Exploring temporal congruence in motor imagery and movement execution in non-specific chronic low back pain.

Chronic non-specific low back pain (NSCLBP) is linked to sensorimotor dysfunctions and altered motor planning, likely due to neuroplastic changes. Motor imagery (MI) and movement execution share neural pathways, but the relationship between imagined and executed movements in NSCLBP patients remains underexplored. This study aimed to assess the temporal congruence between imagined and executed movements in NSCLBP sufferers, with secondary goals of investigating group differences in movement chronometry, psychological well-being, and disability, as well as possible correlations among these factors. Fifty-six participants, including 28 NSCLBP patients and 28 asymptomatic subjects (AS), performed lumbar flexion and Timed Up and Go (TUG) tasks. NSCLBP patients showed significant temporal incongruence in both tasks, executing movements more slowly than imagined, whereas AS displayed incongruence only in the TUG task. NSCLBP patients also took longer to imagine and execute lumbar flexion movements compared to AS, with correlations observed between execution delays, higher disability, and greater fear of movement. The findings highlight a lack of temporal congruence in NSCLBP patients, especially in lumbar flexion, emphasizing the complex relationship between chronic pain, motor ability, and psychological factors. These results suggest that integrated treatment approaches addressing cognitive and emotional aspects are crucial for managing NSCLBP.

Neuromuscular Responses and Perceptions of Health Status and Pain-Related Constructs in End-Stage Knee Osteoarthritis During Resistance Training With Blood Flow Restriction.

ABSTRACT: Ogrezeanu, DC, López-Bueno, L, Sanchís-Sánchez, E, Carrasco, JJ, Cuenca-Martínez, F, Suso-Martí, L, López-Bueno, R, Cruz-Montecinos, C, Martinez-Valdes, E, Casaña, J, and Calatayud, J. Neuromuscular responses and perceptions of health status and pain-related constructs in end-stage knee osteoarthritis during resistance training with blood flow restriction. J Strength Cond Res 38(4): 762-772, 2024-We aimed to evaluate the neuromuscular responses and their relationship with health status, kinesiophobia, pain catastrophizing, and chronic pain self-efficacy in patients with end-stage knee osteoarthritis during acute resistance training with different levels of blood flow restriction (BFR). Seventeen patients with end-stage knee osteoarthritis participated in 3 experimental sessions separated by 3 days, performing 4 sets of knee extensions with low load and 3 levels of concurrent BFR performed in a random order: control (no BFR), BFR at 40% arterial occlusion pressure (AOP), and BFR at 80% AOP. Normalized root-mean-square (nRMS), nRMS spatial distribution (centroid displacement, modified entropy, and coefficient of variation), and normalized median frequency (nFmed) were calculated from the vastus medialis (VM) and lateralis (VL) using high-density surface electromyography. Subjects were asked to report adverse effects after the sessions. In the VM, nRMS was higher with 80% AOP than with 40% AOP ( p = 0.008) and control ( p < 0.001), whereas there were no differences between conditions in the VL. Normalized root-mean-square also showed an association with pain catastrophizing, chronic pain self-efficacy, and health status (VM: -0.50, 0.49, -0.42; VL: -0.39, 0.27, -0.33). Spatial distribution varied between conditions but mostly in the VL. Overall, nFmed did not vary, with only a slight increase in the VL with 40% AOP, between set 3 and 4. BFR during knee extensions at 80% AOP increases VM activity and VL amplitude distribution more than 40% AOP and control. Importantly, muscle activity increases are modulated by pain catastrophizing, chronic pain self-efficacy, and health status in these patients, and kinesiophobia seems to especially modulate entropy.

Effects of therapeutic exercise in primary dysmenorrhea: an umbrella and mapping review.

PURPOSE: Primary dysmenorrhea (PD) is 1 of the most prevalent gynecologic conditions. The main aim of this umbrella review was to assess the effects of therapeutic exercise (TE) on PD. METHODS: A systematic search was carried out in PubMed, Embase, SPORTDiscus, CINAHL, and PEDro (December 10, 2022). The outcome measures assessed were menstrual pain intensity, menstrual pain duration, and quality of life. Methodological quality was analyzed using the AMSTAR and ROBIS scales, and the strength of evidence was established according to the advisory committee grading criteria guidelines. RESULTS: Nine systematic reviews were included. The results showed that TE, regardless of the exercise model and intensity, has a clinical effect in improving menstrual pain intensity in women with PD with moderate quality of evidence. In addition, the results showed that TE has a clinical effect in improving the duration of menstrual pain in women with PD with a limited quality of evidence. However, the results are controversial on the improvement of quality of life in women with PD with a limited quality of evidence. CONCLUSIONS: TE seems an effective option to implement in women with PD to improve the intensity and duration of menstrual pain. We cannot draw robust results for quality of life due to the low number of primary studies. More research in this field can help us establish more robust conclusions, as well as to assess whether there is one exercise model or intensity of training that is more effective than others.PROSPERO number: This review was previously registered in PROSPERO (CRD42022371428).

