Relationship between posture and temporomandibular disorders. Systematic review and meta-analysis

Introducción: La relación entre la postura y los trastornos temporomandibulares (TTM) ha sido abordada desde hace décadas, sin que se haya podido aportar fuerte evidencia en ningún sentido. El objetivo de este estudio fue revisar sistemáticamente y sintetizar de forma cuantitativa (vía metaanálisis) la evidencia existente sobre la relación entre postura y TTM. Material y método: Se realizó una búsqueda en los recursos electrónicos Pubmed, Lilacs, Sciencedirect, Scielo, Pedro y The Cochrane Library de estudios analíticos observacionales de cohortes, de casos y controles y/o transversales de asociación cruzada, que evaluaran la relación entre postura y TTM, publicados a partir de 2012, en inglés, español, portugués y francés. Dos revisores analizaron la calidad metodológica de los artículos incluidos. Resultados: Ocho artículos fueron seleccionados finalmente y evaluados. Cinco encontraron relación, mientras tres no la hallaron. El metanálisis tampoco arrojó resultados esclarecedores, aunque parece indicar que pueden existir diferencias en el ángulo “ojo-trago”-“plano horizontal”, siendo ligeramente menor este ángulo en sujetos sanos en comparación con los sujetos con TTM. Conclusiones: no se puede establecer que haya una fuerte evidencia científica favorable a que exista relación entre postura y TTM, debido a la paridad del número de estudios con resultados en ambos sentidos y a la calidad metodológica que presentan los artículos incluidos

Strain/counterstrain on internal pterygoid muscles. Short-term effects on mandibular dynamics

Objetivo: evaluar la amplitud articular y la fuerza de mordida tras aplicar los métodos de inhibición de tensión/contratensión (TCT) sobre los puntos gatillo miofasciales latentes (PGMs) del músculo pterigoideo interno. Intervención: cuarenta y nueve sujetos, 25 varones y 24 mujeres, fueron aleatoriamente distribuidos en dos grupos; el grupo experimental (25 sujetos) recibió tratamiento de TCT, y el grupo control (24 sujetos) recibió un tratamiento placebo. Las variables de resultado fueron la máxima apertura oral (MAO) y la máxima fuerza de la mordida (MFM). Resultados: los resultados mostraron una mejora significativa en la MAO [Control: (–0,02) mm ± 0,76; Experimental: 1,48 mm ± 1,3; p 0,05). Conclusión: los procedimientos de inhibición muscular mediante TCT se podrían emplear en el tratamiento de los PGMs del músculo pterigoideo interno para mejorar la MAO y la MFM, con independencia del sexo.Objetive: to assess the short-term effects on mandibular dynamics (in terms of jaw opening and bite force) of the application strain/counterstrain (SCS) on latent myofascial trigger points (MTrPs) of the internal pterygoid muscles. Intervention: forty nine subjects, 25 males and 24 females, were randomly allocated to one of two groups: experimental (25 subjects), who received SCS therapy, and control (24 subjects), who received a placebo treatment. As outcome variables, we considered maximum active jaw opening and maximum bite force. Results: the results showed a significant improvement with respect to active jaw opening [controls: (–0,02) mm ± 0,76; experimental subjects: 1,48 mm ± 1,3; p< 0,01] and maximum bite force [controls: (–0,06) N ± 1,21; experimental subjects: 32,43 N ± 16,81; p< 0,001] after treatment of MTrPs with SCS. Conclusions: our results suggest that muscular inhibition methods through the application of strain/counterstrain (SCS) could be used in the treatment of the MTrPs of the internal pterygoid muscles in order to improve maximum jaw opening and maximum bite force. Key words: strain/counterstrain, myofascial pain syndrome, mouth, bite force, muscle hypertonia, temporomandibula

Changes in body balance and functional performance following whole-body vibration training in patients withfibromyalgia syndrome: a randomized controlled trial.

Objective: To determine whether an 8-week exercise pro-gramme supplemented with whole-body vibration improves body balance and dynamic strength in women with fibro-myalgia. Design: Randomized controlled trial. Patients: Forty-six participants diagnosed with fibromyal-gia. Methods: Participants were randomly assigned to: (i) an exercise training group with whole-body vibration (n=15), which performed twice-weekly exercise sessions (aerobic ex-ercise, strengthening and flexibility) combined with 3 whole-body vibration training sessions a week (bilateral squats: 6–9 sets of 30 s with 45-s recovery between sets; and uni-lateral squat: 4–7 sets of 30 s, 30 Hz–4 mm); (ii) an exercise group (n=15) with the same combined exercise therapy; and (iii) a usual-care control group (n=16). Results: Statistically significant improvements in the Medio–Lateral Stability Index and Medio–Lateral Mean Deflection with open eyes were found in the whole-body vibration exer-cise group compared with the control group. Non-significant effects were found for lower-limb physical function. Conclusion: The results show that a traditional exercise pro-gramme, supplemented with whole-body vibration training, improved balance in women with fibromyalgia. This may represent a key factor for falls prevention in this patient grou

Vojta Therapy in Neuromotor Development of Pediatrics Patients with Periventricular Leukomalacia: Case Series

Background and Objectives: Vojta therapy is used by physiotherapists and is based on stimulation through peripheral pressure that leads to the activation of involuntary motor response patterns, thus triggering patterns of reflex locomotion, hence also called reflex locomotion therapy. Objective: To analyze the changes produced by Vojta therapy in the evolution of infant motor development in patients with maturational delay due to periventricular leukomalacia. Materials and methods: One session of Vojta Therapy per week for eleven months, patients’ neuromotor development was evaluated through the Denver II Test and the Baleys Scale. Results: A clinically significant increase in the development of the patients is observed. Conclusions: Neuromotor development seems to generate an adequate progression in the motor area

