February 2017
Short term effectiveness of neural sliders and neural tensioners as an adjunct to static stretching of hamstrings on knee extension angle in healthy individuals: A randomized controlled trial
26.02.17-16:15 // Catégories : Neurodynamique
Sixty healthy individuals (mean age = 22 ± 2.4 years) with reduced hamstring flexibility were randomized to three groups who received static stretching and neurodynamic sliders (NS-SS); static stretching with neurodynamic tensioner (NT-SS) and static stretching (SS) alone. Knee extension angle (KEA) in degrees. Baseline characteristics including demographic, anthropomorphic and KEA between groups were comparable. A significant interaction was observed between group (intervention) and time, [F (2,114) = 3.595; p = 0.031]. Post-hoc pairwise comparisons analyses revealed significant differences at post-intervention measurement time point between NS-SS and SS (mean difference: -6.8; 95%CI = -12, -1.5; p = 0.011) and NT-SS and SS (mean difference: -11.6; 95%CI = -16.7, -6.3; p < 0.001). However there was no significant difference between NS-SS and NT-SS groups (mean difference: 4.8; 95%CI = 0.4, 9.9; p = 0.074).
Neural sliders and tensioners are both effective in increasing hamstring flexibility as an adjunct to static hamstring stretching when compared to static stretching alone. No neural mobilization technique proved to be superior over another.
...Afficher la suiteChanges in Hamstring Range of Motion Following Neurodynamic Sciatic Sliders: A Critically Appraised Topic
26.02.17-16:07 // Catégories : Neurodynamique
Clinical Scenario: Hamstring tightness is a common condition leading to dysfunctional or restricted movement that is often treated with stretching. Neurodynamics has been proposed as an alternative to stretching by targeting the neural system rather than muscle tissue. Focused Clinical Question: In an active population, what is the effect of using neurodynamic sliders compared to stretching on traditional measures of range of motion? Summary of Key Findings: The authors of a well-designed study identified that neurodynamic sliders were more effective than static stretching, while the authors of two less well-designed studies reported no difference with static stretching or that proprioceptive neuromuscular facilitation stretching was more effective than neurodynamic sliders. Clinical Bottom Line: Evidence exists to support the use of neurodynamic sliders to increase measures of hamstring ROM in patients who present with limited hamstring flexibility; however, the effectiveness of neurodynamic sliders compared to traditional stretching is inconclusive. Strength of Recommendation: Grade B evidence exists that neurodynamic sliders perform as well as traditional stretching techniques at increasing measures of hamstring ROM on patients with limited hamstring flexibility.
...Afficher la suiteA Randomised, Placebo-Controlled Trial of Neurodynamic Sliders on Hamstring Responses in Footballers with Hamstring Tightness
26.02.17-16:01 // Catégories : Neurodynamique
Neurodynamics intervention is known to increase apparent muscle extensibility, but information regarding hamstring responses after a neurodynamic sliders (NS) technique is scarce. The aim of this study was to evaluate the effects of NS on apparent hamstring extensibility and activity in footballers with hamstring tightness.Forty eligible healthy male footballers with hamstring tightness were each randomly allocated to either a 4-week NS technique or a control group (CG) receiving placebo shortwave intervention. Knee extension angles were measured with the passive knee extension test, and maximal voluntary isometric contraction (MVIC) of hamstrings was measured by a surface electromyography at baseline and after intervention sessions. The results showed that NS produced a statistically and clinically significant increase in knee extension angle compared to CG (P < 0.001); however, there was no difference between the groups receiving MVIC of hamstrings. Within group comparison, NS also provided a significant increase in knee extension angle (P < 0.001), whereas the control group did not. There was no change in hamstring MVIC in either group after intervention.
The findings of this study reveal that four weeks of NS technique improved apparent hamstring extensibility but did not change the hamstring activity in footballers with hamstring tightness.
...Afficher la suiteEffects of myofascial trigger point dry needling in patients with sleep bruxism and temporo-mandibular disorders: a prospective case series
23.02.17-05:20 // Catégories : Dry Needling/Points Trigger
To investigate the effects of deep dry needling (DN) of myofascial trigger points (MTrPs) of the masseter and temporalis on pain, pressure pain threshold (PPT), pain-free maximal jaw opening and temporomandibular disorder (TMD)-related disability in patients with sleep bruxism (SB) and myofascial TMD. Seventeen subjects (11 women, 6 men) aged 39±13 years (range 23-66) diagnosed with SB and myofascial TMD were invited to participate in this prospective case series study. Each subject received a deep DN intervention in the masseter and temporalis MTrPs. Pain intensity, PPT, pain-free maximal jaw opening and TMD-related disability were assessed before treatment, immediately after treatment and at 1-week follow-up. Jaw disability was assessed using the jaw disability checklist (JDC) at baseline and 1 week post-treatment only. One-way analyses of variance showed significant improvements in pain intensity, PPT and jaw opening (p<0.001). Post-hoc analysis revealed significant differences between baseline and post-intervention follow-up time points in pain (immediate: Cohen's d=1.72, p<0.001; 1 week: d=3.24, p<0.001), jaw opening (immediate: d=0.77, p<0.001; 1 week: d=1.02, p<0.001) and PPT in the masseter (immediate: d=1.02, p<0.001; 1 week: d=1.64, p<0.001) and temporalis (immediate: d=0.91, p=0.006; 1 week: d=1.8, p<0.001). A dependent t-test showed a significant improvement in jaw functioning, reflected by a large reduction in 1-week JDC scores relative to baseline (d=3.15, p<0.001).
Deep DN of active MTrPs in the masseter and temporalis in patients with myofascial TMD and SB was associated with immediate and 1-week improvements in pain, sensitivity, jaw opening and TMD-related disability.
