The immediate effect of plantar stimulation on dynamic and static balance: A randomized controlled trial.

OBJECTIVE: To examine the immediate effect on dynamic and static balance of a manual protocol of plantar stimulation in healthy subjects. MATERIALS AND METHOD: Of the 144 healthy and physically active volunteers recruited, 98 subjects participated. Subjects were randomly assigned and allocated to the experimental group (EG) (n= 50), in which a 10-min manual protocol of plantar stimulation was applied on the right foot, or to the control group (CG) (n= 48). The change scores of the modified Star Excursion Balance Test (mSEBT) and the Unipedal Stance Test (UPST) were used to assess the immediate effect of the protocol on dynamic and static balance, respectively. RESULTS: In the dynamic balance, a group effect was found in the anterior direction, posteromedial direction and composite scores of the mSEBT when groups were compared by limb. Changes in the posteromedial direction of both limbs (right limb: p= 0.002, left limb: p= 0.05) and composite score of the right limb (p= 0.009) were significantly greater in the EG versus the CG. Non-significant results were found in the static balance (UPST time). CONCLUSIONS: The application of a 10-minute manual stimulation protocol without joint mobilization, addressed to stimulate the plantar cutaneous mechanoreceptors, could elicit benefits on dynamic balance. This improvement was observed bilaterally even though only one plantar surface was stimulated. As balance deficits may impair functional movements and regular training in sports, this intervention aims to ameliorate dynamic balancing ability could improve the functional recovery of sport gestures.

Analysis of the upper cervical spine stiffness during axial rotation: A comparative study among patients with tension-type headache or migraine and asymptomatic subjects.

BACKGROUND: Many studies reported the implication of the cervical musculoskeletal system in patients with tension type headache and migraine. The objective of this study is to investigate the upper cervical spine stiffness features in axial rotation among headache patients in comparison with a healthy population. METHODS: 48 subjects including 30 migraine patients with/without aura and 18 patients with tension-type headache, aged between 18 and 60years (mean 36, SD 11years) have been evaluated. Stiffness measurements were carried out for passive axial rotation using a torque meter device. The flexion-rotation test was used to emphasize assessment of the upper cervical spine. FINDINGS: Neither the stiffness nor the neutral zone varies between different populations studied. Passive range of motion in axial rotation is unilaterally reduced in symptomatic subjects (p=0.001). Considering the elastic zone, right and left motion magnitude was significantly lower for clinical groups compared to the control group. INTERPRETATION: Stiffness seems not to be altered among tension type headache and migraine patients. However, patients seem prone to display a larger right-left asymmetry of axial rotation and a reduction in the motion range tolerance, emphasizing the likely link between the cervical discomfort and these pathologies. Any difference is observed in the elastic behavior of the upper cervical spine between the two primary headache populations. However, further investigations are needed to confirm these previous results taking various specific clinical characteristics into consideration.

Effect of manual therapy techniques on headache disability in patients with tension-type headache. Randomized controlled trial.

BACKGROUND: Tension-type headache (TTH) is the most common type of primary headache however there is no clear evidence as to which specific treatment is most effective or whether combined treatment is more effective than individual treatments. AIM: To assess the effectiveness of manual therapy techniques, applied to the suboccipital region, on aspects of disability in a sample of patients with tension-type headache. DESIGN: Randomized Controlled Trial. SETTING: Specialized centre for headache treatment. POPULATION: Seventy-six (62 women) patients (age: 39.9 ± 10.9 years) with episodic chronic TTH. METHODS: Patients were randomly divided into four treatment groups: 1) suboccipital soft tissue inhibition; 2) occiput-atlas-axis manipulation; 3) combined treatment of both techniques; 4) control. Four sessions were applied over 4 weeks and disability was assessed before and after treatment using the Headache Disability Inventory (HDI). Headache frequency, severity and the functional and emotional subscales of the questionnaire were assessed. Photophobia, phonophobia and pericranial tenderness were also monitored. RESULTS: Headache frequency was significantly reduced with the manipulative and combined treatment (P<0.05), and the severity and functional subscale of the HDI changed in all three treatment groups (P<0.05). Manipulation treatment also reduced the score on the emotional subscale of the HDI (P<0.05). The combined intervention showed a greater effect at reducing the overall HDI score compared to the group that received suboccipital soft tissue inhibition and to the control group (both P<0.05). In addition, photophobia, phonophobia and pericranial tenderness only improved in the group receiving combined therapy (P<0.05). CONCLUSION: When given individually, suboccipital soft tissue inhibition and occiput-atlas-axis manipulation resulted in changes in different parameters related to the disability caused by TTH. However, when the two treatments were combined, effectiveness was noted for all aspects of disability and other symptoms including photophobia, phonophobia and pericranial tenderness. CLINICAL REHABILITATION IMPACT: Although individual manual therapy treatments showed a positive change in headache features, measures of photophobia, photophobia and pericranial tenderness only improved in the group that received the combined treatment suggesting that combined treatment is the most appropriate for symptomatic relief of TTH.

