphology, ultrasound imaging (US) could be a potential tool to determine muscle quality assessing the echo-intensity and using offline software to quantify the percentage of intramuscular fatty infiltration. Objective To investigate intra- and inter-rater image measurement reliability of morphological (i.e., cross-sectional area, perimeter) and echo intensity features (i.e., mean muscular echo intensity, fat echo intensity cut-offs, fatty infiltrates percentage estimation) of deep neck extensors in asymptomatic subjects. Methods Brightness-mode images of the cervical spine at C4/C5 were acquired in 25 asymptomatic subjects (40%women, age: 24 years) by an experienced examiner. Cross-sectional area, perimeter and echo-intensity measures of cervical multifidus and short rotators were measured on two separate days (one-week apart) in a randomized order by two assessors. Intra-class correlation coefficients (ICC), standard error of measurement, minimal detectable change, and mean, absolute and percent errors were calculated. Results Intra- (ICC3,1 0.800–0.989) and inter- (ICC3,2 0.841–0.948) examiner reliability of echo-intensity measures ranged from good to excellent. Women exhibited higher echo-intensity features than men. Intra-examiner reliability of morphological measures was excellent (ICC3,1 0.917–0.974) for multifidus and good-excellent (ICC3,1 0.868–0.987) for short rotators. Inter-examiner reliability of morphological measures also ranged from good to excellent (ICC3,2 0.765–0.965). Men exhibited higher CSA and perimeter than women. No side-to-side differences were observed in any ultrasound measure. Conclusion This study found that intra- and inter-rater image analysis reliability of muscle morphology, mean echo intensity, and fatty infiltration quantification of cervical multifidus and short rotators at C4/C5 level was good-to-excellent in healthy subjects.

Current neuroanatomical evidence showed the anatomical relationship between the temporomandibular joint innervation with the vestibular system. However, there is no clear evidence regarding if temporomandibular disorders are associated with balance impairments. Therefore, the aims of this study were to assess the clinical relevance of stabilometric features in populations with temporomandibular disorders and to analyze the influence of the mandibular position and visual afference in the balance scores in both healthy and clinical populations. This observational study was conducted in one sample of healthy controls and one sample with temporomandibular disorders. Sociodemographic data (age, gender, height, weight, body mass index, and foot size), clinical data (presence or absence of temporomandibular disorders) and stabilometric data under six different conditions were collected. Sixty-nine subjects (43.5% male, 36.2% patients) were assessed. No differences between Temporomandibular disorders and healthy groups were found in any stabilometric outcomes, unlike oscillation area with closed eyes and medium interscuspidal position (p &lt, 0.01). Although visual feedback showed to be relevant (p &lt, 0.0001), mandibular position produced no differences in any stabilometric measurement (p &gt, 0.05). This study found that healthy subjects and patients with temporomandibular disorders showed no balance differences in the stabilometric outcomes assessed. Although visual input played an important role in the balance, mandibular position seems to be irrelevant.

Studies analyzing morphometry of neck extensor musculature have mostly used Magnetic Resonance Imaging (MRI). Panoramic Ultrasound View could be used for obtaining high-quality 2D cross-sectional images with a wide field of view more cost-effectively imaging acquisition by creating an automatic construction of 2D cross-sectional images.To measure neck extensors cross-sectional area (CSA) using panoramic ultrasound view in healthy subjects.Cross-sectional study.Panoramic B-mode ultrasound images of the neck extensor muscles at C4/C5 level were acquired in 25 healthy subjects (40% women, mean age: 24 ± 5 years) by an experienced assessor. The CSA of the upper trapezius, splenius (layer), semispinalis (layer), multifidi, short rotators, and levator scapulae were calculated. The relative percentage in the total neck extensor muscle volume of each CSA was also determined. Sex and side-to-side comparisons were conducted.Men showed larger CSAs than women in all muscles (all, P 0.01). No side-to-side differences were found in either men or women (all, P 0.05). Significant positive associations between CSA with weight (r: 0.654 to 0.375, P 0.01), height (r: 0.386 to 0.581, P 0.05), and BMI (r: 0.369 to 0.563, P 0.05) were found. Men showed greater percentage of upper trapezius and semispinalis muscle layers than women (P 0.01), whereas women had a greater percentage of levator scapulae muscle than men (P 0.01) from the total volume of the neck extensors. No side-to-side differences were found either.The current study describes CSA, as assessed with panoramic ultrasound view, of the neck extensors in healthy people. Men exhibited greater CSA than women with no side-to-side differences.

Imaging findings in patellar tendinopathy are questioned. The aim of this pilot study was to characterize ultrasound measures, by calculating ultrasound ratio and neovascularization of the patellar tendon in non-elite sport players with unilateral painful patellar tendinopathy. Cross-sectional area (CSA), width, and thickness of the patellar tendon were assessed bilaterally in 20 non-elite sport-players with unilateral painful patellar tendinopathy and 20 asymptomatic controls by a blinded assessor. Ultrasound ratios were calculated to discriminate between symptomatic and asymptomatic knees. The Ohberg score was used for characterizing neovascularization. We found that non-elite sport players with patellar tendinopathy exhibited bilateral increases in CSA, width, and thickness of the patellar tendon compared to asymptomatic controls (Cohen d &gt, 2). The ability of ultrasound ratios to discriminate between painful and non-painful patellar tendons was excellent (receiver operating characteristic, ROC &gt, 0.9). The best diagnostic value (sensitivity: 100% and specificity: 95%) was observed when a width ratio &ge, 1.29 between the symptomatic and asymptomatic patellar tendon was used as a cut-off. Further, neovascularization was also observed in 70% of non-elite sport players with unilateral patellar tendinopathy. A greater CSA ratio was associated with more related-disability and higher tendon neovascularization. This study reported that non-elite sport players with painful unilateral patellar tendinopathy showed structural ultrasound changes in the patellar tendon when compared with asymptomatic controls. Ultrasound ratios were able to discriminate between symptomatic and asymptomatic knees. Current results suggest that ultrasound ratios could be a useful imaging outcome for identifying changes in the patellar tendon in sport players with unilateral patellar tendinopathy.

Previous studies analyzing morphometry of posterior cervical muscles with ultrasound (US) imaging have mainly used Brightness mode (B-mode). Our aim was to investigate the intra-examiner reliability of panoramic US imaging for assessing posterior-lateral cervical muscle layers. Panoramic US images of the neck at C4/C5 level were acquired in 25 asymptomatic subjects (40% women; mean age: 24 years) by an experienced assessor. The cross-sectional area (CSA) of the upper trapezius, splenius, semispinalis, multifidi, rotators, and levator scapulae was measured from panoramic US scans on two separate days. Intra-class correlation coefficients (ICC3,1), standard error of measurement (SEM), minimal detectable change (MDC) and mean, absolute and percent errors were calculated. In general, intra-examiner reliability was excellent with ICC3,1 ranging from 0.978 (trapezius) to 0.993 (semispinalis). The SEM ranged from 0.02 (multifidus) to 0.07 (semispinalis/levator), whereas the MDC ranged from 0.05 (cervical multifidus) to 0.19 (levator/semispinalis). Absolute error was lower than 0.11 cm2 (levator/semispinalis). No differences between males and females were found. This study found that intra-examiner/rater reliability of panoramic US imaging was excellent for assessing the CSA of the posterior-lateral neck extensor muscles in asymptomatic subjects. The current findings suggest that panoramic US may be a reliable technique for examining the size of the cervical extensor muscles in both males and females.