...Afficher la suiteMyofacial Trigger Points in Advanced Cancer Patients
22.02.17-16:53 // Catégories : Points Trigger
Myofascial pain syndrome is started to be recognized as one of important factors of pain in cancer patients. However, no reports on features of myofascial trigger points were found in terminally-ill cancer populations. This time, we encountered 5 patients with myofascial pain syndrome and terminal cancer in whom delirium developed due to increased doses of opioid without a diagnosis of myofascial pain syndrome on initial presentation. The delirium subsided with dose reductions of opioid and treatment of myofascial pain syndrome. The common reason for a delayed diagnosis among the patients included an incomplete palpation of the painful sites, which led to unsuccessful myofascial trigger points identification. The features of myofascial trigger points included single onset in the cancer pain management site with opioid and the contralateral abdominal side muscles of the non-common sites. Withdrawal reflexes associated with cancer pain in the supine position, which are increasingly seen in the terminal cancer patients, were considered to have contributed to this siuation.
We consider that careful palpation of the painful site is important, in order to obtain greater knowledge and understanding of the features of myofascial trigger points.
...Afficher la suiteEffect of myofascial techniques for treatment of upper limb dysfunctions in breast cancer survivors: randomized controlled trial
22.02.17-09:58 // Catégories : Points Trigger
Besides pain, myofascial dysfunctions may contribute to the presence of upper limb impairments such as impaired range of motion, decreased strength, lymphedema, and altered postures and kinematics. Therefore, the aim of this study was to investigate the effect of myofascial therapy in addition to a standard physical therapy program for treatment of upper limb dysfunctions in breast cancer survivors. Fifty women treated for a unilateral breast cancer with pain and myofascial dysfunctions at the upper limb region. The intervention group received 12 sessions of myofascial therapy consisting of release techniques on myofascial trigger points and adhesions in addition to a standard physical therapy program for 3 months. The control group received 12 sessions of a placebo intervention in addition to the same standard physical therapy program during the 3 months. Outcome parameters are active shoulder range of motion (inclinometer); arm lymphedema (perimeter); upper limb strength (handheld dynamometer); scapular statics and dynamics (acromion-table and pectoralis minor index, inclinometer); shoulder function (Disability of Shoulder, Arm and Hand questionnaire); and quality of life (Short Form 36). Measures were taken before and after the intervention at 6 and 12 months follow-up. No differences between groups were found for all outcome parameters over the course of 1 year. However, overall beneficial effects of the standard physical therapy program for active shoulder range of motion and shoulder function were found in both groups up to 1 year follow-up.
Myofascial therapy has no additional beneficial effect for improvement of upper limb function in breast cancer survivors.
...Afficher la suiteTherapeutic effects of dry needling in patients with upper trapezius myofascial trigger point
12.02.17-09:57 // Catégories : Dry Needling/Points Trigger
Active myofascial trigger points (MTrPs) are major pain generators in myofascial pain syndrome. Dry needling (DN) is an effective method for the treatment of MTrPs. To assess the immediate neurophysiological and clinical effects of DN in patients with upper trapezius MTrPs. This was a prospective, clinical trial study of 20 patients with upper trapezius MTrPs and 20 healthy volunteers (matched for height, weight, body mass index and age), all of whom received one session of DN. Primary outcome measures were neuromuscular junction response (NMJR) and sympathetic skin response (SSR). Secondary outcomes were pain intensity (PI) and pressure pain threshold (PPT). Data were collected at baseline and immediately post-intervention. At baseline, SSR amplitude was higher in patients versus healthy volunteers (p<0.003). With respect to NMJR, a clinically abnormal increment and normal reduction was observed in patients and healthy volunteers, respectively. Moreover, PPT of patients was less than healthy volunteers (p<0.0001). After DN, SSR amplitude decreased significantly in patients (p<0.01), but did not change in healthy volunteers. A clinically important reduction in the NMJR of patients and increment in healthy volunteers was demonstrated after DN. PPT increased after DN in patients, but decreased in healthy volunteers (p<0.0001). PI improved after DN in patients (p<0.001).
The results of this study showed that one session of DN targeting active MTrPs appears to reduce hyperactivity of the sympathetic nervous system and irritability of the motor endplate. DN seems effective at improving symptoms and deactivating active MTrPs, although further research is needed.
...Afficher la suiteNeurophysiological and clinical effects of dry needling in patients with upper trapezius myofascial trigger points.
12.02.17-09:14 // Catégories : Dry Needling/Points Trigger
Dry needling (DN) is a widely used in treatment of myofascial trigger points (MTrPs). The purpose of this pretest-posttest clinical trial was to investigate the neurophysiological and clinical effects of DN in patients with MTrPs. A sample of 20 patients (3 man, 17 women; mean age 31.7 ± 10.8) with upper trapezius MTrPs received one session of deep DN. The outcomes of neuromuscular junction response (NMJR), sympathetic skin response (SSR), pain intensity (PI) and pressure pain threshold (PPT) were measured at baseline and immediately after DN. There were significant improvements in SSR latency and amplitude, pain, and PPT after DN. The NMJR decreased and returned to normal after DN.
A single session of DN to the active upper trapezius MTrP was effective in improving pain, PPT, NMJR, and SSR in patients with myofascial trigger points. Further studies are needed.
