Atlanto-Occipital Joint Manipulation and Suboccipital Inhibition Technique in the Osteopathic Treatment of Patients with Tension-Type Headache.

Introducción. La cefalea tensional tiene una elevada prevalencia, con repercusión en el ámbito laboral y social de los sujetos que la padecen. Objetivo. Evaluar la eficacia de dos tratamientos con terapia manual en pacientes con cefalea tensional. Material y métodos. Se ha llevado a cabo un estudio a doble ciego, aleatorio, con 76 pacientes (81,6% mujeres) diagnosticados de cefalea tensional, con edad media de 39,96 años (DT=10,93), distribuidos en 4 grupos (tres de tratamiento y un grupo de control placebo). Los tratamientos incluyen terapia manual osteopática con: 1) técnica de inhibición de suboccipitales; 2) técnica manipulativa de occipucio-atlas-axis; 3) la combinación de ambas. Se aplicaron 4 sesiones, (1 por semana), y seguimiento a los 30 días. Se evaluó antes, después el tratamiento y en el seguimiento la movilidad cervical, el impacto producido por el dolor, la frecuencia e intensidad del dolor. Resultados. El tratamiento con inhibición mejoró significativamente en el impacto del dolor (p=0,02). El tratamiento manipulativo y el combinado, mejoraron en impacto e intensidad del dolor (p=0,000 a p=0,05), y en flexión y extensión suboccipital (p=0,000 a p=0,04). El tratamiento manipulativo mejoró también en las rotaciones cervicales (p=0,008 a p=0,007). El tratamiento combinado obtuvo resultados significativos en la frecuencia e intensidad del dolor (p=0,000 a p=0,05). Conclusión. Los tres tratamientos aplicados son eficaces en los aspectos de impacto del dolor y en intensidad del dolor. El tratamiento manipulativo de occipucio-atlas-axis es el más eficaz en la ganancia de la movilidad cervical seguido del tratamiento de de inhibición de suboccipitales. El tratamiento combinado resulta más eficaz en la reducción de la frecuencia e intensidad del dolor

Effects of Osteopathic T9-T10 Vertebral Manipulation in Tonsillitis: A Randomized Clinical Trial

This study aimed to determine whether osteopathic manipulation of the T9-T10 vertebrae improves the evolution of tonsillitis. A randomized, stratified, controlled clinical trial with blinded patients, evaluator and data analyst was performed. The patients in the control group (CG) underwent a "sham" manipulation. A high-speed, low-amplitude technique was applied to the T9-T10 vertebrae in the osteopathic manipulative group (OMG) patients. The number of days needed to resolve the tonsillitis was significantly lower (p = 0.025) in the OMG (2.03 +/- 0.95 days) than the CG (2.39 +/- 0.82 days). Additionally, the number of episodes of tonsillitis after the treatment decreased significantly more in the OMG (0.8 +/- 1.88 episodes/year in total) than the CG (2 +/- 2.12) (p = 0.005). In the OMG, 60.8% had no recurrences of tonsillitis, compared to 22.5% of the CG, in the following year (chi(2) (1) = 15.57, p < 0.001). No patients reported adverse effects. It has been concluded that during an episode of tonsillitis, the number of days to resolution was significantly lower after the application of an osteopathic manipulation of the T9-T10 vertebrae, compared to a sham manipulation. The number of subsequent year tonsillitis episodes was greatly reduced in both groups, significantly more in the OMG than in the CG patients

Visceral origin: an underestimated source of neck pain

The diagnosis of neck pain is challenging. Many visceral disorders are known tocause it, and clinical practice guidelines recommend to rule them out during neck pain diagnosis.However, the absence of suspicion of any cause impedes one from establishing that specific aetiology asthe final diagnosis. To investigate the degree of consideration given to visceral aetiology, a systematicsearch of trials about neck pain was carried out to evaluate their selection criteria. The search yielded309 eligible articles, which were screened by two independent reviewers. The PEDro scale score wasused to assess the methodological quality of the studies. The following information was retrieved:number of authors affiliated to a clinical or non-clinical institution, number of citations in the Webof Science, study aims, characteristics of participants, and eligibility criteria. The top 15 most citedtrials, and the 15 most recent studies about treatment efficacy in neck pain, published in first quartilejournals of the Journal Citation Reports, were selected. Females represented 67.5% of participants.A single study was of poor methodological quality (4/10). Based on the eligibility criteria of thearticles that were systematically reviewed, it would appear that visceral aetiology was not consideredin eighty percent of the trials on neck pain, showing a low level of suspicion both in research andclinical settings

Local and Widespread Pressure Pain Hyperalgesia Is Not Side Specific in Females with Unilateral Neck Pain that Can Be Reproduced during Passive Neck Rotation

