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Background. Cervical radiculopathy is defined as a disorder involving dysfunction of the cervical nerve roots characterised by pain radiating and/or loss of motor and sensory function towards the root affected. There is no consensus on a good definition of the term. In addition, the evidence regarding the effectiveness of manual therapy in radiculopathy is contradictory. Objective. To assess the effectiveness of manual therapy in improving pain, functional capacity, and range of motion in treating cervical radiculopathy with and without confirmation of altered nerve conduction. Methods. Systematic review of randomised clinical trials on cervical radiculopathy and manual therapy, in PubMed, Web of Science, Scopus, PEDro, and Cochrane Library Plus databases. The PRISMA checklist was followed. Methodological quality was evaluated using the PEDro scale and RoB 2.0. tool. Results. 17 clinical trials published in the past 10 years were selected. Manual therapy was effective in the treatment of symptoms related to cervical radiculopathy in all studies, regardless of the type of technique and dose applied. Conclusions. This systematic review did not establish which manual therapy techniques are the most effective for cervical radiculopathy with electrophysiological confirmation of altered nerve conduction. Without this confirmation, the application of manual therapy, regardless of the protocol applied and the manual therapy technique selected, appears to be effective in reducing chronic cervical pain and decreasing the index of cervical disability in cervical radiculopathy in the short term. However, it would be necessary to agree on a definition and diagnostic criteria of radiculopathy, as well as the definition and standardisation of manual techniques, to analyse the effectiveness of manual therapy in cervical radiculopathy in depth.

Studies evaluating sensory function of the entire trigeminocervical region in patients with cluster headache (CH), migraine (MH), and tension-type headache (TH) are required. The purpose of the present study was to evaluate and compare sensory function in the trigeminocervical region in patients with CH, MH, and TH and healthy controls (HC).Quantitative sensory testing (QST), including pressure pain threshold (PPT), tactile detection threshold (TDT), prick detection threshold (PDT), and two-point detection threshold (2PDT), was evaluated in 139 patients with headache (CH = 16, MH = 52, TH = 71) and 30 HC. Test sites included bilaterally the first, second, and third divisions of trigeminal nerve (V1, V2, and V3), cervical spine, and thenar eminence.TH presented significantly lower PPT values compared with CH (p 0.015), MH (p 0.048), and HC (p 0.009), while MH demonstrated significantly lower values than HC (p = 0.001-0.023). When analyzing TDT, CH in the symptomatic side presented significantly higher values in V1 compared with MH (p = 0.001), TH (p 0.001), and HC (p 0.001) and in V2 compared with TH (p = 0.035). No statistically significant differences were found for PDT (p 0.005). With regard to 2PDT, CH-s presented significantly higher values in V1 with respect to HC (p = 0.016) but lower values in V2 compared with MH (p 0.001) and TH (p = 0.003).The results of the present study indicate specific and different altered mechanical sensory thresholds in CH, MH, and TH patients compared with HC subjects.

The Ober test is an orthopedic evaluation procedure used to assess for tightness of the tensor fascia latae (TFL) and iliotibial band (ITB). Multiple versions of this test have been described using different degrees of contralateral hip joint flexion to stabilize the pelvis. The aim of this study was to analyze the hip range of motion (ROM) in the frontal plane and perceived tension produced during the Ober test using four different angles of contralateral hip flexion prepositioning. The secondary objective was to analyze the differences in the Ober test with different contralateral hip flexion angles according to limb dominance. This cross-sectional study included healthy individuals aged 18 years or older. The Ober test was performed on the right and left leg of each participant with the contralateral hip joint stabilized at 0° flexion, 45° flexion, 90° flexion, and maximal flexion. Hip range of motion in the frontal plane (abduction or adduction) was measured using a digital inclinometer. Three measurements were performed on each limb for every angle of contralateral prepositioning, using the average of the three measurements for statistical analysis. Participants were asked to report the location of any perceived tension and the intensity of tension using a Numeric Rating Scale during the test. Twenty-eight participants (17 men and 11 women) were examined. Significant differences in the Ober test hip ROM in the frontal plane ( p < 0.01 ) were observed when comparing different angles of contralateral hip flexion prepositioning. Significant differences between tests were also present for intensity of perceived tension ( p ≤ 0.001 ), except for the intensity of perceived tension between 0° and 45°. No statistically significant differences were observed related to limb dominance ( p > 0.05 ) or gender ( p > 0.05 ), except for the Ober test at 0° ( p < 0.001 ) which was higher in men (9.61° ± 5.01°) than in women (5.05° ± 2.87°). Greater contralateral hip flexion prepositioning during the Ober test results in decreased hip adduction ROM in the tested limb and greater perceived tension in the region of tensor fascia latae-iliotibial band.