...Afficher la suiteA critical overview of the current myofascial pain literature - January 2017
12.02.17-09:14 // Catégories : Dry Needling/Points Trigger
Due to a change in the production schedule of this journal, two issues of this article were due within a month of each other, which precluded the usual group of authors from contributing to the current paper, but they will participate in this review in the next issue. This overview includes several articles questioning the use of dry needling (DN) by non-acupuncturists, which continues to be a controversial topic especially in the United States. Several researchers examined the effects of manual trigger point (TrP) techniques applied to TrPs in the upper trapezius muscle. The results were mixed and not necessarily consistent among studies. The research of the clinical management of TrPs is still limited, because of small sample sizes, insufficient power, the inherent risk of the introduction of bias, and poor study methodologies.
...Afficher la suiteReliability of assessment of upper trapezius morphology, its mechanical properties and blood flow in female patients with myofascial pain syndrome using ultrasonography
12.02.17-09:14 // Catégories : Dry Needling/Points Trigger
In the present study, the intra-rater reliability of upper trapezius morphology, its mechanical properties and intramuscular blood circulation in females with myofascial pain syndrome were assessed using ultrasonography. A total of 37 patients (31.05 ± 10 years old) participated in this study. Ultrasonography producer was set up in three stages: a) Gray-scale: to measure muscle thickness, size and area of trigger points; b) Ultrasound elastography: to measure muscle stiffness; and c) Doppler imaging: to assess blood flow indices. According to data analysis, all variables, except End Diastolic Velocity (EDV), had excellent reliability (>0.806). Intra-class Correlation Coefficient (ICC) for EDV was 0.738, which was considered a poor to good reliability.
The results of this study introduced a reliable method for developing details of upper trapezius features using muscular ultrasonography in female patients. These variables could be used for objective examination and provide guidelines for treatment plans in clinical settings.
...Afficher la suiteShort-Term Clinical Effects of Dry Needling Combined With Physical Therapy in Patients With Chronic Postsurgical Pain Following Total Knee Arthroplasty: Case Series
12.02.17-09:14 // Catégories : Dry Needling/TMO
The purpose of this case series is to describe a combined program of dry needling (DN) and therapeutic exercise in a small group of patients with persistent pain post total knee arthroplasty. Fourteen total knee arthroplasty patients with persistent post-surgical pain and myofascial trigger points non-responsive to treatment with conventional physical therapy or medications received dry needling treatment in combination with therapeutic exercises for four weeks. Dry needling sessions occurred once weekly. Pre- and post-intervention, pain perception was assessed with the visual analogue scale; functional assessments with the WOMAC questionnaire; six-minute walking test; Timed Up and Go test, 30-Second Chair Stand Test and knee joint range of motion. Patients presented symptoms for 6.3 ± 3.1 months post-operation. Dry needling resulted in significantly decreased pain intensity (55.6 ± 6.6 to 19.3 ± 5.6, p<0.001) and improved WOMAC values for pain (10.1 ± 0.8 to 4.9 ± 1.0, p<0.001), stiffness (5.3 ± 0.4 to 2.4 ± 1.2, p<0.001), and function (36.7 ± 2.0 to 20.1 ± 3.2, p<0.001). Knee flexion increased from 82.7 ± 5.2° to 93.3 ± 4.3° (p<0.001), while joint extension improved from 15.8 ± 2.9° to 5.3 ± 2.4° (p<0.05). The six-minute walking test also showed better post-intervention values (391.4 ± 23.7 m to 424.7 ± 28.4 m, p<0.05).
Dry needling together with therapeutic exercises had clinical and significant functional benefits for patients with chronic post-surgical pain and myofascial trigger points following total knee replacement. Future randomized clinical trials should further investigate the effectiveness of this protocol under similar conditions.
...Afficher la suiteThe Concept of "Chair Massage" in the Workplace as Prevention of Musculo-skeletal Overload and Pain
07.02.17-06:15 // Catégories : TMO
Accumulation of musculoskeletal overload experienced daily over a long period, for months or even years may lead to serious health problems. Simple, quick and easy-to-administer prophylactic and therapeutic interventions not involving complicated medical procedures can bring tangible benefits for sufferers. The aim of the study was to evaluate the efficacy and effects of a massage programme performed during breaks at work among persons exposed to long-term overload of the spinal column and areas around the spine. We studied 50 office workers (20 women and 30 men, mean age 34.04 years). The subjects were randomly divided into an experimental group (massage, 25 people) and a control group (25 people). The study was completed in four weeks, during which 8 massage sessions took place (twice a week for 15 minutes). Subjective assessment tools were used, namely the IPAQ-short version for evaluation of physical activity, Cornell Musculoskeletal Discomfort Questionnaire (CMDQ) for assessment of musculoskeletal pain and a survey to assess the participants' satisfaction with the massage programme. An objective assessment tool was an algometric evaluation of the pain threshold (kg/cm2) in selected muscle trigger points. Statistical significance of differences was set at p <0.05. The level of physical activity was comparable between the groups, with 42% of the experimental group and 40% in the control group declaring a high level of physical activity. According to the CMDQ, the biggest differences after massage were noted with regard to the reduction of pain in the lower and upper spine and the right arm (p <0.001), while slightly smaller improvements were noted in the right shoulder and left forearm (p <0.05). In other parts of the body and in the control group, the changes were not statistically significant. The pain threshold assessed by algometry increased at all points examined in the experimental group, with pain sensitivity decreasing the most in the trapezius and supraspinous muscles on the left side of the spine (p <0.001). In the control group, the changes were not significant.
1. The proposed programme of chair massage in the workplace proved to be effective in relieving musculoskeletal overload and discomfort of the spine and upper limbs.
2. The advantages of this method include its accessibility, cost-effectiveness, ease of administration in different places and short treatment time. It seems advisable to popularise it and increase its use in practice in the prevention of physical and mental work-related overload.
...Afficher la suiteThe effect of manipulation plus massage therapy versus massage therapy alone in people with tension-type headache. A randomized controlled clinical trial.