Short-term changes in median nerve neural tension after a suboccipital muscle inhibition technique in subjects with cervical whiplash: a randomised controlled trial.

OBJECTIVES: To assess the immediate effect of a suboccipital muscle inhibition (SMI) technique on: (a) neck pain, (b) elbow extension range of motion during the upper limb neurodynamic test of the median nerve (ULNT-1), and (c) grip strength in subjects with cervical whiplash; and determine the relationships between key variables. DESIGN: Randomised, single-blind, controlled clinical trial. SETTING: Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Spain. PARTICIPANTS: Forty subjects {mean age 34 years [standard deviation (SD) 3.6]} with Grade I or II cervical whiplash and a positive response to the ULNT-1 were recruited and distributed into two study groups: intervention group (IG) (n=20) and control group (CG) (n=20). INTERVENTIONS: The IG underwent the SMI technique for 4minutes and the CG received a sham (placebo) intervention. Measures were collected immediately after the intervention. MAIN OUTCOME MEASURES: The primary outcome was elbow range of motion during the ULNT-1, measured with a goniometer. The secondary outcomes were self-perceived neck pain (visual analogue scale) and free-pain grip strength, measured with a digital dynamometer. RESULTS: The mean baseline elbow range of motion was 116.0° (SD 10.2) for the CG and 130.1° (SD 7.8) for the IG. The within-group comparison found a significant difference in elbow range of motion for the IG [mean difference -15.4°, 95% confidence interval (CI) -20.1 to -10.6; P=0.01], but not for the CG (mean difference -4.9°, 95% CI -11.8 to 2.0; P=0.15). In the between-group comparison, the difference in elbow range of motion was significant (mean difference -10.5°, 95% CI -18.6 to -2.3; P=0.013), but the differences in grip strength (P=0.06) and neck pain (P=0.38) were not significant. CONCLUSION: The SMI technique has an immediate positive effect on elbow extension in the ULNT-1. No immediate effects on self-perceived cervical pain or grip strength were observed.

Técnica semidirecta de thrust para una disfunción en rotación del atlas, con contacto indexial / Semidirect thrust technique for rotation disorder in the atlas with index finger contact

Debido a sus grandes diferencias, anatómicas y funcionales, el estudio de la región craneocervical se separa del resto de la columna cervical. El complejo craneocervical se considera responsable de signos y síntomas muy diferentes a los que encontramos en el raquis cervical inferior, como por ejemplo vértigos, cefaleas de distinto origen, etc. El objetivo de la técnica de thrust para una disfunción en rotación del atlas con contacto indexial es devolver la movilidad y funcionalidad a la vértebra. Es importante dominar los principios básicos de realización de la técnica para poder aplicar una correcta intervención terapéutica tras haber descartado los posibles riesgos de la manipulación (AU)

Due to the large anatomical and functional differences, the study of the craniocervical region is separated from the rest of the cervical column. The craniocervical junction is considered as responsible for very different signs and symptoms to those we find in the inferior cervical spine, such as for example vertigo, headaches with different origins, etc. The objective of the thrust technique for an atlas rotation disorder with index finger contact is to return mobility and functionality to the vertebra. It is important to master the basic principles of performing the technique to be able to apply the correct therapeutic procedure after having ruled out the possible risks of manipulation (AU)

Tratamiento osteopático mediante la técnica manipulativa occipucio-atlas-axis y de inhibición de suboccipitales en la cefalea tensional / Technique in the osteopathic treatment of patients with tension-type headache atlanto-occipital joint manipulation and suboccipital inhibition