Effectiveness of Therapeutic Exercise Models on Cancer-Related Fatigue in Patients With Cancer Undergoing Chemotherapy: A Systematic Review and Network Meta-analysis.

OBJECTIVE: To assess and compare the effectiveness of different exercise modalities in reducing cancer-related fatigue (CRF) in patients with cancer undergoing chemotherapy. Exercise intensities for selected exercise types were also compared. DATA SOURCES: We conducted a search in MEDLINE, Embase, CINAHL, Scopus, SPORTDiscus, and Web of Science from inception to October 15, 2021. STUDY SELECTION: Randomized controlled trials concerning the effectiveness of exercise modalities on CRF in patients with cancer undergoing chemotherapy were included. DATA EXTRACTION: Study characteristics were extracted using a structured protocol. Methodological quality was assessed employing the PEDro scale and risk of bias was assessed using the Revised Cochrane Risk of Bias Tool for Randomized Trials. The certainty of evidence was assessed based on Grading of Recommendations, Assessment, Development and Evaluation. The measure of effect used was the adjusted standardized mean difference (SMD) or Hedge's g, together with the corresponding 95% confidence intervals (CI). DATA SYNTHESIS: Forty-seven studies were included. Data were pooled employing a random-effects model. There was a trend that adding low-intensity aerobic and resistance exercise (SMD=1.28, 95% CI -0.18; 2.75, P=.086), or moderate-intensity aerobic and resistance exercise (SMD=0.85; 95% CI -0.12; 1.82, P=.087), was more effective than adding flexibility training to usual care (UC). There was also a trend that UC alone was less effective than adding moderate-intensity aerobic and resistance exercise (SMD=-0.47, 95% CI -0.96, 0.02, P=.060) to UC. CONCLUSIONS: The addition of low- to moderate-intensity aerobic and/or resistance exercise demonstrated a positive trend for improvement in CRF in patients with cancer undergoing chemotherapy, when compared with UC alone or UC with flexibility training.

Association of difficulties in daily physical activities and handgrip strength with cancer diagnoses in 65,980 European older adults.

BACKGROUND: People with cancer usually report physical deconditioning, which can limit daily activities. AIMS: Our aim was to analyze associations between daily physical activities and handgrip strength with cancer diagnoses among European older adults. METHODS: We used data from SHARE (a representative survey of individuals aged 50 years or older) wave 7, residing in 27 European countries and Israel. Participants self-reported difficulties in daily physical activities and cancer diagnoses, and handgrip strength was objectively assessed using a handheld dynamometer. Data were analyzed using binary logistic regression. RESULTS: Overall, 65,980 participants (average age 67.6 years (SD = 9.4)) were analyzed. Having difficulties in any daily physical activity was significantly associated with higher odds of cancer diagnoses. Lower handgrip strength was significantly associated with cancer diagnoses among participants included in the first (adjusted odds ratio (AOR) = 1.27 [95%CI = 1.11-1.45]) and the second third (AOR = 1.15 [95%CI = 1.03-1.28]) when compared with participants from the last third in the final adjusted model. DISCUSSION: Having difficulties in daily physical activities as well as lower levels of handgrip strength is positively associated with cancer diagnoses. CONCLUSION: Adults with difficulties lifting or carrying weights over 5 kilos or having difficulties in two or more activities showed critical associations with cancer diagnosis.

Effectiveness of Foam Rolling vs. Manual Therapy in Postexercise Recovery Interventions for Athletes: A Randomized Controlled Trial.

ABSTRACT: Espí-López, GV, Ruescas-Nicolau, MA, Castellet-García, M, Suso-Martí, L, Cuenca-Martínez, F, and Marques-Sule, E. Effectiveness of foam rolling vs. manual therapy in postexercise recovery interventions for athletes: A randomized controlled trial. J Strength Cond Res 37(6): e361-e368, 2023-Self-massage using foam rolling (FR) has been posited to have similar benefits as those traditionally associated with manual therapy (MT) but more economical, easy, and efficient. Despite the widespread use of this technique for the recovery of athletes, there is no evidence supporting the effectiveness of FR vs. MT. The purpose of this study was to assess the effects of FR self-massage in athletes after a high-intensity exercise session compared with a MT protocol. A randomized controlled trial was performed. Forty-seven volunteer amateur athletes (22.2 ± 2.5 years, 53.2% men) were divided into 3 groups: a FR group ( n = 18, performed FR self-massage), a MT group ( n = 15, received a MT protocol), and a control group ( n = 14, passive recovery). After an intense exercise session, dynamic balance, lumbar and hip flexibility, and leg dynamic force were assessed before and after the intervention and 1 week later. Results showed that, in the FR group, dynamic balance scores increased for both limbs at postintervention ( p = 0.001) and at follow-up ( p = 0.001). These scores were higher for the FR group vs. the MT group at postintervention (right limb, p = 0.048) and at follow-up (right limb: p = 0.049; left limb: p = 0.048), although this variable differed at baseline. In all the groups, lumbar flexion increased at postintervention ( p < 0.05), although it was only maintained in the FR group at follow-up ( p = 0.048). In conclusion, self-massage with FR may be more effective than MT for the recovery of dynamic balance in athletes after intense exercise, although this result should be interpreted with caution. Foam rolling could have a relevant role in postexercise recovery to prevent injuries in athletes.