Current evidence for widespread hyperalgesia in non-specific neck pain (NSNP) is unclear. It is currently recommended to group NSNP patients according to pain-provoking movements. The aim of this study was to investigate local and widespread pain sensitivity in females with unilateral NSNP that is reproducible during passive neck rotation compared with matched controls, and to compare the side specific effect of pain location on pressure pain sensitivity among females with unilateral NSNP. Thirty-six females with unilateral NSNP evoked during passive ipsilateral (n = 20) or contralateral (n = 16) rotation toward the painful side were compared with 20 controls. Participants reported their pain intensity at rest and during passive neck rotation and completed the Neck Disability Index. Pressure pain thresholds (PPTs) were assessed bilaterally over the anterior scalene; the sternocleidomastoid; the levator scapulae; lateral to the spinous process of C6; the median, ulnar, and radial nerves; and the tibialis anterior. The ANOVA revealed lower PPTs in females with unilateral NSNP compared with the controls (all at p < 0.001), but no differences were found between the sides, nor was there any Groupside interaction. Among females with NSNP, those with higher pain intensity during ipsilateral rotation toward the painful side showed lower PPTs over the anterior scalene, median nerve, ulnar nerve, and tibialis anterior (all, p < 0.05) than females with higher pain intensity during contralateral rotation toward the painful side. These findings demonstrated bilateral local and widespread pressure pain hyperalgesia in females with unilateral NSNP that was reproducible during passive neck rotation compared with controls. There was no side specific effect of pain location on PPTs among females with unilateral NSNP.Ministerio de Educación, Cultura y Deporte (CAS 16/00046

Reinforced Feedback in Virtual Environment for Plantar Flexor Poststroke Spasticity Reduction and Gait Function Improvement

Background. Ankle spasticity is a frequent phenomenon that limits functionality in poststroke patients. Objectives. Our aim was to determine if there was decreased spasticity in the ankle plantar flex (PF) muscles in the plegic lower extremity (LE) and improvement of gait function in stroke patients after traditional rehabilitation (TR) in combination with virtual reality with reinforced feedback, which is termed "reinforced feedback virtual environment" (RFVE). Methods. The evaluation, before and after treatment, of 10 hemiparetic patients was performed using the Modified Ashworth Scale (MAS), Functional Ambulatory Category (FAC), and Functional Independence Measure (FIM). The intervention consisted of 1 hour/day of TR plus 1 hour/day of RFVE (5 days/week for 3 weeks; 15 sessions in total). Results. The MAS and FAC reached statistical significance (P<0.05). The changes in the FIM did not reach statistical significance (P=0.066). The analysis between the ischemic and haemorrhagic patients showed significant differences in favour of the haemorrhagic group in the FIM scale. A significant correlation between the FAC and the months after the stroke was established (P=-0.711). Indeed, patients who most increased their score on the FAC at the end of treatment were those who started the treatment earliest after stroke. Conclusions. The combined treatment of TR and RFVE showed encouraging results regarding the reduction of spasticity and improvement of gait function. An early commencement of the treatment seems to be ideal, and future research should increase the sample size and assessment tools

The role of daily physical activity and nutritional status on bone turnover in cystic fibrosis: a cross-sectional study

Background: Nutritional status and daily physical activity (PA) may be an excellent tool for the maintenance of bone health in patients with cystic fibrosis (CF). Objective: To evaluate the relationship between nutritional status, daily physical activity and bone turnover in cystic fibrosis patients. Method: A cross-sectional study of adolescent and adult patients diagnosed with clinically stable cystic fibrosis was conducted. Total body, femoral neck, and lumbar spine bone mineral density (BMD) were determined by dual energy X-ray absorptiometry and bone metabolism markers ALP, P1NP, PICP, and ß-CrossLaps. PA monitoring was assessed for 5 consecutive days using a portable device. Exercise capacity was also determined. Serum 25-hydroxyvitamin D and vitamin K were also determined in all participants. Results: Fifty patients (median age: 24.4 years; range: 16-46) were included. BMI had positive correlation with all BMD parameters, with Spearman’s coefficients ranging from 0.31 to 0.47. Total hip bone mineral density and femoral neck BMD had positive correlation with the daily time spent on moderate PA (>4.8 metabolic equivalent-minutes/day; r=0.74, p7.2 metabolic equivalent-minutes/day; r=0.45 p<0.001), body mass index (r=0.44, p=0.001), and muscle mass in limbs (r=0.41, p=0.004). Levels of carboxy-terminal propeptide of type 1 collagen were positively associated with the daily time spent on moderate (r=0.33 p=0.023) and vigorous PA (r=0.53, p<0.001). Conclusions: BMI and the daily time spent on moderate PA were found to be correlated with femoral neck BMD in CF patients. The association between daily PA and biochemical markers of bone formation suggests that the level of daily PA may be linked to bone health in this patient group. Further research is needed to confirm these findings