Introducción: La cefalea tensional tiene una elevada prevalencia, con repercusión en el ámbito laboral y social de los sujetos que la padecen. Objetivo: Evaluar la eficacia de varias intervenciones con terapia osteopática en pacientes con cefalea tensional. Material y Métodos: Se ha llevado a cabo un estudio a doble ciego, aleatorio, con 76 pacientes (81,6% mujeres) diagnosticados de cefalea tensional (edad media 39,9±10,9 años), distribuidos en cuatro grupos de estudio, integrados por 19 pacientes cada uno de ellos (tres grupos experimentales y un grupo de control). Los tratamientos aplicados a los grupos experimentales incluyen terapia osteopática con: 1) técnica de inhibición de suboccipitales (IS); 2) técnica manipulativa de occipucio-atlas-axis (OAA); 3) la combinación de ambas (IS+OAA). Se aplicaron 4 sesiones, (1 por semana), y seguimiento a los 30 días. Se evaluó antes, después del tratamiento y en el seguimiento, la movilidad cervical, el impacto producido por el dolor y la frecuencia e intensidad del dolor. Resultados: El grupo IS mejoró significativamente en el impacto del dolor (p=0,02). Los grupos OAA y IS+OAA, mejoraron en impacto e intensidad del dolor (p<0,001 a p=0,05), y en flexión y extensión suboccipital (p<0,001 a p=0,04). El grupo OAA mejoró también en las rotaciones cervicales (p=0,008 a p=0,007). El grupo IS+OAA obtuvo resultados significativos en la frecuencia e intensidad del dolor (p<0,001 a p=0,05). Conclusiones: Los tres tratamientos aplicados son eficaces en el impacto del dolor y en la intensidad del dolor. El tratamiento OAA es el más eficaz en la ganancia de la movilidad cervical, seguido del tratamiento IS. El tratamiento combinado IS+OAA, resulta más eficaz en la reducción de la frecuencia e intensidad del dolor (AU)

Introduction: The tension-type headache is extremely common, and has repercussions in both the work environment and the social life of the people who suffer from them. Objectives: To evaluate the efficiency of two manual therapy treatments in patients with tension-type headaches. Material and Methods: A random, double-blind trial was undertaken, with seventy-six (n=76) patients (81.6% women) diagnosed with tension-type headache (39.9 ± 10.9 years), distributed in four groups (n=19 each one), three experimental groups and one control group (without intervention). Interventions in experimental groups included osteopathic manual therapy with: 1) Suboccipital soft tissue Inhibition Technique (SIT); 2) Occiput-Atlas-Axis global manipulation (OAA); 3) The combination of both (SIT+OAA). Treatments were applied during four sessions (one per week), with follow-up at 30 days. Patients were evaluated before and after treatment and during follow-up, by monitoring cervical mobility, the impact of pain and the frequency and intensity of the headache. Results: The SIT group significantly improved the impact of the pain (p=0.02). The OAA group and the SIT+OAA group, improved the headache impact and intensity (p<0.001 to p=0.05), and suboccipital flexion and extension (p<0.001 to p=0.04). The OAA group also improved cervical rotations (p=0.008 to p=0.007). The SIT+OAA group obtained significant results in the frequency and intensity of the pain (p<0.001 to p=0.05). Conclusions: The three treatments applied were effective in the impact of headache and in pain intensity. The OAA treatment is the most effective in increasing cervical mobility, followed by the SIT treatment. The combined treatment SIT +OAA was the most effective in reducing the frequency and the intensity of the pain caused by tension-type headache(AU)

Efectos de un programa de ejercicios oculocervicales en adultos en la movilidad cervical / Effects of an oculo-cervical exercise program in adults on cervical spine mobility

IntroducciónLa orientación de la cabeza en el espacio y la postura, requieren del sistema visual, vestibular y propioceptivo. Tanto los ejercicios cervicales como oculares son importantes en el mantenimiento de esta dinámica cervical, disminuida por lo general por la edad, los movimientos y posturas incorrectas.ObjetivoEvaluar la ganancia articular en la región cervical tras un programa de ejercicios específicos oculocervicales en adultos.Material y métodoVeinticinco mujeres sanas fueron asignadas de forma aleatoria a un programa específico oculocervical y a un grupo control con una duración de un mes a razón de dos sesiones semanales. Se utilizó un goniómetro cervical (CROM) para la valoración de los resultados, al inicio y al final de cada sesión.ResultadosLa flexión suboccipital presentó cambios significativos en el grupo experimental (p=0,036) tras la aplicación del bloque de ejercicios oculares. En cuanto al efecto del programa de ejercicios oculocervicales durante las 4 semanas, se encontraron cambios significativos atendiendo al factor tiempo y grupo en los rangos de flexión (p=0,000) y extensión suboccipital (p=0,041), rotación cervical derecha (p=0,000) e izquierda (p=0,000), e inclinación cervical izquierda (p=0,027). Estas mejorías se dieron en el grupo experimental.ConclusiónLos ejercicios oculares influyen en la movilidad cervical. El programa de ejercicios oculares y cervicales planteado presenta evidencia de mejora en el rango articular cervical en la mayor parte de los movimientos evaluados. A pesar de la disminución de estos valores durante la última semana tras el cese del tratamiento, se conserva este aumento con respecto al momento inicial (AU)