05.02.17-05:29 // Catégories : TMO
Manipulative techniques have shown promising results for relief of tension-type headache (TTH), however prior studies either lacked a control group, or suffered from poor methodological quality. The aim of this study was to compare the effect of spinal manipulation combined with massage versus massage alone on range of motion of the cervical spine, headache frequency, intensity and disability in patients with TTH.Randomized, single-blinded, controlled clinical trial. We enrolled 105 subjects with TTH. Participants were divided into two groups: 1) manipulation and massage; 2) massage only (control). Four treatment sessions were applied over four weeks. The Headache Disability Inventory (HDI) and range of upper cervical and cervical motion were evaluated at baseline, immediately after the intervention and at a follow-up, 8 weeks after completing the intervention. Both groups demonstrated a large (ƒ=1.22) improvement on their HDI scores. Those that received manipulation reported a medium-sized reduction (ƒ=0.33) in headache frequency across all data points (P<0.05) compared to the control group. Both groups showed a large within-subject effect for upper cervical extension (ƒ=0.62), a medium-sized effect for cervical extension (ƒ=0.39), and large effects for upper cervical (ƒ=1.00) and cervical (ƒ=0.27) flexion. The addition of manipulation resulted in larger gains of upper cervical flexion range of motion, and this difference remained stable at the follow-up. These findings support the benefit of treating TTH with either massage or massage combined with a manipulative technique. However, the addition of manipulative technique was more effective for increasing range of motion of the upper cervical spine and for reducing the impact of headache.
Although massage provided relief of headache in TTH sufferers, when combined with cervical manipulation, there was a stronger effect on range of upper cervical spine motion.
...Afficher la suiteEffectiveness of Physical Therapy in Patients with Tension-type Headache: Literature Review
04.02.17-06:06 // Catégories : TMO
Tension-type headache (TTH) is a disease with a great incidence on quality of life and with a significant socioeconomic impact. The aim of this review is to determine the effectiveness of physical therapy by using manual therapy (MT) for the relief of TTH.A review was done identifying randomized controlled trials through searches in MEDLINE, PEDro, Cochrane and CINAHL (January 2002 - April 2012). English-language studies, with adult patients and number of subjects not under 11, diagnosed with episodic tension-type headache (ETTH) and chronic tension-type headache (CTTH) were included. Initial search was undertaken with the words Effectiveness, Tension-type headache, and Manual therapy (39 studies). In addition, a search which included terms related to treatments such as physiotherapy, physical therapy, spinal manipulation was performed (25 studies). From the two searches 9 studies met the inclusion criteria and were analysed finding statistically significant results: 1) myofascial release, cervical traction, neck muscles trigger points in cervical thoracic muscles and stretching; 2) Superficial heat and massage, connective tissue manipulation and vertebral Cyriax mobilization; 3) cervical or thoracic spinal manipulation and cervical chin-occipital manual traction; 4) massage, progressive relaxation and gentle stretching, program of active exercises of shoulder, neck and pericranial muscles; 5) massage, passive rhythmic mobilization techniques, cervical, thoracic and lumbopelvic postural correction and cranio-cervical exercises; 6) progressive muscular relaxation combined with joint mobilization, functional, muscle energy, and strain/counterstrain techniques, and cranial osteopathic treatment; 7) massage focused on relieving myofascial trigger point activity; 8) pressure release and muscle energy in suboccipital muscles; 9) combination of mobilizations of the cervical and thoracic spine, exercises and postural correction. All studies used a combination of different techniques and none analyzed treatments separately, also all the studies have assessed aspects related to TTH beyond frequency and intensity of pain.
The findings from these studies showed evidence that physiotherapy with articulatory MT, combined with cervical muscle stretching and massage are effective for this disease in different aspects related with TTH. No evidence was found of the effectiveness of the techniques applied separately.
...Afficher la suiteEffects of lower body quadrant neural mobilization in healthy and low back pain populations: A systematic review and meta-analysis
03.02.17-05:59 // Catégories : Neurodynamique
Neural mobilization (NM) is widely used to assess and treat several neuromuscular disorders. However, information regarding the NM effects targeting the lower body quadrant is scarce. To determine the effects of NM techniques targeting the lower body quadrant in healthy andlow back pain (LBP) populations. Systematic review with meta-analysis. Randomized controlled trials were included if any form of NM was applied to the lower body quadrant. Pain, disability, and lower limb flexibility were the main outcomes. PEDro scale was used toassess methodological quality. Forty-five studies were selected for full-text analysis, and ten were included in the meta-analysis, involving 502 participants. Overall, studies presented fair to good quality, with a mean PEDro score of 6.3 (from 4 to 8). Five studies used healthy participants, and five targeted people with LBP. A moderate effect size (g . 0.73, 95% CI: 0.48e0.98) was determined, favoring the use of NM to increase flexibility in healthy adults. Larger effect sizes were found for the effect of NM in pain reduction (g . 0.82, 95% CI 0.56e1.08) and disability improvement (g . 1.59, 95% CI: 1.14e2.03), in people with LBP. Evidence suggests that there are positive effects from the application of NM to the lowerbody quadrant.
Specifically, NM shows moderate effects on flexibility in healthy participants, and large effects on pain and disability in people with LBP. Nevertheless, more studies with high methodological quality are necessary to support these conclusions.
