Is any feature of the stabilometric evaluation clinically relevant in patients with temporomandibular disorders? A cross-sectional study

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 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

Pain intensity and sensory perception of Tender Points in female patients with fibromyalgia: A pilot study

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 < 0.05). Significant differences between all 18 TPs were found for PPTs (p < 0.0001), and SPP (p < 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

Association of Neuropathic Pain Symptoms with Sensitization Related Symptomatology in Women with Fibromyalgia

We aimed to analyze potential correlations between S-LANSS and PainDETECT with proxies for pain sensitization, e.g., the Central Sensitization Inventory (CSI) and pressure pain hyperalgesia (construct validity), pain-related or psychological variables (concurrent validity) in women with fibromyalgia (FMS). One-hundred-and-twenty-six females with FMS completed demographic, pain-related variables, psychological, and sensitization outcomes as well as the S-LANSS and the PainDETECT questionnaires. S-LANSS was positively associated with BMI (r = 0.206), pain intensity (r = 0.206 to 0.298) and CSI score (r = 0.336) and negatively associated with all PPTs (r = −0.180 to −0.336). PainDETECT was negatively associated with age (r = −0.272) and all PPTs (r = −0.226 to −0.378) and positively correlated with pain intensity (r = 0.258 to 0.439), CSI (r = 0.538), anxiety (r = 0.246) and depression (r = 0.258). 51.4% of the S-LANSS was explained by PainDETECT (45.3%), posterior iliac PPT (0.2%) and mastoid PPT (5.9%), whereas the 56.4% of PainDETECT was explained by S-LANSS (43.4%), CSI (10.4%), and pain intensity (2.6%). This study found good convergent association between S-LANSS and PainDETECT in women with FMS. Additionally, S-LANSS was associated with PPTs whereas PainDETECT was associated with pain intensity and CSI, suggesting that both questionnaires assess different spectrums of the neuropathic and pain sensitization components of a condition and hence provide synergistic information

The hand grip force test as a measure of physical function in women with fibromyalgia

Previous studies have reported the presence of muscle weakness in women with fibromyalgia syndrome (FMS) which is considered a risk factor for developing earlier disability and dependence during activities of daily life (ADL). We aimed to assess the relationship between hand grip force with sociodemographic, clinical, disease‐specific, cognitive, and physical function variables in women with FMS. One hundred twenty‐six women with FMS completed demographic (age, gender, height, weight, body mass index), pain‐related (pain history, pain intensity at rest and during ADL), disease‐ specific severity (Fibromyalgia Impact Questionnaire ‐FIQ‐S‐, Fibromyalgia Health Assessment Questionnaire ‐FHAQ‐, EuroQol‐5D, Pain Catastrophizing Scale ‐PCS‐, Pittsburgh Sleep Quality Index‐ PSQI‐, Pain Vigilance and Awareness Questionnaire ‐PVAQ‐, and Central Sensitization Inventory ‐CSI‐ ), psychological (Tampa Scale for Kinesiophobia, TKS‐11; Pain Vigilance and Awareness Questionnaire, PVAQ; Pain Catastrophizing Scale, PCS), and physical function (hand grip force, and Timed Up and Go Test, TUG). Hand grip force was associated with height (r = −0.273), BMI (r = 0.265), worst pain at rest (r = −0.228), pain during ADL (r = −0.244), TUG (r = −0.406), FHAQ (r = −0.386), EuroQol‐5D (r = 0.353), CSI (r = −0.321) and PSQI (r = −0.250). The stepwise regression analysis revealed that 34.4% of hand grip force was explained by weight (6.4%), TUG (22.2%), and FHAQ (5.8%) variables. This study found that hand grip force is associated with physical function indicators, but not with fear‐avoidance behaviors nor pain‐related features of FMS. Hand grip force could be considered as an easy tool for identifying the risk of fall and poorer physical health status.Vicerrectorado de Investigación - Universidad Camilo José Cel

Cervical Multifidus Morphology and Quality Are Not Associated with Clinical Variables in Women with Fibromyalgia: An Observational Study