Previous studies indicate that maximum upper cervical axial rotation occurs only through a combination of transverse, frontal, and sagittal plane motions. This study explores the relationship between transection of the alar ligament and combined upper cervical axial rotation movements. Ten cryopreserved upper cervical spines were manually mobilized in bilateral axial rotation and two different motion combinations with simultaneous motion in the three anatomical planes: rotation in extension (extension + axial rotation + contralateral lateral bending) and rotation in flexion (flexion + axial rotation + ipsilateral lateral bending). These three motions were performed before and after right alar ligament transection. The occiput-axis axial rotation was measured using an optical motion capture system while measuring the applied load. With intact alar ligament, the axial rotation in flexion showed the lowest range of motion (right, R: 9.81 ± 3.89°; left, L: 15.54 ± 5.89°). Similar results were found between the other two mobilizations: axial rotation (R: 33.87 ± 6.64°; L: 27.99 ± 6.90°) and rotation in extension (R: 35.15 ± 5.97°; L: 28.96 ± 6.47°). After right alar ligament transection, rotation in flexion (particularly in left rotation) showed the largest increase in motion: rotation in flexion (R: 13.78 ± 9.63°; L: 23.04 ± 5.59°), rotation in extension (R: 36.39 ± 7.10°; L: 31.71 ± 7.67°), and axial rotation (R: 38.50 ± 9.47°; L: 31.59 ± 6.55°). Different combinations of movements should be evaluated when analyzing the maximum axial rotation of the upper cervical spine, as axial rotation alone and rotation in extension showed a larger range of motion than rotation in flexion. After unilateral alar ligament injury, rotation to the non-injured side in flexion demonstrates the most movement increase. info:eu-repo/semantics/publishedVersion

Context: Tightness or lack of flexibility of several muscles of the thigh has been associated with patellofemoral joint pain. A tight iliotibial band can lead to laterally located patella and an abnormal patellar tracking pattern. Diacutaneous fibrolysis (DF) is commonly used to reduce muscle tightness, but no studies have evaluated the effects of this technique in the treatment of patients with patellofemoral pain syndrome. Objective: To assess the effect of DF on patellar position in patients with patellofemoral pain syndrome. Design: A single-group, pretest–posttest clinical trial. Setting: University of Zaragoza. Participants: A total of 46 subjects with patellofemoral pain (20 males, 26 females; age: 27.8 [6.9] y). Intervention: Three sessions of DF. Main Outcome Measures: Patellar position measurement using real-time ultrasound scanning; pain intensity measured with visual analog scale and function measured with the Anterior Knee Pain Scale. Results: The application of 3 sessions of DF significantly increased the patellar position at posttreatment evaluation (P P P = .28). There were also a statistically significant decrease in pain and increase in function at posttreatment and at 1-week follow-up measurements (P Conclusion: This study found that patellar position, pain intensity, and function were significantly improved after 3 sessions of DF and at 1-week follow-up.

Background Cervical pain is the biggest musculoskeletal health problem in industrialised countries. There is an important association between this and decrease in range of motion. Objective Estimate the validity and reliability intra and inter examiner of two Smartphone apps regarding the measurement of lower and upper cervical spine range of motion in subjects with chronic cervical pain. Methods A cross-sectional study was conducted. The sample consisted of 25 subjects with chronic cervical pain. An examiner made a measurement of the range of motion using the CROM device as a gold standard, afterwards, another examiner did the same using a Smartphone, in order to establish validity. After this, the Smartphone examiner and a new examiner simultaneously conducted the intra and inter examiner reliability. Results Measurement of the lower and upper cervical spine range show an excellent validity (> 0.75), with an excellent intra and inter reliability (> 0.75) in all movements except flexion of upper cervical spine (0.75-0.65). Conclusion The two Smartphone applications used in this study showed an excellent validity compared to the CROM. The intra and inter reliability is excellent for all movements, except for the upper cervical spine flexion.

Miguel Malo-Urriés,1 César Hidalgo-García,1 Elena Estébanez-de-Miguel,1 José Miguel Tricás-Moreno,1 Sonia Santos-Lasaosa,2 Marjan Jahanshahi3 1Physiotherapy Research Unit, Department of Physiatry and Nursing, University of Zaragoza, Zaragoza, Spain; 2Neurology Service, University Clinical Hospital Lozano Blesa, Zaragoza, Spain; 3Cognitive Motor Neuroscience Group, Department of Clinical and Movement Neurosciences, University College London Queen Square Institute of Neurology, The National Hospital for Neurology and Neurosurgery, London, UK Background: Based on inconsistent sensory alterations demonstrated in cluster headache (CH), the aim of this study was to determine whether patients with CH develop sensory changes in the symptomatic side compared to the asymptomatic side.Methods: Quantitative sensory testing (QST), including pressure pain threshold (PPT), tactile detection threshold (TDT), prick detection threshold (PDT), and two-point detection threshold (2PDT), was evaluated in 16 patients (seven women; age 41.9±6.8 years) with CH. Test sites included the first, second, and third divisions of the trigeminal nerve, cervical spine, and thenar eminence in the symptomatic and asymptomatic sides.Results: The symptomatic side, compared to the asymptomatic side, presented significantly decreased PPT in the first (P=0.011; 423.81±174.05 kPa vs 480.13±214.99 kPa) and second (P=0.023; 288.88±140.80 kPa vs 326.38±137.33 kPa) divisions of the trigeminal nerve, significantly increased TDT in the first (P=0.002; 2.44±0.40 vs 1.74±0.24) and second (P=0.016; 1.92±0.34 vs 1.67±0.09) divisions, and increased 2PDT in the first division (P=0.004; 18.13±4.70 mm vs 15.0±4.92 mm) and neck (P=0.007; 45.31±20.65 mm vs 38.44±16.10 mm).Conclusion: These results support the prior evidence suggesting a specific pattern of alteration of sensory function with alterations in the symptomatic side compared to the asymptomatic side. Keywords: cluster headache, trigeminal autonomic cephalalgia, quantitative sensory testing

Analyse the short-term effects of traction-manipulation protocol in dizziness and pain intensity and disability, cervical mobility and postural instability.Randomized controlled assessor-blind clinical trial. The traction-manipulation protocol was carried out in the intervention group and compared with a control group where the subjects were kept supine. The intervention protocol follows the IFOMPT safety recommendations. Dizziness and pain intensity, Dizziness Handicap Inventory (DHI), cervical mobility and balance were measured after 48 h and a one-month follow-up.Forty subjects with cervicogenic dizziness were randomly assigned to an intervention or control group. Significant differences were found in favour of the intervention protocol group in: dizziness intensity (The traction-manipulation protocol reduces the dizziness and pain intensity, ameliorates disability and improves upper cervical mobility and postural instability.IMPLICATIONS FOR REHABILITATIONThe intervention protocol reduces the dizziness and pain intensity, and improves self-perceived disability in patients with cervicogenic dizziness.Manual therapy improves the cervical range of motion and the postural instability in the cervicogenic dizziness.The intervention protocol follows the safety recommendations of the International Federation of Orthopaedic Manipulative Physical Therapists.