...Afficher la suiteOrofacial manual therapy improves cervical movement impairment associated with headache and features of temporo-mandibular dysfunction: A randomized controlled trial
03.02.17-05:54 // Catégories : TMO
There is evidence that temporomandibular disorder (TMD) may be a contributing factor to cervicogenic headache (CGH), in part because of the influence of dysfunction of the temporomandibular joint on the cervical spine. The purpose of this randomized controlled trial was to determine whether orofacial treatment in addition to cervical manual therapy, was more effective than cervical manual therapy alone on measures of cervical movement impairment in patients with features of CGH and signs of TMD. In this study, 43 patients (27 women) with headache for more than 3-months and with some features of CGH and signs of TMD were randomly assigned to receive either cervical manual therapy (usual care) or orofacial manual therapy to address TMD in addition to usual care. Subjects were assessed at baseline, after 6 treatment sessions (3-months), and at 6-months follow-up. 38 subjects (25 female) completed all analysis at 6-months follow-up. The outcome criteria were: cervical range of movement (including the C1-2 flexion-rotation test) and manual examination of the upper 3 cervical vertebra. The group that received orofacial treatment in addition to usual care showed significant reduction in all aspects of cervical impairment after the treatment period. These improvements persisted to the 6-month followup, but were not observed in the usual care group at any point.
These observations together with previous reports indicate that manual therapists should look for features of TMD when examining patients with headache, particularly if treatment fails when directed to the cervical spine.
...Afficher la suitePertinent Dry Needling Considerations for mimimizing adverse effects - Part Two
03.02.17-05:52 // Catégories : Dry Needling/Points Trigger
Dry needling (DN) is an evidence based treatment technique that is accepted and used by physical therapists in the United States. This clinical commentary is the second in a two-part series outlining some of the pertinent anatomy and other issues that are needed for optimal utilization of this treatment modality. Part one was an overview of the thorax with a summary of reported adverse effects (AEs) and the underlying anatomy that could be used to minimize patient risk. As is the case with any intervention, the technique of dry needling has some inherent patient risk. The incidence of AEs with this procedure is typically low, ranging from zero to approximately 10 percent. Knowledge of the underlying anatomy can be a key factor associated with decreasing the likelihood of an AE. The second part of this clinical commentary goes beyond the thorax, to explore thanatomy associated with dry needling the abdomen, pelvis, and back. In the abdomen, pelvis and back, dry needling can penetrate the peritoneal cavity or adjacent organs, resulting in AEs. A physiological reactionthat is an AE secondary to a needle insertion, pain or fear, is an autonomic vasovagal response. Additionally, suggestions for dealing with the fearful patient, the obese patient, universal precautions, and other clinical considerations, are discussed. The purpose of parts one and part two of this clinical commentary is to minimize the risk of a dry needling AE.
Dry needling is an effective adjunctive treatment procedure that is within the recognized scope of practice of the physical therapist. An evidence-based implementation of the procedure must be based on a thorough understanding of the underlying anatomy and the potential risks, with risks communicated to patients via informed consent.
...Afficher la suiteEffectiveness of dry needling for chronic nonspecific neck pain: a randomized, single-blinded, clinical trial
03.02.17-05:49 // Catégories : Dry Needling/Points Trigger
Chronic neck pain attributed to a myofascial pain syndrome is characterized by the presence of muscle contractures referred to as myofascial trigger points. In this randomized, parallel-group, blinded, controlled clinical trial, we examined the effectiveness of deep dry needling (DDN) of myofascial trigger points in people with chronic nonspecific neck pain. The study was conducted at a public Primary Health Care Centre in Madrid, Spain, from January 2010 to December 2014. A total of 130 participants with nonspecific neck pain presenting with active myofascial trigger points in their cervical muscles were included. These participants were randomly allocated to receive: DDN plus stretching (n = 65) or stretching only (control group [n = 65]). Four sessions of treatment were applied over 2 weeks with a 6-month follow-up after treatment. Pain intensity, mechanical hyperalgesia, neck active range of motion, neck muscle strength, and perceived neck disability were measured at baseline, after 2 sessions of intervention, after the intervention period, and 15, 30, 90, and 180 days after the intervention. Significant and clinically relevant differences were found in favour of dry needling in all the outcomes (all P < 0.001) at both short and long follow-ups.
Deep dry needling and passive stretching is more effective than passive stretching alone in people with nonspecific neck pain. The results support the use of DDN in the management of myofascial pain syndrome in people with chronic nonspecific neck pain.
...Afficher la suiteComparing Trigger Point Dry Needling and Manual Pressure Technique for the Management of Myofascial Neck/ Shoulder Pain: A Randomized Clinical Trial
03.02.17-05:40 // Catégories : Dry Needling/Points Trigger
The aim of this study was to investigate short-term and long-term treatment effects of dry needling (DN) and manual pressure (MP) technique with the primary goal of determining if DN has better effects on disability, pain, and muscle characteristics in treating myofascial neck/shoulder pain in women. In this randomized clinical trial, 42 female office workers with myofascial neck/shoulder pain were randomly allocated to either a DN or MP group and received 4 treatments. They were evaluated with the Neck Disability Index, general numeric rating scale, pressure pain threshold, and muscle characteristics before and after treatment. For each outcome parameter, a linear mixed-model analysis was applied to reveal group-by-time interaction effects or main effects for the factor "time." No significant differences were found between DN and MP. In both groups, significant improvement in the Neck Disability Index was observed after 4 treatments and 3 months (P < .001); the general numerical rating scale also significantly decreased after 3 months. After the 4-week treatment program, there was a significant improvement in pain pressure threshold, muscle elasticity, and stiffness. Both treatment techniques lead to short-term and long-term treatment effects. Dry needling was found to be no more effective than MP in the treatment of myofascial neck/shoulder pain.