Effects of Osteopathic Visceral Treatment in Patients with Gastroesophageal Reflux: A Randomized Controlled Trial

Osteopathic manual treatment has been recommended as a non-pharmacological therapy for Gastroesophageal Reflux Disease (GERD). However, to date, no study has supported the effectiveness of this intervention with respect to the symptoms of the disease. Our goal was to assess the effect of an osteopathic manual technique for the lower esophageal sphincter on GERD symptoms, cervical mobility and on the C4 spinous process pressure pain threshold (PPTs). Methods: A randomized, double-blind placebo-controlled trial was performed. Sixty subjects suffering from GERD participated in this study and were randomly assigned to either an experimental group (EG) (n = 29), who received the osteopathic technique for the lower esophageal sphincter, or to a control group (CG) (n = 31), who received a manual contact, which mimicked the osteopathic technique without exerting any therapeutic force. Randomization was computer-generated, with allocation concealed by sequentially numbered, opaque, sealed envelopes. The GerdQ questionnaire was used to assess symptom changes the week after intervention. Cervical Range of Motion (CROM) and algometer were used to evaluate cervical mobility and PPTs before and after both treatments. Before-after between groups comparison (t-test) was used for statistical analysis of the outcome, with two measurement points (GerdQ), while repeated-measures ANOVA was used for those outcomes with four measurement points (CROM and PPT). Results: The application of the osteopathic manual treatment in subjects with GERD produced a significant improvement in symptoms one week after the intervention (p = 0.005) with a between-groups difference of 1.49 points in GerdQ score (95% CI: 0.47-2.49). PPT C4 improved in the EG after the treatment (p = 0.034; eta(2) = 0.048) (between-groups difference 8.78 Newton/cm(2); 95% CI: 0.48-17.09). CROM also increased in the EG compared to the CG (p < 0.001; eta(2) = 0.108) (between-groups difference 33.89 degrees; 95% CI: 15.17-52.61). Conclusions: The manual osteopathic technique produces an improvement in GERD symptoms one week after treatment, cervical mobility, and PPTs. This may mean that osteopathic treatment is useful for improving symptoms of GERD

Virtual reality and physiotherapy in post-stroke functional re-education of the lower extremity: A controlled clinical trial on a new approach

Numerous Virtual Reality (VR) systems address post-stroke functional recovery of the lower extremity (LE), most of them with low early applicability due to the gait autonomy they require. The aim of the present study was to evaluate the feasibility of a specific VR treatment and its clinical effect on LE functionality, gait, balance, and trunk control post-stroke. A controlled, prospective, clinical trial was carried out with 20 stroke patients, who were divided into two groups: the first group (VR + CP; n = 10) received combined therapy of 1 h VR and 1 h of conventional physiotherapy (CP) and the second group (CP; n = 10) received 2 h of CP (5 days/week, for 3 weeks). The following pre-post-intervention measuring scales were used: Functional Ambulatory Scale (FAC), Functional Independence Measure (FIM), Fugl-Meyer Assessment (FM), Berg Balance Scale (BBS), and Trunk Control Test (TCT). Only VR + CP showed a significant improvement in FAC. In FIM, CP presented a tendency to significance, whereas VR + CP showed significance. Both groups improved significantly in FM (especially in amplitude/pain in VR + CP and in sensitivity in CP) and in BBS. In TCT, there was a non-significant improvement in both groups. The results indicate that the intervention with VR is a feasible treatment in the post-stroke functional re-education of the LE, with the potential to be an optimal complement of CP

Virtual Reality and Physiotherapy in Post-Stroke Functional Re-Education of the Lower Extremity: A Controlled Clinical Trial on a New Approach

Numerous Virtual Reality (VR) systems address post-stroke functional recovery of the lower extremity (LE), most of them with low early applicability due to the gait autonomy they require. The aim of the present study was to evaluate the feasibility of a specific VR treatment and its clinical effect on LE functionality, gait, balance, and trunk control post-stroke. A controlled, prospective, clinical trial was carried out with 20 stroke patients, who were divided into two groups: the first group (VR + CP; n = 10) received combined therapy of 1 h VR and 1 h of conventional physiotherapy (CP) and the second group (CP; n = 10) received 2 h of CP (5 days/week, for 3 weeks). The following pre-post-intervention measuring scales were used: Functional Ambulatory Scale (FAC), Functional Independence Measure (FIM), Fugl-Meyer Assessment (FM), Berg Balance Scale (BBS), and Trunk Control Test (TCT). Only VR + CP showed a significant improvement in FAC. In FIM, CP presented a tendency to significance, whereas VR + CP showed significance. Both groups improved significantly in FM (especially in amplitude/pain in VR + CP and in sensitivity in CP) and in BBS. In TCT, there was a non-significant improvement in both groups. The results indicate that the intervention with VR is a feasible treatment in the post-stroke functional re-education of the LE, with the potential to be an optimal complement of CP