Background: Exercise training has proven to be effective for treatment of metabolic diseases, such as type 2 diabetes mellitus. The aims of this study were to compare anthropometric measurements, metabolic profile and physical fitness between active and sedentary women with type 2 diabetes, and to analyse relationships between anthropometry and metabolic profile and components of physical fitness (balance, flexibility, strength and endurance). Methods: Cross-sectional research on 28 women with type 2 diabetes. Amount of daily physical activity, BMI, waist circumference, HbA1c, fibrinogen, hs-CRP, tiptoe dynamic balance, static balance, finger floor distance, abdominal, upper and lower limb strength and walking cardiovascular endurance were recorded. Results: Age: 58.5 ± 7.8. Overall, 16 subjects were physically active and 12 were sedentary. Active subjects had lower BMI (p = 0.033) and better cardiovascular endurance (p = 0.025). BMI and waist circumference were not influenced by any physical fitness component. HbA1c, fibrinogen and hs-CRP were related with worse dynamic balance (p = 0.036, 0.006 and 0.031, respectively). Conclusions: Active women had lower BMI and showed a better performance in cardiovascular endurance. Tiptoe dynamic balance impairments were related to worse glycaemic control, hypercoagulation and inflammatory state. info:eu-repo/semantics/publishedVersion

Background Positional plagiocephaly frequently affects healthy babies. It is hypothesized that manual therapy tailored to pediatrics is more effective in improving plagiocephalic cranial asymmetry than just repositioning and sensory and motor stimulation. Methods Thirty-four neurologically healthy subjects aged less than 28 weeks old with a difference of at least 5 mm between cranial diagonal diameters were randomly distributed into 2 groups. For 10 weeks, the pediatric integrative manual therapy (PIMT) group received manual therapy plus a caregiver education program, while the controls received the same education program exclusively. Cranial shape was evaluated using anthropometry; cranial index (CI) and cranial vault asymmetry index (CVAI) were calculated. Parental perception of change was assessed using a visual analogue scale (− 10 cm to + 10 cm). Results CVAI presented a greater decrease in PIMT group: 3.72 ± 1.40% compared with 0.34 ± 1.72% in the control group (p = 0.000). CI did not present significant differences between groups. Manual therapy led to a more positive parental perception of cranial changes (manual therapy: 6.66 ± 2.07 cm; control: 4.25 ± 2.31 cm; p = 0.004). Conclusion Manual therapy plus a caregiver education program improved CVAI and led to parental satisfaction more effectively than solely a caregiver education program. Trial registration Trial registration number: NCT03659032; registration date: September 1, 2018. Retrospectively registered.

Background: Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy in the upper extremity. Conservative treatment has been effective for mild and moderate idiopathic CTS. However, severe CTS and systemic conditions were an exclusion criterion from the studies. The aim of this study is to review the effectiveness of conservative treatment in patients with CTS regardless of the level of severity and the presence or not of systemic diseases in the last ten years. Methods: Randomized controlled clinical trials that compared the effect of conservative treatment on the Boston questionnaire and pain were selected. PubMed, PEDro, Scopus, Cochrane, and Web of Science databases were used. PRISMA statement checklist was performed. Results: 876 studies were recorded, 29 were selected. Pharmacology, Electrotherapy and Manual Therapy had benefits for CTS. Electrotherapy and manual therapy could be effective for severe CTS patients with a systemic condition in the short term, but there was a low percentage of these patients included in the studies. Conclusion: Some pharmacological treatments, manual therapy and electrotherapy have shown benefits for handling CTS, although the most effective combination of techniques is unknown. It would be necessary to include patients with systemic conditions in the selection criteria for future studies. info:eu-repo/semantics/publishedVersion

(1) Background: Diabetic peripheral neuropathy (DPN) is one of the most common complications of diabetes mellitus (DM). Control of hyperglycaemia as well as surgical decompression are effective treatments for these patients. However, surgery is not indicated for all candidates. Manual therapy and physical exercise have been shown to be effective for peripheral neuropathies, and exercise for DM. The aim is to review the effectiveness of manual therapy and/or exercise in patients with DPN. (2) Methods: Randomised controlled clinical trials comparing the effects of manual therapy and/or exercise on pain, function and/or balance were selected. The search strategy was performed in PubMed, PEDro, Scopus, Cochrane and Web of Science databases. The PRISMA statement was followed. (3) Results: A total of 656 articles were registered, and 29 were selected. There was little consensus on DPN criteria selection. Aerobic, strength and balance exercises are beneficial for DPN. Sessions of 30–60 min, three times per week for 8 weeks seems to be the most used dose. Manual therapy is effective in the short term. A combination of both modalities was more beneficial than alone in one study. (4) Conclusions: Exercise and manual therapy are beneficial for patients with DPN. More studies should be carried out for analysing the potential effect of combining manual therapy and exercise.