Objective. Some studies have reported the presence of histological alterations, such as myofiber disorganization and abnormalities in the number and shape of mitochondria, in patients with fibromyalgia syndrome (FMS). Although Ultrasound imaging (US) is used to quantitatively characterize muscle tissues, US studies in patients with FMS are lacking. Therefore, we aimed to describe morphological and qualitative cervical multifidus (CM) muscle US features in women with FMS and to assess their correlation with clinical indicators. Design. Observational study. Setting. AFINSYFACRO Fibromyalgia Association (Madrid, Spain). Subjects. Forty-five women with FMS participated. Methods. Sociodemographic variables (e.g., age, height, weight, body mass index) and clinical outcomes (e.g., pain as assessed on a numerical pain rating scale, evolution time, pain-related disability as assessed by the Fibromyalgia Impact Questionnaire) were collected. Images were acquired bilaterally at the cervical spine (C4–C5 level) and mea sured by an experienced examiner for assessment of muscle morphology (e.g., cross-sectional area, perimeter, and shape) and quality (mean echo intensity and intramuscular fatty infiltration). Side-to-side comparisons and a correla tional analysis were conducted. Results. No significant side-to-side differences were found for morphology or quality features (P > 0.05). None of the clinical indicators were associated with US characteristics (all, P > 0.05). Conclusion. Our results showed no side-to-side differences for CM morphology and quality as assessed with US. No associa tions between CM muscle morphology or quality and Fibromyalgia Impact Questionnaire, pressure pain threshold, numerical pain rating scale score, or evolution time were observed. Our preliminary data suggest that muscle mor phology is not directly related to pain and pain-related disability in women with FM

Effects of Percutaneous Electrical Nerve Stimulation on Countermovement Jump and Squat Performance Speed in Male Soccer Players: A Pilot Randomized Clinical Trial

Abstract: 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 < 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

Eficacia de la técnica de punción seca en el tratamiento de la cervicalgia crónica