...Afficher la suitePertinent Dry Needling Considerations for mimimizing adverse effects - Part One
03.02.17-05:33 // Catégories : Dry Needling/Points Trigger
Dry needling is an evidence-based treatment technique that is accepted and used by physical therapists in the United States. This treatment approach focuses on releasing or inactivating muscular trigger points to decrease pain, reduce muscle tension, and assist patients with an accelerated return to active rehabilitation. While commonly used, the technique has some patient risk and value of the treatment should be based on benefit compared to the potential risk. Adverse effects (AEs) with dry needling can be mild or severe, with overall incidence rates varying from zero to rates of approximately 10 percent. While mild AEs are the rule, any procedure that involves a needle insertion has the potential for an AE, with select regions and the underlying anatomy increasing the risk. Known significant AEs from small diameter needle insertion include pneumothorax, cardiac tamponade, hematoma, infection, central nervous system injury, and other complications. Underlying anatomy across individuals has variability, requiring an in-depth knowledge of anatomy prior to any needle placement. This commentary is an overview of pertinent anatomy in the region of the thorax, with a 'part two' that addresses the abdomen, pelvis, back, vasovagal response, informed consent and other pertinent issues. The purpose of the commentary is to minimize the risk of a dry needling AE. Dry needling is an effective adjunct treatment procedure that is within the recognized scope of physical therapy practice. Physical therapy education and training provides practitioners with the anatomy, basic sciences, and clinical foundation to use this intervention safely and effectively. A safe and evidenced-based implementation of the procedure is based on a thorough understanding of the underlying anatomy and the potential risks, with risks coordinated with patients via informed consent.
...Afficher la suiteDry needling of the trapezius muscle in office workers with neck pain: a randomized clinical trial
03.02.17-05:23 // Catégories : Dry Needling/Points Trigger
Neck pain is a frequent complaint in office workers. This pain can be caused by myofascial trigger points (MTrPs) in the trapezius muscle. This study aimed to determine the effectiveness of deep dry needling (DDN) of active MTrPs in the trapezius muscle. A randomized, single blinded clinical trial was carried out at the Physical Therapy Department at Physiotherapy in Women's Health Research Group at Physical Therapy Department of University of Alcalá, in Alcalá de Henares, Madrid, Spain. Forty-four office workers with neck pain and active MTrPs in the trapezius muscle were randomly allocated to either the DDN or the control group (CG). The participants in the DDN group were treated with DDN of all MTrPs found in the trapezius muscle. They also received passive stretch of the trapezius muscle. The CG received the same passive stretch of the trapezius muscle only. The primary outcome measure was subjective pain intensity, measured using a visual analogue scale (VAS). Secondary outcomes were pressure pain threshold (PPT), cervical range of motion (CROM) and muscle strength. Data were collected at baseline, after interventions and 15 days after the last treatment. Differences were found between the DDN group and the CG for the VAS (P < 0.001), PPT (P < 0.001), range of motion (AROM) (P < 0.05) and strength (P < 0.05) after intervention and at the 15-day follow-up. Deep dry needling and passive stretch seems to be more effective than passive stretch only. The effects are maintained in the short term. The results support the use of DDN in the management of trapezius muscle myofascial pain syndrome in neck pain
...Afficher la suiteRelationship of the Lateral Rectus Muscle, the Supraorbital Nerve, and Binocular Coordination with Episodic Tension-Type Headaches Frequently Associated with Visual Effort.
02.02.17-05:52 // Catégories : Points Trigger/Neurodynamique
To study the relationship between tension-type headaches and the oculomotor system in terms of binocular coordination, mechanosensitivity of the supraorbital nerve, and myofascial trigger points in the lateral rectus muscle, assessing the influence of visual effort caused by using a computer at work. Observational study with blind evaluation of the response variable. Two groups were compared: 19 subjects with tension-type headaches and 16 healthy subjects, both exposed to computer use at work. A blinded assessor conducted three tests: measurement of the supraorbital nerve pressure pain threshold using a pressure algometer, evaluation of myofascial trigger points of the lateral rectus using the verbal numerical scale, and assessment of binocular coordination in smooth pursuit eye movements using an innovative video-oculography system. Tests were performed before work began and four hours later, and subjects in the headache group were examined when they presented a headache score of less than or equal to 3 on the verbal numerical scale. The headache group presented a greater sensitivity of the supraorbital nerve and greater local and referred pain of the lateral rectus (P < 0.05). Visual effort caused a significant worsening of these variables in both groups. However, binocular coordination after visual effort was only significantly affected in the headache group (P < 0.05), primarily in horizontal movements.
The finding of a higher alteration of the sensitivity of the supraorbital nerve, the myofascial trigger points of the lateral rectus, binocular coordination, and the significant influence of visual effort in patients with tension-type headaches suggest a new clinical perspective for problems related to tension-type headaches.
...Afficher la suiteInterrater Agreement of Manual Palpation for Identification of Myofascial Trigger Points: A Systematic Review and Meta-Analysis
01.02.17-09:50 // Catégories : Points Trigger
To achieve a statistical estimate of the agreement of manual palpation for identification of myofascial trigger points (MTrPs) and secondarily to investigate potential factors impacting the agreement of this technique. We searched MEDLINE(R) and Embase for studies examining the reproducibility of manual palpation for the identification of MTrPs from the year 2007 to present. In addition, we utilized studies identified by 2 comprehensive systematic reviews that covered the period before 2007. The included studies were original peer-reviewed research articles and included Cohen κ measures or data with which to calculate Cohen κ. Studies were excluded if they lacked a measure of variability or information required to calculate variability. Studies that examined palpation through body cavities were also excluded. Of the 18 potentially relevant articles only 6 met inclusion criteria including 363 patients. Modified QUADAS tool was used to assess study validity. Subgroup comparisons were made utilizing Q and Z tests. An estimate of κ=0.452 (95% confidence interval, 0.364-0.540) was obtained for interrater agreement of manual palpation of MTrPs. Localized tenderness (κ=0.676) and pain recognition (κ=0.575) were the most reliable criteria. Only 1 study met inclusion criteria for intrarater agreement and therefore no meta-analysis was performed.