Background: Positional plagiocephaly (PP) is a cranial deformation frequent amongst children and consisting in a flattened and asymmetrical head shape. PP is associated with excessive time in supine and with congenital muscular torticollis (CMT). Few studies have evaluated the efficiency of a manual therapy approach in PP. The purpose of this parallel randomized controlled trial is to compare the effectiveness of adding a manual therapy approach to a caregiver education program focusing on active rotation range of motion (AROM) and neuromotor development in a PP pediatric sample. Methods: 34 children with PP and less than 28 week old were randomly distributed into two groups. AROM and neuromotor development with Alberta Infant Motor Scale (AIMS) were measured. The evaluation was performed by an examiner, blinded to the randomization of the subjects. A pediatric integrative manual therapy (PIMT) group received 10-sessions involving manual therapy and a caregiver education program. The control group received the caregiver education program exclusively. To compare intervention effectiveness across the groups, improvement indexes of AROM and AIMS were calculated using the difference of the final measurement values minus the baseline measurement values. If the distribution was normal, the improvement indexes were compared using the Student t-test for independent samples; if not, the Mann-Whitney U test was used. The effect size of the interventions was calculated using Cohen's d. Results: All randomized subject were analysed. After the intervention, the PIMT group showed a significantly higher increase in rotation (29.68 ± 18.41º) than the control group (6.13 ± 17.69º) (p< 0.05). Both groups improved the neuromotor development but no statistical significant differences were found. No harm was reported during the study.Conclusion: The PIMT intervention program was more effective in increasing AROM than using only a caregiver education program.

Background Positional plagiocephaly (PP) is a cranial deformation frequent amongst children and consisting in a flattened and asymmetrical head shape. PP is associated with excessive time in supine and with congenital muscular torticollis (CMT). Few studies have evaluated the efficiency of a manual therapy approach in PP. The purpose of this parallel randomized controlled trial is to compare the effectiveness of adding a manual therapy approach to a caregiver education program focusing on active rotation range of motion (AROM) and neuromotor development in a PP pediatric sample. Methods Thirty-four children with PP and less than 28 week-old were randomly distributed into two groups. AROM and neuromotor development with Alberta Infant Motor Scale (AIMS) were measured. The evaluation was performed by an examiner, blinded to the randomization of the subjects. A pediatric integrative manual therapy (PIMT) group received 10-sessions involving manual therapy and a caregiver education program. Manual therapy was addressed to the upper cervical spine to mobilize the occiput, atlas and axis. The caregiver educational program consisted in exercises to reduce the positional preference and to stimulate motor development. The control group received the caregiver education program exclusively. To compare intervention effectiveness across the groups, improvement indexes of AROM and AIMS were calculated using the difference of the final measurement values minus the baseline measurement values. If the distribution was normal, the improvement indexes were compared using the Student t-test for independent samples; if not, the Mann-Whitney U test was used. The effect size of the interventions was calculated using Cohen’s d. Results All randomized subjects were analysed. After the intervention, the PIMT group showed a significantly higher increase in rotation (29.68 ± 18.41°) than the control group (6.13 ± 17.69°) (p = 0.001). Both groups improved the neuromotor development but no statistically significant differences were found. No harm was reported during the study. Conclusion The PIMT intervention program was more effective in increasing AROM than using only a caregiver education program. The study has been retrospectively registered at clinicaltrials.gov, with identification number NCT03659032. Registration date: September 1, 2018.

(1) Background: anthropometric measurements with calipers are used to objectify cranial asymmetry in positional plagiocephaly but there is controversy regarding the reliability of different methodologies. Purpose: to analyze the interrater and intrarater reliability of direct anthropometric measurements with caliper on defined craniofacial references in infants with positional plagiocephaly. (2) Methods: 62 subjects (&lt, 28 weeks), with a difference of at least 5 mm between cranial diagonal diameters. Maximal cranial circumference, length and width and diagonal cranial diameters were measured. Intrarater (2 measurements) and interrater (2 raters) reliability was analyzed. (3) Results: intra- and interrater reliability of the maximal cranial length and width and right cranial diagonal was excellent: intraclass correlation coefficient (ICC) &gt, 0.9. Intrarater and interrater reliability for the left cranial diagonal was excellent: ICC &gt, 0.9 and difference in agreement in the Bland-Altman plot 0.0 mm, respectively. Intrarater and interrater reliability for the maximal cranial circumference was good: differences in agreement in Bland-Altman plots: intra: &minus, 0.03 cm, inter: &minus, 0.12 cm. (4) Conclusions: anthropometric measurements in a sample of infants with moderate positional plagiocephaly have shown excellent intra- and interrater reliability for maximal cranial length, maximal cranial width, and right and left cranial diagonals, and good intra- and interrater reliability in maximal cranial circumference measurement.

Chronic neck pain is one of today&rsquo, s most prevalent pathologies. The International Classification of Diseases categorizes four subgroups based on patients&rsquo, associated symptoms. However, this classification does not encompass upper cervical spine dysfunction. The aim is to compare the short- and mid-term effectiveness of adding a manual therapy approach to a cervical exercise protocol in patients with chronic neck pain and upper cervical spine dysfunction. Fifty-eight subjects with chronic neck pain and upper cervical spine dysfunction were recruited (29 = Manual therapy + Exercise, 29 = Exercise). Each group received four 20-min sessions, one per week during four consecutive weeks, and a home exercise regime. Upper flexion and flexion-rotation test range of motion, neck disability index, craniocervical flexion test, visual analogue scale, pressure pain threshold, global rating of change scale, and adherence to self-treatment were assessed at the beginning, end of the intervention and at 3- and 6-month follow-ups. The Manual therapy + Exercise group statistically improved short- and medium-term in all variables compared to the Exercise group. Four 20-min sessions of Manual therapy + Exercise along with a home-exercise program is more effective in the short- to mid-term than an exercise protocol and a home-exercise program for patients with chronic neck pain and upper cervical dysfunction.