Tesis inédita presentada en la Universidad Europea de Madrid. Facultad de Ciencias de la Salud. Programa de Doctorado en Fisioterapia AvanzadaEl dolor de cuello crónico es una de las principales causas de discapacidad en los países occidentales. Se calcula que un 50% de su población padecerá cervicalgia a lo largo de su vida. Anualmente, un 30% de la población tendrá dolor agudo de cuello, y aproximadamente la mitad evolucionará en uno u otro grado a dolor crónico. Según la última Encuesta Nacional de Salud de España (2011/2012), el 18% de la población española había padecido durante los 12 últimos meses dolor crónico cervical. Se necesita más evidencia científica que clarifique los mecanismos fisiopatológicos subyacentes a la cervicalgia crónica. Suele asociarse a trastornos musculo-esqueleticos, enfermedades reumáticas, predisposición genética e incluso alteraciones psicológicas. En la presente tesis se analiza la cervicalgia crónica que se origina en la existencia de puntos gatillos miofasciales en la musculatura cervical, siguiendo el enfoque de Travell y Simons. En pacientes con dolor de cuello crónico, se observa una alta prevalencia de puntos gatillo activos en los músculos que se analizarán en la presente Tesis: trapecio y elevador de la escápula. Según Travell y Simons, los puntos gatillo miofasciales son nódulos palpables de sensibilidad dolorosa que se encuentran en una banda tensa de una fibra muscular. Los puntos gatillo provocan alteraciones sensitivas, motoras y autonómicas. Limitan la movilidad, generan dolor referido y pueden provocar una respuesta de espasmo local. Hay distintas hipótesis sobre la fisiopatología de los puntos gatillo. Estudios como los de Shah et al. muestran la concentración de sustancias químicas algógenos y sensibilizantes en los puntos gatillo y sus alrededores, en los que también se produce una disminución de flujo sanguíneo. La punción seca de los puntos gatillo en una técnica habitual en el tratamiento fisioterapéutico de la cervicalgia crónica. La técnica consiste en introducir una aguja filiforme dentro del punto gatillo que produce una respuesta de espasmo local, la cual, a su vez, reducirá las sustancias algógenas existentes en los puntos gatillo y un proceso regenerativo. Metodología Se ha llevado a cabo un ensayo clínico sobre un tratamiento combinado de terapia manual y punción seca en pacientes con cervicalgia crónica. Se trata de un ensayo clinico a simple ciego, aleatorizado. Además del grupo de intervención, se cuenta con grupo de placebo (terapia manual y falsa punción seca) y grupo control sin tratamiento. El ensayo fue aprobado por el comité ético del Hospital clínico San Carlos (C.P. - C.I. 13/021). Ha sido registrado en clinicaltrials.gov con la referencia de NCT02435966. La muestra del estudio fue de 131 pacientes de los cuales un 39,2% (n=51) son hombres y un 60,8% (n=79) mujeres. La edad de los pacientes osciló entre los 18 y los 55 años con un promedio de 34,6 años (DT=8,5) 47 pacientes formaron el grupo de intervención, 53 el grupo placebo y 30 el grupo control. Los grupos de intervención y placebo recibieron dos sesiones de tratamiento separadas por 7 días. Las variables de resultado fueron el dolor subjetivo del paciente (medido con una escala de evaluación numérica [EEN], de 0 a 10); el umbral de dolor a la presión ([UDP] medido con algómetro, en kg/cm2); el recorrido articular ([ROM] medido con goniómetro en grados); y la discapacidad cervical (medida con el Neck Disability Index [NDI]). En los grupos de intervención y placebo se midieron las variables EEN, UDP y ROM antes y después de cada intervención, separadas por 7 días, y en el seguimiento a las 4 semanas. El EEN tuvo además un seguimiento a los 365 días. La variable NDI se midió al inicio del estudio, en el seguimiento a las 4 semanas, y a los 365 días. En el grupo de control sin tratamiento se midieron EEN, UDP y ROM al iniciarse el estudio, 7 días después, y 4 semanas después. En el grupo de control el NDI se midió al iniciarse el estudio y a las 4 semanas. El grupo de intervención recibió terapia manual más punción seca en el punto gatillo más mecanosensible de entre los puntos gatillo activos encontrados en los músculos trapecio y elevador de la escapula. El grupo placebo recibió terapia manual más falsa punción seca, efectuada con aguja retráctil. El grupo control no recibió ningún tipo de tratamiento, sólo se midieron las variables de resultado para seguir el curso natural de la enfermedad. Para determinar el punto gatillo más mecano-sensible se midió el UDP con algómetro en los puntos gatillo activos en los distintos músculos estudiados. Para poder comparar su mecano-sensibilidad, normalizamos el valor del UDP utilizando una tabla de valores elaborada en un estudio sobre pacientes sanos. En esta tabla se analiza cada localización coincidiendo con el área topográfica de los 10 puntos gatillo descritos por Travell y Simons en el trapecio superior e inferior, así como en el elevador de la escápula. Realizamos además un ensayo de fiabilidad intra- e inter-evaluadora para analizar el procedimiento de localización y selección del punto gatillo activo más mecano-sensible en los músculos estudiados. Resultados De los 141 pacientes que aceptaron participar en el ensayo, 131 cumplieron los criterios de inclusión y exclusión. El ensayo clínico se llevó a cabo entre mayo de 2013 y junio de 2014. El grupo de intervención se componía de 47 pacientes, el grupo de placebo de 54 y el grupo de control de 30. Sólo 1 paciente no completó el tratamiento, en el grupo de placebo. La muestra del estudio la constituyeron así 130 pacientes. Los grupos resultaron estadísticamente homogéneos. En el seguimiento a los 365 dias sólo obtuvimos datos de 30 pacientes (15 en el grupo de intervención y 15 en el grupo de placebo). Se produjo una reducción clínica y estadísticamente significativa de la EEN respecto a los valores basales del grupo intervención con respecto al grupo placebo respectivamente [6,66±1,4 vs. 6,17±1,6] tras la primera sesión en el grupo de intervención respecto al placebo [3,19±1,6 vs. 4,51±1,9], tras la segunda sesión [1,89±1,3 vs. 3,57±1,6] y a las cuatro semanas [1,77±1,4 vs. 3,34±1,2]. En el grupo control no hubo una reducción estadísticamente significativa ni a la semana ni a las cuatro semanas. En el seguimiento al año se perdieron muchos pacientes, pero aun así se aprecia una diferencia clínica y estadísticamente significativa entre el grupo de intervención y el grupo de placebo respectivamente [1,50±0,9 vs. 4,47±1,0]. En cuanto al UDP, se produjo un aumento clínico y estadísticamente significativo en el grupo de intervención respecto al placebo respectivamente, desde los umbrales basales [1,75±0,4 vs. 1,88±0,5 kg/cm2] del UDP, tanto tras la primera sesión [3,09±0,8 vs. 2,58±0,8 kg/cm2], como tras la segunda sesión [3,52±0,9 vs. 2,69±0,9 kg/cm2] y a las cuatro semanas [3,63±1,0 vs. 2,24±0,7 kg/cm2]. En el grupo control no hubo un aumento estadísticamente significativo ni a la semana ni a las cuatro semanas. Los recorridos articulares aumentaron uniformemente en los grupos placebo e intervención. En el grupo de intervención, el aumento de una medida para la siguiente fue estadísticamente significativo en todos los planos. En el grupo de control apenas hubo diferencias significativas entre medidas. Se produjo una reducción clínica y estadísticamente significativa desde las medidas basales del grupo intervención con respecto al grupo placebo [28,95±10,2 vs 23,69±9,8] del NDI a las cuatro semanas, tras concluirse el tratamiento, el ensayo mostraba una mayor reducción en la discapacidad en el grupo intervención respecto el grupo placebo [4,61±6,2 vs. 11,52±7,3]. En el grupo control no hubo una reducción significativa entre las dos medidas. En el seguimiento al año se perdieron muchos pacientes, pero aun así se aprecia una diferencia clínica y estadísticamente significativa entre el grupo de intervención y el grupo de placebo [5,45±3,2 vs. 16,00±5,5]. Conclusión La técnica de punción seca sobre el punto gatillo activo más mecano-sensible del trapecio superior y elevador de la escápula, en combinación con un protocolo de terapia manual, constituye un tratamiento efectivo y clínicamente relevante en el dolor de cuello crónico a corto, medio y largo plazo.UE

