Efectividad del abordaje integrador de terapia manual y entrenamiento vs entrenamiento en pacientes con cervicalgia crónica y disfunción cervical superior en el dolor, función cervical e índice de discapacidad

La cervicalgia crónica es una patología muy común en la actualidad. Sin embargo, es una dolencia que engloba muchos tipos de pacientes y se ha visto la necesidad creciente de dividirlos en subgrupos clínicos.Dentro de los subgrupos considerados en la bibliografía están: dolor cervical con déficit de movilidad, dolor cervical con irradiación, dolor cervical asociado a cefalea y dolor cervical con déficit de coordinación.Consideramos que existe un nuevo subgrupo de cervicalgia crónica con disfunción de la columna cervical superior, el cual, no respondería de la misma forma que otros subgrupos al tratamiento recomendado por las guías clínicas.Dos de los tratamientos más recomendados en fisioterapia son la terapia manual asociada a entrenamiento y el entrenamiento de manera aislada. La terapia manual asociada a entrenamiento consigue buenos resultados en estos pacientes aunque en los últimos años se ha comprobado que el entrenamiento cervical por sí solo consigue resultados muy similares.Consideramos que este subgrupo de disfunción cervical superior se comporta de manera diferente a otros subgrupos y que es necesario aplicar técnicas manuales específicas para restaurar la cantidad y la calidad de movimiento antes de realizar el entrenamiento cervicalEste estudio se plantea comparar el efecto de la terapia manual específica de la columna cervical superior asociada a entrenamiento cervical con el entrenamiento cervical en la intensidad de dolor, el rango de movimiento activo cervical inferior y superior, el test de flexión rotación, la cinestesia cervical, el tono muscular, el dolor a la presión, la mejora de la fuerza y la sección transversal de la musculatura profunda cervical, el índice de discapacidad, la kinesiofobia cervical, el dolor de cabeza, la disminución de la medicación y la percepción subjetiva de cambio clínico en sujetos con cervicalgia crónica y disfunción cervical superior.Para alcanzar los objetivos del estudio, el trabajo realizado es un estudio analítico, longitudinal, prospectivo, experimental. Se trata de un ensayo clínico controlado en paralelo, aleatorio, simple ciego con dos grupos.Se han obtenido las siguientes conclusiones:1. Añadir terapia manual específica en la región cervical superior al tratamiento con entrenamiento cervical para el tratamiento de la cervicalgia crónica, produce una mejoría adicional en la sintomatología y la función en comparación con el tratamiento de entrenamiento cervical, en sujetos con cervicalgia crónica y disfunción de la columna cervical superior a corto y medio plazo.2. Añadir terapia manual específica en la región cervical superior al tratamiento con entrenamiento cervical para el tratamiento de la cervicalgia crónica, produce una mejoría adicional en la intensidad del dolor en comparación con el tratamiento de entrenamiento cervical, en pacientes con cervicalgia crónica y disfunción de la columna cervical superior a corto y medio plazo.3. Añadir terapia manual específica en la región cervical superior al tratamiento con entrenamiento cervical para el tratamiento de la cervicalgia crónica, produce una mejoría adicional en la ganancia del rango de movimiento articular en comparación con el tratamiento de entrenamiento cervical, en pacientes con cervicalgia crónica y disfunción de la columna cervical superior a corto y medio plazo.4. Añadir terapia manual específica en la región cervical superior al tratamiento con entrenamiento cervical para el tratamiento de la cervicalgia crónica, produce una mejoría adicional en la normalización del test de flexión rotación en comparación con el tratamiento de entrenamiento cervical, en pacientes con cervicalgia crónica y disfunción de la columna cervical superior a corto y medio plazo.5. Añadir terapia manual específica en la región cervical superior al tratamiento con entrenamiento cervical para el tratamiento de la cervicalgia crónica, no produce una mejoría adicional en la mejora del error de reposicionamiento cervical en comparación con el tratamiento de entrenamiento cervical, en pacientes con cervicalgia crónica y disfunción de la columna cervical superior a corto y medio plazo.6. Añadir terapia manual específica en la región cervical superior al tratamiento con entrenamiento cervical para el tratamiento de la cervicalgia crónica, produce una mejoría adicional en la discapacidad cervical en comparación con el tratamiento de entrenamiento cervical, en pacientes con cervicalgia crónica y disfunción de la columna cervical superior a corto y medio plazo.7. Añadir terapia manual específica en la región cervical superior al tratamiento con entrenamiento cervical para el tratamiento de la cervicalgia crónica, produce una mejoría adicional en las variables de resultado de dolor a la presión, juego articular, kinesiofobia, dolor de cabeza, disminución de medicación y apreciación subjetiva de cambio clínico en comparación con el tratamiento de entrenamiento cervical, en pacientes con cervicalgia crónica y disfunción de la columna cervical superior a corto y medio plazo.<br /