Objective The purpose of this study was to evaluate the effects of upper cervical translatoric spinal mobilization (UC-TSM) on headache, quality of life, cervical mobility and pressure pain threshold in subjects with cervicogenic headache (CEH). Methods Eighty-two volunteers (41.5 ± 15.3 years; 20 males and 62 females) with CEH participated in the study and were randomly assigned to control or treatment group. The treatment group received 3 sessions of UC-TSM and the control group remained the same sessions, in the same position and time but received no treatment. Primary outcomes were Headache Impact Test for headache-related quality of life and flexion-rotation test for upper cervical mobility. Secondary outcomes included intensity, frequency and duration of headache, general cervical mobility and pressure pain thresholds over cervical spine. They were measured at baseline, at the end of the treatment and one month after the intervention. Results UC-TSM group increased significantly headache-related quality of life (p d = .857). Headache intensity, frequency and duration improved in UC-TSM group (p = .000-.013), in contrast to control group which did not obtain significant changes (p = .234-.965). UC-TSM group presented significant increases in upper cervical mobility (p ). Between-group effect sizes were considered large at T1 (d = 0.90–1.21) and moderate to large at T2 (d = 0.78–1.17). Conclusions Three sessions of UC-TSM increased headache-related quality of life and upper cervical mobility in subjects with CEH. Intensity, duration and frequency of headache, cervical mobility and PPT also improved. Further research considering the limitations of the present clinical trial is required to confirm this tendency.

BACKGROUND: Damage on the somatosensory system could cause sensation of dizziness, a condition known as cervicogenic dizziness (CD). Manual physical therapy has shown beneficial effects, relieving the symptoms of cervicogenic dizziness. However, the effect of upper cervical spine manipulation is unknown, as this is a technique that respects the International Federation of Orthopedic Manipulative Physical Therapists (IFOMPT) safety criteria. OBJECTIVE: To assess the effects of upper cervical spine traction-manipulation in subjects with cervicogenic dizziness. METHODS: This was a descriptive case series study. Treatment focused on the upper cervical spine manipulation procedure. Evaluation was performed before and after the treatment. Variables recorded include upper and lower cervical range of motion, Cervical Flexion-Rotation Test (CFRT), dizziness intensity and cervical pain (VAS), self-perceived dizziness measured with Dizziness Handicap Inventory (DHI) and subjective perception of outcome (GROC-scale). RESULTS: Ten subjects were recruited. After the treatment protocol, there was an increased range of movement towards the most restricted side, as measured by the CFRT (p< 0.001), decreased intensity of dizziness (p< 0.001) and intensity of pain (p< 0.001). Functional capacity also improved after the intervention (p< 0.011). CONCLUSION: Upper cervical spine manipulation may decrease dizziness intensity and cervical pain and improve functional ability and upper cervical spine mobility in patients with cervicogenic dizziness.

Background Calf muscle strain and Achilles tendon injuries are common in many sports. For the treatment of muscular and tendinous injuries, one of the newer approaches in sports medicine is capacitive-resistive electric transfer therapy. Our objective was to analyze this in vitro, using invasive temperature measurements in cadaveric specimens. Methods A cross-sectional study designed with five fresh frozen cadavers (10 legs) were included in this study. Four interventions (capacitive and resistive modes; low- and high-power) was performed for 5 min each by a diathermy “T-Plus” device. Achilles tendon, musculotendinous junction and superficial temperatures were recorded at 1-min intervals and 5 min after treatment. Results With the low-power capacitive protocol, at 5 min, there was a 25.21% increase in superficial temperature, a 17.50% increase in Achilles tendon temperature and an 11.27% increase in musculotendinous junction temperature, with a current flow of 0.039 A ± 0.02. With the low-power resistive protocol, there was a 1.14% increase in superficial temperature, a 28.13% increase in Achilles tendon temperature and an 11.67% increase in musculotendinous junction temperature at 5 min, with a current flow of 0.063 A ± 0.02. With the high-power capacitive protocol there was an 88.52% increase in superficial temperature, a 53.35% increase in Achilles tendon temperature and a 39.30% increase in musculotendinous junction temperature at 5 min, with a current flow of 0.095 A ± 0.03. With the high-power resistive protocol, there was a 21.34% increase in superficial temperature, a 109.70% increase in Achilles tendon temperature and an 81.49% increase in musculotendinous junction temperature at 5 min, with a current flow of 0.120 A ± 0.03. Conclusion The low-power protocols resulted in only a very slight thermal effect at the Achilles tendon and musculotendinous junction, but current flow was observed. The high-power protocols resulted in a greater temperature increase at the Achilles tendon and musculotendinous junction and a greater current flow than the low-power protocols. The high-power resistive protocol gave the greatest increase in Achilles tendon and musculotendinous junction temperature. Capacitive treatments (low- and high-power) achieved a greater increase in superficial temperature.