Introduction: The proprioceptive, vestibular and visual systems are necessary for head in spaceorientation and posture. Both cervical spine and ocular exercises are important for the maintenanceof this cervical spine kinematics, which is usually reduced with age, incorrect posturesand movements.Objective: To evaluate the improvement in cervical range of motion after a program of oculocervicalspecific exercises in adults.Material and methods: Twenty-five healthy women were randomly assigned to a program ofoculo-cervical specific exercises and a control group, with 2 sessions per week, for one month. Acervical range of motion (CROM) goniometer was used to assess the results, with measurementsat the beginning and at the end of each session.Results: Suboccipital flexion showed significant changes in the treatment group (P = 0.0036)after application of the ocular exercise program.As for the effect of the oculo-cervical exerciseprogram during the four-week period, significant changes were found considering time andgroup factors for the ranges of suboccipital flexion (P = 0.000) and extension (P = 0.041), rightcervical rotation (P = 0.000) and left cervical rotation (P = 0.027).Conclusion: Ocular exercises have an influence on cervical spine mobility. The proposed programof cervical and ocular exercises shows evidence of improvement in cervical range ofmotion, for the majority of the movements assessed. Despite the decrease of these valuesduring the last week after the end of the treatment, the increase compared to the baselinelevel is maintained (AU)

Eficacia del tratamiento en la cefalea tensional / Efficacy of the treatment in tension-type headache

Objetivos Conocer los tratamientos más eficaces para el alivio de la cefalea tensional crónica.Material y métodosSe llevó a cabo una revisión sistemática en las bases de datos de MEDLINE, PEDro, Cochrane y CINAHL, que incluyó ensayos controlados aleatorios y metaanálisis, con pacientes adultos y un número de sujetos no inferior a 15, con cefaleas tensionales y no migrañas o secundarias a otras patologías. Estudios publicados desde enero de 1998 hasta octubre de 2008, en lengua inglesa, con las palabras "effectiveness", "tension-type headache" y "treatment". En esta primera búsqueda se localizaron y revisaron 81 estudios. Posteriormente, se incluyeron en la búsqueda los términos relativos a los tratamientos: "pharmacology", "botulinum toxin A", "manual therapy", "physiotherapy", "physical therapy", "psychological", "osteophathy", "chiropractic" y "cupuncture". Tras esta búsqueda, se localizaron y revisaron 80 estudios más. Finalmente, se analizaron 15 estudios que, procedentes de ambas búsquedas, reunieron los criterios de inclusión de este estudio.ResultadosLos 15 estudios analizados incluyeron tratamientos con toxina botulínica, antidepresivos, antidepresivos y terapia de control de estrés, cinesiterapia, cinesiterapia y masaje o relajación, masaje, fisioterapia manipulativa y cinesiterapia, tejido conectivo, masaje y calor, osteopatía y relajación muscular, osteopatía craneal, quiropraxia y acupuntura.ConclusionesEl tratamiento con toxina botulínica es el más utilizado entre los médicos, aunque existe una importante controversia sobre su eficacia. El tratamiento de fisioterapia más eficaz consiste en la manipulación vertebral combinado con estiramientos de la musculatura cervical y masaje. El tratamiento farmacológico más efectivo son los antidepresivos tricíclicos(AU)

Objectives To identify the most effective treatments for chronic tension-type headache relief.Material and methodsA systematic review was conducted in MEDLINE, PEDro, Cochrane and CINAHL databases. It included randomized controlled trials and meta-analysis with adult patients and a minimum of 15 subjects, with tension-type headache that were not migraines or headache secondary to other conditions. We selected studies published from January 1998 to October 2008, in English, including the terms Effectiveness, Tension-type headache, and Treatment. In this first search, 81 studies were found and reviewed. Subsequently, specific terms related to treatment—Pharmacology, Botulinum toxin A, Manual therapy, Physiotherapy, Physical therapy, Psychological, Osteopathy, Chiropractic and Acupuncture were included in our search. After this second search, 80 more studies were found and reviewed. Finally, 15 studies were found to meet the inclusion criteria and were selected to be analyzed in the present study.ResultsThe 15 studies analyzed include treatments with botulinum toxin, antidepressants, antidepressants and stress control therapy, kinesitherapy, kinesitherapy and massage or relaxation therapy, massage, kinesitherapy and manipulative physiotherapy, connective tissue therapy, massage and heat therapy, osteopathy muscular relaxation, cranial osteopathy, chiropractic and acupuncture.ConclusionsTreatment with botulinum toxin is the most frequently used among doctors, although there is significant controversy about its effectiveness. The most effective physiotherapy treatment consists of spinal manipulation, combined with cervical muscle stretching and massage. Tricyclic antidepressants are the most effective pharmacological treatment(AU)