Is Shear-Wave Elastography a Clinical Severity Indicator of Myofascial Pain Syndrome? An Observational Study

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 p p > 0.05). No stiffness differences were found between active MTrPs with latent MTrPs or control points (p > 0.05). However, significant control point stiffness differences between-samples were found (p p > 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

Pain Intensity and Sensory Perception of Tender Points in Female Patients with Fibromyalgia: A Pilot Study

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

Influence of Examiners’ Experience and Region of Interest Location on Semiquantitative Elastography Validity and Reliability

Semi‐quantitative elastography is a promising imaging technique to evaluate tissue stiffness differences, providing data regarding relative stiffness differences between two targets. The aims of this study were to assess the validity, inter‐examiner reliability and variability of semi‐ quantitative elastography for calculating strain ratios (SR) in a homogeneous gel phantom in different locations within the image. A diagnostic accuracy study was performed in a homogeneous stiffness phantom. Four examiners participated (two novice and two experienced). Each examiner assessed the SR in two locations. Difference between examiners, variability of measurements, SR error and absolute error, mean error of the measurements and coefficient of variation were calculated. The agreement between examiners, validity and variability of measurements were higher in the central area than the lateral areas of the images. Thus, the experience of the examiner was relevant for the concordance of the measurements in the lateral areas of the images (SR difference of 0.14 ± 0.05; p 0.05). Our data suggested that semi‐quantitative elastography is an accurate tool for assessing small magnitude stiffness differences within the same image in central areas, but the experience of the examiner is a determinant factor