Capacitive–resistive electric transfer therapy is used in physical rehabilitation and sports medicine to treat muscle, bone, ligament and tendon injuries. The purpose is to analyze the temperature change and transmission of electric current in superficial and deep knee tissues when applying different protocols of capacitive–resistive electric transfer therapy. Five fresh frozen cadavers (10 legs) were included in this study. Four interventions (high/low power) were performed for 5 min by a physiotherapist with experience. Dynamic movements were performed to the posterior region of the knee. Capsular, intra-articular and superficial temperature were recorded at 1-min intervals and 5 min after the treatment, using thermocouples placed with ultrasound guidance. The low-power protocols had only slight capsular and intra-capsular thermal effects, but electric current flow was observed. The high-power protocols achieved a greater increase in capsular and intra-articular temperature and a greater current flow than the low-power protocols. The information obtained in this in vitro study could serve as basic science data to hypothesize capsular and intra-articular knee recovery in living subjects. The current flow without increasing the temperature in inflammatory processes and increasing the temperature of the tissues in chronic processes with capacitive–resistive electric transfer therapy could be useful for real patients.

Background Morphology of the carpal tunnel changes with varying wrist postures and compressive forces applied to the wrist. These changes may affect the morphology and pressure on the median nerve and could be used as part of the treatment of the carpal tunnel syndrome patients. Reliability of the ultrasonographic measurements of the median nerve has been widely studied. However, there is a lack of investigation regarding reliability of ultrasonographic measurements of the carpal tunnel. Objective The purpose of this study was to assess intra-tester and inter-tester reliability of measurement of dimensions of the carpal tunnel and median nerve with ultrasound in asymptomatic volunteers. Design A cross-sectional methodological study. Methods Aspects measured were mediolateral and anteroposterior diameters, flattening ratio, circularity, perimeter and cross-section area of the carpal tunnel and median nerve. Results Intra-tester reliability was excellent for the carpal tunnel (ICCs from 0.91 to 0.97) and for the median nerve (ICCs from 0.79 to 0.94) measurements. The flattening ratio of the median nerve showed good agreement (ICC = 0.68). Inter-tester reliability was excellent for the carpal tunnel measurements (ICCs from 0.76 to 0.95) and, for the cross sectional area, the perimeter and mediolateral diameter of the median nerve, the ICC values were 0.89, 0.84 and 0.81, respectively. Conclusion In the context of this study, ultrasound was a reliable instrument for measuring carpal tunnel and median nerve dimensions in asymptomatic subjects. Level of evidence 1b

Objective: To assess the end of treatment and three months after treatment effects of diacutaneous fibrolysis as adjuvant of physical therapy for chronic lateral epicondylalgia. Design: Double-blind (patient and evaluator) randomized controlled trial. Setting: Primary Care Center of the Spanish NHS. Subjects: A total of 54 people with 60 elbows affected with chronic lateral epicondylalgia, 33 women, mean (SD) age was 48.43 (8.69) years. Interventions: All three groups (Intervention, Placebo and Control) received three weeks of physical therapy treatment and in addition Intervention Group received six sessions of real diacutaneous fibrolysis and Placebo Group received six sessions of sham diacutaneous fibrolysis. Main measures: Pain intensity, pressure pain threshold, pain free grip strength, function and subjective assessment were assessed at baseline, at the end of treatment and three months after treatment. Results: Between-group results at three months after treatment showed a statistically significant improvement of the Intervention Group in pain free grip strength (mean, 7.91 km/cm2; SD, 9.23) compared to the Placebo Group (mean, 1.47 km/cm2; SD, 7.86) and to the Control Group (mean, 2.09 km/cm2; SD, 4.45) ( P values Conclusion: Diacutaneous fibrolysis added to physical therapy provides better results in the treatment of chronic lateral epicondylalgia, with greater clinical satisfaction among patients.

Background The side-bending stress test is a pre-manipulative screening test for assessing upper cervical instability. To our knowledge, there is no study that simulates the clinical application of side bending stress test before and after alar ligament transection with fixation of C2. Objective To simulate the effect of alar ligament transection in the side bending stress test for an in vitro validation. Design In vitro study. Methods After the dissection of the superficial structures to the alar ligament and the fixation of C2, ten cryopreserved upper cervical spines were manually mobilized in right and left lateral flexion with and without right alar ligament transection. Upper cervical lateral flexion range of motion and mobilization force were measured with the Vicon motion capture system and a load cell respectively. Results The right alar ligament transection increased the upper cervical spine (UCS) range of motion (ROM) in both side bendings (1.30°±1.54° and 1.88°±1.51° increase for right and left side bending respectively). As an average, with standardized forces of 2N, 4N and 6N, right alar ligament transection increased both right and left lateral flexion UCS ROM. Conclusion This in vitro study simulates the clinical application of the side bending stress test with intact and right transected alar ligament. Unilateral transection of the alar ligament revealed a predominantly bilateral increase in upper cervical side bending and variability in the mobilization force applied during the test.

[Purpose] Ankylosing spondylitis is prevalent in men. Modern and expert consensus documents include physical therapy among the strategies for the treatment of ankylosing spondylitis. This study aimed to describe the physical therapy approach in an athlete with ankylosing spondylitis. [Subject and Methods] The patient, refractory to treatment with anti-inflammatory medication, showed pelvic and lumbar pain and joint, muscle, and functional disorders, which were treated with orthopedic joint mobilization, dry needling, exercise, and whole-body hyperthermia. [Results] After the treatment, pain relief, normal joint mobility, improved muscle function, and return to activities of daily living and competitive sporting activities were recorded. [Conclusion] The literature provides evidence for the use of joint mobilization techniques; however, no previous studies have used the same techniques and methods. There is no previous evidence for the use of dry needling in this pathology. Exercise therapy has a higher level of evidence, and guidelines with scientific support were followed. This research confirms the effectiveness of hyperthermia for arthritis. The early stage of ankylosing spondylitis, and the young age, good overall condition, and cooperative attitude of the patient led to positive outcomes. In conclusion, a favorable response that promoted the remission of the disease was observed.