Relación de la estructura con las propiedades eléctricas en solución sólida La2/3-xLi3xTiO3 (0.03 x 0.167)

En este trabajo se investigó la solución sólida La2/3-xLi3xTiO3 (0.03<x<0.167) por las técnicas de difracción de rayos-X en polvos (DRX), espectroscopía de impedancias (EI) y resonancia magnética nuclear (RMN) de 7Li. En estas muestras se observó un cambio en la simetría de tetragonal a ortorrómbica cuando disminuye el contenido de litio por debajo de x=0.06. Hallamos que las modificaciones estructurales producidas se deben principalmente al ordenamiento de las vacancias a lo largo del eje c. Estas modificaciones disminuyen gradualmente al incrementarse el contenido de litio en la solución sólida. Se detectaron dos señales de litio con diferente constante cuadrupolar para el espectro de RMN del 7Li en las perovskitas ortorrómbicas/tetragonales, las cuales asociamos con dos sitios cristalográficos para el litio dentro de la estructura. Para la perovskita de composición La0.5Li0.5TiO3, se realizó un experimento enfriándola rápidamente desde 1300° C en nitrógeno líquido. En ésta se detectó una elevada movili- dad del litio en el espectro de RMN del 7Li. Para las perovskitas analizadas, la dependencia de la conductividad eléctrica con el contenido de litio no sigue el comportamiento esperado, basado en la teoría de una distribución aleatoria de los átomos de La y Li sobre los sitios A. La conductividad DC aumenta rápidamente con el contenido de litio en las muestras ortorrómbicas, aunque el cambio es mucho más gradual en las tetragonales, donde la distribución de las vacancias se desordena progresivamente. En todas las perovskitas analizadas, la dependencia de la conductividad dc con la temperatura muestra un comportamiento no-Arrhenius con energías de activación de 0.39±0.02 eV y 0.29±0.02 eV en los rangos de temperatura de 160 – 250 y 250 – 360 K, respectivamente

Does Upper Cervical Manual Therapy Provide Additional Benefit in Disability and Mobility over a Physiotherapy Primary Care Program for Chronic Cervicalgia? A Randomized Controlled Trial

Introduction: Neck pain is a condition with a high incidence in primary care. Patients with chronic neck pain often experience reduction in neck mobility. However, no study to date has investigated the effects of manual mobilization of the upper cervical spine in patients with chronic mechanical neck pain and restricted upper cervical rotation. Objective: To evaluate the effect of adding an upper cervical translatoric mobilization or an inhibitory suboccipital technique to a conventional physical therapy protocol in patients with chronic neck pain test on disability and cervical range of motion. Design: Randomized controlled trial. Methods: Seventy-eight patients with chronic neck pain and restricted upper cervical rotation were randomized in three groups: Upper cervical translatoric mobilization group, inhibitory suboccipital technique group, or control group. The neck disability index, active cervical mobility, and the flexion–rotation test were assessed at baseline (T0), after the treatment (T1), and at three-month follow-up (T2). Results: There were no statistically significant differences between groups in neck disability index. The upper cervical translatoric mobilization group showed a significant increase in the flexion–rotation test to the more restricted side at T1 (F = 5.992; p < 0.004) and T2 (F = 5.212; p < 0.007) compared to the control group. The inhibitory suboccipital technique group showed a significant increase in the flexion–rotation test to the less restricted side at T1 (F = 3.590; p < 0.027). All groups presented high percentages of negative flexion–rotation tests. (T1: 69.2% upper neck translator mobilization group; 38.5% suboccipital inhibition technique group, 19.2% control group; at T2: 80.8%; 46.2% and 26.9% respectively). No significant differences in the active cervical mobility were found between groups. Conclusion: Adding manual therapy to a conventional physical therapy protocol for the upper cervical spine increased the flexion–rotation test in the short- and mid-term in patients with chronic neck pain. No changes were found in the neck disability index and the global active cervical range of motion