Effects of the Fourth Ventricle Compression in the Regulation of the Autonomic Nervous System: A Randomized Control Trial

Introduction. Dysfunction of the autonomic nervous system is an important factor in the development of chronic pain. Fourth ventricle compression (CV-4) has been shown to influence autonomic activity. Nevertheless, the physiological mechanisms behind these effects remain unclear. Objectives. This study is aimed at evaluating the effects of fourth ventricle compression on the autonomic nervous system. Methods. Forty healthy adults were randomly assigned to an intervention group, on whom CV-4 was performed, or to a control group, who received a placebo intervention (nontherapeutic touch on the occipital bone). In both groups, plasmatic catecholamine levels, blood pressure, and heart rate were measured before and immediately after the intervention. Results. No effects related to the intervention were found. Although a reduction of norepinephrine, systolic blood pressure, and heart rate was found after the intervention, it was not exclusive to the intervention group. In fact, only the control group showed an increment of dopamine levels after intervention. Conclusion. Fourth ventricle compression seems not to have any effect in plasmatic catecholamine levels, blood pressure, or heart rate. Further studies are needed to clarify the CV-4 physiologic mechanisms and clinical efficacy in autonomic regulation and pain treatment

Effect of Combined Manual Therapy and Therapeutic Exercise Protocols on the Postural Stability of Patients with Non-Specific Chronic Neck Pain. A Secondary Analysis of Randomized Controlled Trial

Postural stability is a little-studied factor in non-specific chronic neck pain; the causes that can alter it are unknown. The relationship with chronic pain could be a determining factor for its deficit. The aim of this study was to investigate the relationship between sustained pain and a postural stability deficit. A randomized and blinded clinical trial (double-blind; placebo control; 12 weeks follow-up) was conducted with a total of 69 subjects divided into three groups, two experimental (manual therapy and specific exercise) and a control treatment, and carried out over a treatment period of three weeks with a follow-up after 12 weeks. Their postural stability was assessed through the overall balance index (OBI). The postural stability of subjects with non-specific chronic neck pain improved in the experimental treatments. There were no statistically significant differences between the experimental groups. This trial found that manual therapy and therapeutic exercise significantly improved OBI compared to the control group. Trial registration: Brazilian Clinical Trial Registry, RBR-2vj7sw

Effects of the Fourth Ventricle Compression in the Regulation of the Autonomic Nervous System: A Randomized Control Trial

Introduction. Dysfunction of the autonomic nervous system is an important factor in the development of chronic pain. Fourth ventricle compression (CV-4) has been shown to influence autonomic activity. Nevertheless, the physiological mechanisms behind these effects remain unclear. Objectives. This study is aimed at evaluating the effects of fourth ventricle compression on the autonomic nervous system. Methods. Forty healthy adults were randomly assigned to an intervention group, on whom CV-4 was performed, or to a control group, who received a placebo intervention (nontherapeutic touch on the occipital bone). In both groups, plasmatic catecholamine levels, blood pressure, and heart rate were measured before and immediately after the intervention. Results. No effects related to the intervention were found. Although a reduction of norepinephrine, systolic blood pressure, and heart rate was found after the intervention, it was not exclusive to the intervention group. In fact, only the control group showed an increment of dopamine levels after intervention. Conclusion. Fourth ventricle compression seems not to have any effect in plasmatic catecholamine levels, blood pressure, or heart rate. Further studies are needed to clarify the CV-4 physiologic mechanisms and clinical efficacy in autonomic regulation and pain treatment

Incidencia del ejercicio físico y el entrenamiento vibratorio sobre la amplitud de movimiento de mujeres con fibromialgia

Objetivo. En la presente investigación hemos planteado como objetivos principales, por un lado, valorar el efecto del ejercicio físico y el entrenamiento vibratorio sobre la amplitud de movimiento en mujeres con fibromialgia (FM) y, por otro, determinar si existe alguna relación entre dicha variable y el dolor y la rigidez. Método. La muestra estuvo constituida por un total de cuarenta y seis mujeres (edad: 58,2 ± 8,5 años; peso: 72,1 ± 9,6 kg; altura: 156,9 ± 6,1 cm) diagnosticadas con FM. Los participantes fueron divididos aleatoriamente en tres grupos: ejercicio físico y entrenamiento vibratorio (WBV + EJ; n = 15); ejercicio físico sin vibraciones (EJ; n = 15) y un grupo control (GC; n = 16). Los grupos WBV + EJ y EJ realizaron dos sesiones semanales de ejercicio físico durante 8 semanas. Además, los integrantes de WBV + EJ realizaron 3 sesiones semanales de entrenamiento vibratorio (30 Hz, 4 mm). Las pruebas de evaluación incluyeron el test de sit and reach (variable principal), la valoración del número de tender points (TP) y una escala analógica visual (VAS) para determinar la rigidez. Resultados. Los resultados derivados del análisis intra e intergrupo no mostraron diferencias significativas en la rigidez o el número de TP, si bien, la prueba de sit and reach mostró una mejora estadísticamente significativa en WBV + EJ (58%; p < 0,05). El análisis correlacional mostró una relación inversa (r = -0,55; p < 0,05) entre el sit and reach y el número de TP. Conclusión. Como conclusión, podemos indicar que los datos obtenidos en la presente investigación han mostrado los efectos significativos del entrenamiento vibratorio sobre la amplitud de movimiento en mujeres con FM, aunque el número de TP o la rigidez no se vieron afectados en ningún caso