Background Several studies have analysed the use of the Upper Limb Neurodynamic Test 1 (ULNT1) for diagnosing Carpal Tunnel Syndrome (CTS) obtaining weak diagnostic accuracy, which could be related to the lack of consensus in the selected diagnostic criteria of ULNT1. Objective To determine the concurrent validity of ULNT1 in comparison to Nerve Conduction Studies (NCS) for the diagnosis of CTS, considering the structural differentiation (SD) as an essential part of the diagnosis. Design Prospective diagnostic test study. Methods Individuals with suspected CTS referred for NCS were invited to voluntarily participate in the study. Each participant was tested with NCS and ULNT1. ULNT1 result was considered positive when the patient's clinical symptoms were reproduced during the test and symptoms changed during contralateral neck side bending (SD). Results 58 Participants (17 men, 44 women) with suspected CTS and a total of 95 limbs were examined using the NCS and ULNT1. Sensitivity of the ULNT1 was 57.9%, specificity was 84.2%, and the positive and negative likelihood ratios were 3.67 and 0.50 respectively. Conclusion Results obtained in the study may indicate the ability of the ULNT1 to generate small shifts from pre-test to post-test probability. However, imprecision in the CIs limits interpretation from the data. Level of evidence 1b.

Objective To assess the relationship between static frontal knee alignment in asymptomatic subjects and flexibility of the main muscles functionally related to the knee. Methods A descriptive cross-sectional study was performed in 33 healthy adults (19–31 years). The frontal knee angle (valgus/varus angle) was measured by photogrammetry and it was measured in the lateral side. Therefore, high values were assigned for genu varum and low values for genu valgum. Iliopsoas, gluteus maximus and medius, rectus femoris, biceps femoris, vastus of the quadriceps, and gastrocnemius muscles were stretched. Muscles were classified as normal, reflex hypomobile, or structural hypomobile. Results Women had significantly greater valgus than did men (right angle, women: 174.41°/men: 177.41°; left angle, women: 174.20°/men: 178.70°). The right frontal plane knee angle was higher in women with structural hypomobile vastus. The left frontal plane knee angle was higher in women with structural hypomobile iliopsoas. No relationships were found in men. Conclusions A tighter vastus of the quadriceps and tighter iliopsoas are related to greater genu varum in adult women. Stretching the vastus of the quadriceps and iliopsoas when there is a tendency for excess varus in the knee, to prevent overuse injury or early osteoarthritis, might be clinically relevant.

Cross-sectional study.The carpal tunnel is a clinically important fibro-osseous conduit for the median nerve and associated tendons. It is mechanically dynamic and therapeutic manual techniques that appear to move and change tunnel shape is part of clinical practice.To measure changes in dimensions of the carpal tunnel and median nerve with manual mobilization of the carpal bones in cadavers.A total of 20 cryopreserved upper extremities from cadaveric specimens were used in the study. The wrist was cut using an anatomical saw at the level of the pisiform. Measurements of the cross-sectional area (CSA), anteroposterior diameter (APD), transverse diameter (TD), perimeter, flattening ratio and circularity of the carpal tunnel and of the median nerve, were taken, both in the anatomical position of the wrist and during the mobilization technique of the carpal bones.During the mobilization technique, the tunnel CSA (p 0.011), APD (p 0.001) and circularity (p 0.001) significantly increased, while TD (p 0.001), perimeter (p 0.004) and flattening ratio (p 0.001), decreased. The median nerve showed similar behavioral tendencies to the tunnel but only the CSA (p 0.005), APD (p 0.005) and flattening ratio (p 0.004) of the nerve showed significant differences.Application of external manually applied compressive force across the wrist can increase the CSA of the carpal tunnel and the median nerve in cadavers. These results are consistent with other studies in which similar results were found non-invasively using ultrasound.