Correlation between Power Elbow Flexion and Physical Performance Test: A Potential Predictor for Assessing Physical Performance in Older Adults

Correlation; Functional tests; Muscle power; Older adultsCorrelación; Pruebas funcionales; Poder muscular; Personas mayoresCorrelació; Proves funcionals; Potència muscular; Gent granBackground: With the increasing number of older adults and their declining motor and cognitive function, it is crucial to find alternative methods for assessing physical functionality. The Short Physical Performance Battery (SPPB), the Time Up and Go (TUG) test, the 4 Meter Walk Test and the Barthel Index (BI) have been used to evaluate mobility and fragility and predict falls. But some of these functional test tasks could be difficult to perform for frail older adults or bedridden patients that cannot ambulate. This study aimed to evaluate the relationship between these functional tests and the power elbow flexion (PEF test). Material and methods: A correlation study was designed with 41 older adults over 65 years of age. The upper limb muscle power was measured using a linear encoder (VITRUBE VBT) with the flexion of the elbow. Results: Strong correlations were found between the PEF test and the 4mWT (rho = 0.715, p = 0.001) and TUG (rho= -0.768, p = 0.001), indicating that the greater the upper limb muscle power is, the greater physical performance will be. Moderate correlations were also found between the PEF and Barthel Index (rho = 0.495, p = 0.001) and SPPB (rho = 0.650, p < 0.001). Conclusions: There is a strong correlation between PEF and the functional tests, proving that older adults that have greater upper limb muscle power have better physical performance. Upper limb muscle power and PEF could be an interesting tool for the assessment of physical performance in bedridden older adults

Breast Vascularization and Its Implication in Breast Reduction and Mastopexy Surgery: Anatomical Study

(1) Background: Breast reduction is one of the most frequently performed plastic surgeries in women worldwide. The Wise pattern breast reduction is one of the most frequent skin designs for this surgery. One key point of the surgery is to preserve a well-vascularized NAC by using different surgical pedicles. This study aims to test and update the anatomical knowledge of breast vascularization, the topographic and anatomical basis of the different surgical vascular pedicles, and the differences between the right and left sides. (2) Methods: A descriptive observational anatomical study was carried out on 15 breasts from 10 cryopreserved body donors. A dissection was performed by quadrants to know the affected arteries' origin in the different patterns. (3) Results: The largest and most frequently dissected internal mammary perforator artery was in the second intercostal space. A total of 44.9% of the dissected perforators are located in the upper inner quadrant, compared to 53.5% in the lower quadrants. (4) Conclusions: The upper inner quadrant alone has the most arterial perforators. In contrast, the sum of the two lower quadrants represents the greatest vascularization of the breast, with a small difference between both

Short-Term Effects of Three Types of Hamstring Stretching on Length, Neurodynamic Response, and Perceived Sense of Effort—A Randomised Cross-Over Trial