Use of manual palpation for identification of MTrPs is unreliable, and future investigation should focus on integration with more reliable techniques.
...Afficher la suitePrevalence, Incidence, Localization, and Pathophysiology of Myofascial Trigger Points in Patients With Spinal Pain: A Systematic Literature Review.
01.02.17-09:50 // Catégories : Points Trigger
A systematic review was performed to evaluate the existing evidence related to the prevalence, incidence, localization, and pathophysiology of myofascial trigger points (MTrPs) in patients with spinal (back and neck) pain. A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed in 2 electronic databases (PubMed and Web of Science) using predefined keywords regarding MTrPs and spinal pain. A "PICOS" questionnaire was used to set up the search strategies and inclusion criteria. Full-text reports concerning MTrPs in patients with back or neck pain, which described their prevalence, incidence, location, or underlying physiopathology were included and screened for methodological quality by 3 independent researchers. Each study was assessed for risk of bias using a checklist derived from the Web site of the Dutch Cochrane Centre. Fourteen articles were retrieved for quality assessment and data extraction. Studies reporting the incidence of MTrPs in patients with spinal pain were lacking. Within spinal pain, patients with neck pain were found to have the highest prevalence rates of MTrPs. The trapezius descendens, levator scapulae, and suboccipitales muscles were the most prevalent locations for active MTrPs in patients with neck pain. Latent MTrPs were present in asymptomatic people, but no significant differences were found in the prevalence rate of latent MTrPs between patients with spinal (neck) pain and healthy controls. The only study investigating prevalence of MTrPs in different localizations of the same muscle reported no significant differences in prevalence between active and latent MTrPs within the trapezius descendens muscle. Studies examining pathophysiological mechanisms underlying MTrPs demonstrated an acidic environment, high concentration of algogenic/inflammatory substances, stiffer muscle tissue, retrograde diastolic blood flows, spontaneous muscle activity at rest, and loss of muscle contractibility in muscles with MTrPs. Altered central processing was also found to play a role in the development of MTrPs. Myofascial trigger points are a prevalent clinical entity, especially in patients with neck pain.
Evidence was not found to support or deny the role of MTrPs in other spinal pain. Compelling evidence supports local mechanisms underlying MTrPs. Future research should unravel the relevance of central mechanisms and investigate the incidence of MTrPs in patients with spinal pain.
...Afficher la suitePrevalence of Myofascial Trigger Points in Spinal Disorders: A Systematic Review and Meta-Analysis.
01.02.17-09:50 // Catégories : Points Trigger
To retrieve, appraise, and synthesize the results of studies on the prevalence of active and latent myofascial trigger points (MTrPs) in subjects with spinal pain disorders. The databases PubMed, Embase, and CINAHL were searched, with no date or language restrictions. Search terms included controlled and free-text terms for spinal disorders and MTrPs. Further searches were conducted in Google Scholar and by contacting 3 experts in the field. Citation tracking of eligible studies was performed. Two reviewers independently selected observational studies assessing the prevalence of active and/or latent MTrPs in at least 1 group of adults with a spinal disorder. Twelve studies met the eligibility criteria. Methodologic quality was assessed by 2 reviewers independently using a modified version of the Downs and Black checklist. Two reviewers also used a customized form to extract studies and subjects' characteristics and the proportions of subjects with active and/or latent MTrPs in each muscle assessed. A meta-analysis was performed when there was sufficient clinical homogeneity in at least 2 studies for the same spinal disorder. The Grading of Recommendations Assessment, Development and Evaluation approach was used to rate the body of evidence in each meta-analysis. A qualitative description of the results of single studies was provided. Low-quality evidence underpinned pooled estimates of MTrPs in the upper-body muscles of subjects with chronic neck pain. The point prevalence of MTrPs in different muscles of other disorders (eg, whiplash-associated disorders, nonspecific low back pain) was extracted from single studies with low methodologic quality and small samples. Active MTrPs were found to be present in all assessed muscles of subjects diagnosed with different spinal pain disorders. Latent MTrPs were not consistently more prevalent in subjects with a spinal disorder than in healthy controls.
The MTrPs point prevalence estimates in this review should be viewed with caution because future studies with large samples and high methodologic quality are likely to change them substantially.
...Afficher la suiteInterrater Reliability in the Clinical Evaluation of Myofascial Trigger Points in Three Ankle Muscles.
01.02.17-09:50 // Catégories : Points Trigger
The purpose of this study was to evaluate interrater reliability in the diagnosis of myofascial trigger points (MTrPs) in the tibialis anterior, peroneus brevis, and extensor digitorum longus muscles. A reliability research study was performed. Three physical therapists with clinical experience in myofascial pain functioned as raters and randomly and bilaterally evaluated the ankles of 40 subjects in the Madrid public health care system. The absence or presence of MTrPs, nodules in taut bands, patterns of referred pain, local twitch response (LTR), and jump-sign were evaluated. We calculated the pairwise interrater agreement and κ-value concordance of the presence or absence of trigger points (55%-85%; κ = 0.12-0.60), palpable nodules in taut bands (63%-90%; κ = 0.24-0.60), referred pain (63%-85%; κ = 0.20-0.54), and jump sign (62%-89%; κ = 0.15-0.72) in the 3 studied muscles. The LTR could only be evaluated in the tibialis anterior (43%-70%; κ = 0.05-0.21), and evaluation was not possible for the other muscles. Three blinded raters were able to reach acceptable pairwise interrater agreement (percentage of agreement value ≥70%) for the presence or absence of MTrPs and LTR in the tibialis anterior, as well as for nodules in taut bands, referred pain, and the jump sign for the extensor digitorum longus. The peroneus brevis showed a wide percentage of agreement value, ranging from 31% to 82%.