En los pacientes con diabetes tipo 2, el riesgo de sufrir algún tipo de malestar psicológico, con síntomas de depresión y ansiedad, es aproximadamente el doble que en población normal. Cuando son síntomas relacionados con condiciones concomitantes, físicas y psicológicas deben ser tratados. El objetivo de este trabajo, fue examinar los efectos de un programa de ejercicios de fisioterapia y técnicas psicológicas, en el bienestar psíquico de una población diabética. El programa de 12 semanas, se aplicó en 25 pacientes y se evaluó: dolor, tensión arterial, antropometría, analítica sanguínea y bienestar psíquico (cuestionario de Goldberg de 28 ítems: GHQ-28). A pesar de la edad (84% < de 65 años), solo el 12% trabajaban, debido a su situación clínica de alto riesgo cardiovascular, presencia de comorbilidades (96%) y dolor asociado. Todo ello afectaba negativamente el bienestar psíquico de los pacientes que puntuaron alto en el GHQ: disfunción social (14.8±2.2), síntomas somáticos (13.5±3.6), ansiedad e insomnio (11.9±3.4) y depresión severa (9.2±4.4). La situación clínica determinó el diseño del programa, que mostró gran eficacia terapéutica para el dolor y el aumento del bienestar psicológico, con gran repercusión en la puntuación total del GHQ, en los síntomas somáticos y en la disfunción social, aunque en la ansiedad e insomnio y la depresión los cambios fueron menores. En síntesis, el programa mejoró el bienestar físico y psíquico de la muestra, lo que aumenta la evidencia sobre la opción de incluir fisioterapia y psicología para tratar las circunstancias que causan malestar psíquico en la diabetes. Diabetic patients are around twice as likely to suffer from anxiety and depression symptoms as the general population. When these symptoms are related to concurrent conditions they should be treated. The objective of this study has been to examine the effects of a physical therapy exercises and psychological techniques program, in mental wellness of a diabetic population. The twelve weeks program was applied in 25 patients. Pain, arterial pressure, anthropometry, blood samples and mental wellness (with 28 items Goldberg questionnaire: GHQ-28) were evaluated. Though they were relatively young (84 % < than 65 years), only 12 % were working, due to the high cardiovascular risk clinical situation, the existence of comorbidities (96 %) and the associated pain. These facts negatively affected the mental wellness of the people, so they scored high in GHQ questionnaire: social dysfunction (14.8 ± 2.2), somatic symptoms (13.5 ± 3.6), anxiety and insomnia (11.9 ± 3.4) and severe depression (9.2 ± 4.4). The clinical situation determined the design of the program, which showed good treatment effects for pain and general mental wellness, with high effect sizes, in GHQ total score, in somatic symptoms and in social dysfunction, though in anxiety and insomnia and severe depression the effect size was small. In conclusion, the program improved physical and psychological wellness of our patients. The evidence for inclusion of physical therapy and psychology techniques in the management of concurrent conditions in diabetes, source of mental discomfort, had been reinforced.

Objective The purpose of this study was to evaluate the immediate effects of upper cervical translatoric spinal mobilization (UC-TSM) on cervical mobility and pressure pain threshold in subjects with cervicogenic headache (CEH). Methods Eighty-two volunteers (41.54 ± 15.29 years, 20 male and 62 female) with CEH participated in the study and were randomly divided into the control and treatment groups. The treatment group received UC-TSM and the control group remained in the same position for the same time as the UC-TSM group, but received no treatment. Cervical mobility (active cervical mobility and flexion-rotation test), pressure pain thresholds over upper trapezius muscles, C2-3 zygapophyseal joints and suboccipital muscles, and current headache intensity (visual analog scale) were measured before and immediately after the intervention by 2 blinded investigators. Results After the intervention, UC-TSM group exhibited significant increases in total cervical mobility (P =.002, d = 0.16) and the flexion–rotation test (P .05). Nevertheless, there was a significantly lower intensity of headache in the UC-TSM group (P =.039, d = 0.57). Conclusions Upper cervical translatoric spinal mobilization intervention increased upper, and exhibited a tendency to improve general, cervical range of motion and induce immediate headache relief in subjects with CEH.

Objective. To identify adherence to Mediterranean diet among two groups of Spanish adults: diabetic patients and nondiabetic subjects.Methods. Adherence to Mediterranean diet was measured by a 14-item screener (scale: 0–14; ≤5: low, 6–9: moderate, and ≥10: high) in 351 volunteers.Results. Mean age was 50.97 ± 12.58 in nondiabetics (n=154) and 59.50 ± 13.34 in diabetics (n=197). The whole sample scored 8.77 ± 1.82. Score was 9.19 ± 1.84 in nondiabetic females (n=58) and 8.15 ± 1.79 in diabetic females (n=85) (p=0.003), due to lower consumption of olive oil (p=0.005) and nuts (p=0.000). Type 2 diabetic males (n=79; 8.76 ± 1.88) consumed less olive oil than healthy males (n=28; 9.36 ± 1.59) (p=0.046). Up to 30-year-old nondiabetics scored lower than more than 60-year-old nondiabetics (8.40 ± 1.5 versus 9.74 ± 2.03;p=0.047). The youngest ate less olive oil (p=0.002) and more pastries (p=0.007).Conclusions. The sample presented moderate adherence to Mediterranean diet in all subgroups. Scientific evidence about the benefits of Mediterranean diet, olive oil, and nuts supports the recommendation to increase consumption of olive oil and nuts in diabetic women and of daily olive oil in type 2 diabetic men, reducing consumption of red meat, butter, and pastries, and to promote Mediterranean diet among the youngest of the sample studied.

Objectives To systematically review cervical artery blood flow behaviour by duplex Doppler ultrasonography with different cervical movements often used during vascular premanipulative testing. Methods PRISMA guidelines were followed to conduct this systematic review. Electronic search was carried out using the following databases: Pubmed, Web of Science, ScienceDirect, Scopus, IME, Dialnet, Lilacs, ENFISPO and AMED. Observational studies focussing on the duplex Doppler ultrasound measurements of cervical artery flow (VA or ICA) in different cervical positions were included. Studies selection was conducted by two reviewers who screened firstly for titles, then for abstracts and finally for full articles. The following data were extracted from the studies: author, year, sample, measurements and instruments, cervical movement and results. Results 379 records were identified. Seven articles met the inclusion criteria and were considered for this systematic review. Five studies tested only vertebral artery flow, one study assessed internal carotid artery flow and the remaining study examined both. There is a lack of homogeneity concerning the samples included in the studies (age, sex and presence or absence of symptoms) and the methodology used for measuring blood flow. Four out of the seven studies did not obtain any significant decrease of cervical arteries blood flow in different neck positions, while the remaining three studies found a significant decrease of the contralateral vertebral artery blood flow. Conclusions Results of the studies included in this systematic review show no consensus. Further research and better methodological designs are required to analyze cervical artery blood flow behaviour with different neck movements and elucidate the role of vascular premanipulative testing.