Background: Stretching techniques for hamstring muscles have been described both to increase muscle length and to evaluate nerve mechanosensitivity. Aim: We sought to evaluate the short-term effects of three types of hamstring stretching on hamstring length and report the type of response (neural or muscular) produced by ankle dorsiflexion and perceived sense of effort in asymptomatic subjects. Methods: A randomised cross-over clinical trial was conducted. A total of 35 subjects were recruited (15 women, 20 men; mean age 24.60 ± 6.49 years). Straight leg raises (SLR), passive knee extensions (PKE), and maximal hip flexion (MHF) were performed on dominant and non-dominant limbs. In addition, the intensity of the applied force, the type and location of the response to structural differentiation, and the perceived sensation of effort were assessed. Results: All stretching techniques increased hamstring length with no differences between limbs in the time*stretch interaction (p &lt; 0.05). The perceived sensation of effort was similar between all types of stretching except MHF between limbs (p = 0.047). The type of response was mostly musculoskeletal for MHF and the area of more neural response was the posterior knee with SLR stretch. Conclusions: All stretching techniques increased hamstring length. The highest percentage of neural responses was observed in the SLR stretching, which produced a greater increase in overall flexibility

Thermal and non-thermal effects off capacitive-resistive electric transfer application on the achilles tendon and musculotendinous junction of the gastrocnemius muscle: a cadaveric study

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

Safety of Dry Needling of the Pronator Teres Muscle in Cadavers: A Potential Treatment for Pronator Syndrome

Background: Entrapment of the median nerve at the pronator teres muscle can contribute to symptoms in the forearm and wrist. The pronator teres is also involved in patterns of spasticity observed in people who had suffered a stroke. Research on treatment efficacy with dry needling is scarce. Objective: To determine if a solid filiform needle safely penetrates the pronator teres muscle during the clinical application of dry needling. Design: A cadaveric descriptive study. Methods: Needle insertion of the pronator teres was conducted in ten cryopreserved forearms with a 30*0.32 mm filiform needle. With the forearm supinated, the needle was inserted 3 cm distal to the mid-point between the biceps tendon insertion and the medial epicondyle. The needle was advanced in a cranial and medial direction to a depth clinically judged to be in the pronator teres muscle. Safety was assessed by measuring the distance from the needle to the surrounding neurovascular bundles. Results: Accurate needle penetration of the pronator teres was observed in 100% of the specimens (mean needle penetration: 16.7 ± 4.3 mm, 95%CI 13.6 to 19.7 mm). No neurovascular bundles were pierced in any of the specimen's forearms. The distances from the tip of the needle to the surrounding neurovascular bundles were 16.4 ± 3.9 mm (95%CI 13.6 to 19.2 mm) to the ulnar nerve (A), 9.0 ± 2.2 mm (95%CI 7.3 to 19.5 mm) to the median nerve (B), and 12.8 ± 4.0 mm (95%CI 10.0 to 15.7 mm) to brachial artery (C). Conclusion: The results from this cadaveric study support the assumption that needling of the pronator teres using described anatomical landmarks can be accurately and safely conducted by an experienced clinician

Comparison of resistive capacitive energy transfer therapy on cadaveric molars and incisors with and without implants.

Capacitive-resistive energy transfer therapy (CRet) is used to improve the rehabilitation of different injuries. This study aimed to evaluate and compare the changes in temperature and current flow during different CRet applications on upper and lower molars and incisors, with and without implants, on ten cryopreserved corpses. Temperatures were taken on molars and incisors with invasive devices and skin temperature was taken with a digital thermometer at the beginning and after treatments. Four interventions: 15 VA capacitive hypothermic (CAPH), 8 watts resistive (RES8), 20 watts resistive (RES20) and 75 VA capacitive (CAP75) were performed for 5 min each. All treatments in this study generated current flow (more than 0.00005 A/m2) and did not generate a significant temperature increase (p > 0.05). However, RES20 application slightly increased surface temperature on incisors without implants (p = 0.010), and molar with (p = 0.001) and without implant (p = 0.008). Also, CAP75 application increased surface temperature on molars with implant (p = 0.002) and upper incisor with implant (p = 0.001). In conclusion, RES8 and CAPH applications seem to be the best options to achieve current flow without an increase in temperature on molars and incisors with and without implants

Thermal and non-thermal effects of capacitive–resistive electric transfer application on different structures of the knee: A cadaveric study

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