The results of this study showed that expert raters can agree, with slight-to-moderate concordance, with regard to the clinical testing of muscle trigger points by direct palpation of the 3 muscles studied: the tibialis anterior, the extensor digitorum longus, and the peroneus brevis. Interrater reliability seems to be muscle dependent, especially with regard to the depth of the muscle.
...Afficher la suiteThe Prevalence of Latent Trigger Points in Lower Limb Muscles in Asymptomatic Subjects.
01.02.17-09:21 // Catégories : Points Trigger
Latent trigger points (LTrPs) are prevalent in persons with musculoskeletal pain. Because they could be present in healthy persons, it is necessary to evaluate the prevalence of LTrPs in asymptomatic subjects.To assess the prevalence of LTrPs in lower limb muscles, to evaluate the relationship between LTrP prevalence, gender, and leg dominance, and to determine intra-rater reliability for the diagnosis of LTrPs.A total of 206 asymptomatic subjects (113 women and 93 men, aged 23.2 ± 5.2 years). The prevalence of the LTrPs located in the gastrocnemius, soleus, peroneus longus, peroneus brevis, tibialis anterior, extensor digitorum longus, flexor digitorum longus, rectus femoris, vastus medialis, and vastus lateralis was studied, using the diagnosis criteria recommended by Simons, Travell, and Simons. The pressure pain threshold was also evaluated. Of the 206 subjects evaluated, 166 (77.7%; 95% confidence interval [CI], 72-83.4) were found to have at least one LTrP in the lower limb muscles. The average number of LTrPs found per individual was 7.5 ± 7.7. The prevalence in each muscle group ranged from 19.9% (95% CI, 14.4-25.4) to 37.4% (95% CI, 30.8-44), with gastrocnemius LTrPs being the most prevalent. Women had more LTrPs (9.6 ± 7.8) than did men (4.9 ± 6.6) (P < .01). No relationship was found between the LTrPs and leg dominance (P > .05). The most prevalent diagnosis criteria were the presence of a taut band and a tender spot (98%-100%); the local twitch response was the least prevalent diagnosis criteria (0%-3.5%). Intra-rater reliability was excellent for all the diagnosis criteria in all the muscles evaluated (κ = 0.762-1), except for the jump sign and the referred pain in several LTrPs. LTrPs were prevalent in the lower limb muscles of asymptomatic subjects. Women have more LTrPs than do men. No differences in LTrP prevalence were found between sides.
The presence of the taut band and the tender spot were the most prevalent and reliable diagnosis criteria. It is necessary to determine if the evaluation of LTrPs in the lower limb muscles of asymptomatic subjects has clinical relevance.
...Afficher la suiteCervical flexion-rotation test and physio-logical range of motion - A comparative study of patients with myogenic temporo-mandibular disorder versus healthy subjects
01.02.17-09:13 // Catégories : TMO
Temporomandibular Disorders (TMD) refer to several common clinical disorders whichinvolve the masticatory muscles, the temporomandibular joint (TMJ) and the adjacent structures. Although neck signs and symptoms are found with higher prevalence in TMD patients compared to the overall population, whether limitation of cervical mobility is an additional positive finding in this cohort is still an open question. To compare the physiological cervical range of motion (CROM) and the extent of rotation during cervical flexion (flexion-rotation test, FRT) in people with TMD (muscular origin) and healthy control subjects. The range of motion of the neck and FRT was measured in 20 women with myogenic TMD and 20 age matched healthy controls. Women with myogenic TMD had significantly lower FRT scores compared to their matched healthy women. No difference was found between groups in CROM in any of the planes of movement. The FRT was positive (less than 32) in 90% of the TMD participants versus 5% in the healthy control but the findings were not correlated with TMD severity.
The results point out a potential involvement of the upper cervical joints (C1-C2) in women with myogenic TMD.
...Afficher la suiteInter-examiner Classification Reliability of Mechanical Diagnosis and Therapy for Extremity Problems - Systematic review
01.02.17-09:05 // Catégories : TMO
Mechanical Diagnosis and Therapy (MDT) is used in the treatment of extremity problems. Classifying clinical problems is one method of providing effective treatment to a target population. Classification reliability is a key factor to determine the precise clinical problem and to direct an appropriate intervention. To explore inter-examiner reliability of the MDT classification for extremity problems in three reliability designs: 1) vignette reliability using surveys with patient vignettes, 2) concurrent reliability, where multiple assessors decide a classification by observing someone's assessment, 3) successive reliability, where multiple assessors independently assess the same patient at different times. Systematic review with data synthesis in a quantitative format. Agreement of MDT subgroups was examined using the Kappa value, with the operational definition of acceptable reliability set at _ 0.6. The level of evidence was determined considering the methodological quality of the studies. Six studies were included and all studies met the criteria for high quality. Kappa values for the vignette reliability design (five studies) were _ 0.7. There was data from two cohorts in one study for the concurrent reliability design and the Kappa values ranged from 0.45 to 1.0. Kappa values for the successive reliability design (data from three cohorts in one study) were < 0.6.
The current review found strong evidence of acceptable inter-examiner reliability of MDT classification for extremity problems in the vignette reliability design, limited evidence of acceptable reliability in the concurrent reliability design and unacceptable reliability in the successive reliability design.
...Afficher la suiteDoes altered mandibular position and dental occlusion influence upper cervical movement: A cross-sectional study in asymptomatic people
01.02.17-08:08 // Catégories : TMO