The Influence of the Weight of the Backpack on the Biomechanics of the Child and Adolescent: A Systematic Review and Meta-analysis With a Meta-Regression.

PURPOSE: To evaluate and explore the influence of the weight of a backpack on standing posture and gait in children and adolescents. METHODS: We conducted a search of MEDLINE (PubMed), Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science, with the last search in July 2021. Standardized mean differences (SMD) and 95% confidence intervals were calculated for relevant outcomes and were pooled in a meta-analysis using the random-effects model. The participants were healthy children or adolescents. The outcomes were postural variables, spatiotemporal gait variables, gait kinematics, and muscle activity. We analyzed the influence of a loaded backpack on posture while standing and spatiotemporal and kinematic variables while walking. We used GRADE, Risk of Bias 2, ROBINS-I, MINORS, and PEDro scales to rate the quality, certainty, and applicability of the evidence. RESULTS: Wearing a loaded backpack induces a significant increase of the craniohorizontal angle while standing and a decrease of walking speed and stride length while walking. Only the craniovertebral angle had a significant relationship with the weight of the backpack. CONCLUSIONS: Wearing a backpack induces postural changes while standing and affects gait in children and adolescents; however, almost all the changes are not related to the backpack weight.

Hypoalgesic effects of a blood flow restriction technique at moderate intensity with or without motor imagery: a single-blind randomized controlled trial.

PURPOSE: The main objective was to assess the hypoalgesic effect of adding blood flow restriction (BFR) training with or without motor imagery (MI) to moderate-intensity exercise. The secondary objective was to analyse the correlations of the pain pressure thresholds (PPTs) regarding perceived pain intensity, perceived fatigue, and cuff pressure discomfort. METHODS: A sample of 42 asymptomatic participants were randomly assigned to 3 groups: control group (CG), BFR group, and BFR with MI group. All participants performed a squat exercise at an intensity of 60% of 1RM. For the BFR groups, blood occlusion occurred at 80% of maximal arterial occlusive pressure. Local, bilateral, and distal PPT were assessed pre-intervention, post-intervention and 48 h post-intervention. The perceived fatigue was assessed post-intervention, and pain intensity was assessed only 48 h post-intervention. RESULTS: There were intragroup differences in the CG and BFR + MI group in the local PPT between the pre-intervention and post-intervention measurements (p = 0.039, d= -0.32 and p = 0.009, d= -0.46, respectively) and only in the CG in the bilateral PPT (p = 0.002, d= -0.41). The CG and BFR group showed significant differences at 48 h post-intervention, with a decrease in local PPT (p = 0.009, d = 0.51 and p = 0.049, d = 0.43, respectively) and bilateral PPT (p = 0.004, d = 0.53 and p = 0.021, d = 0.46, respectively). There was a negative moderate correlation between local PPT at the post-intervention time and perceived discomfort of the occlusion device only in the BFR group (r=-0.54, p = 0.045). CONCLUSION: Moderate-intensity resistance training with high occlusion did not generate hypoalgesia but did appear to generate a hyperalgesic response within 48 h after the intervention.

Effectiveness of Pain Neuroscience Education in Patients with Fibromyalgia: A Systematic Review and Meta-Analysis.

PURPOSE: To assess the effects of pain neuroscience education (PNE) on patients with fibromyalgia in terms of pain intensity, fibromyalgia impact, anxiety, and pain catastrophizing. METHODS: A systematic review with meta-analysis of randomized controlled trials was conducted. Standardized mean differences (SMDs) and 95% confidence intervals (CIs) were calculated with RStudio software (RStudio, Boston, MA) for relevant outcomes and were pooled in a meta-analysis with the random effects model. RESULTS: A total of eight studies were included. The meta-analysis showed statistically significant differences in pain intensity with a moderate clinical effect in seven studies at the post-intervention assessment (SMD: -0.76; 95% CI: -1.33 to -0.19; P < 0.05) with evidence of significant heterogeneity (P < 0.05, I2 = 92%), but it did not show statistically significant differences in fibromyalgia impact, anxiety, and pain catastrophizing (P > 0.05). With regard to the follow-up assessment, only the fibromyalgia impact showed significant improvements, with a very small clinical effect in nine studies (SMD: -0.44; 95% CI: -0.73 to -0.14; P < 0.05) and evidence of significant heterogeneity (P < 0.05, I2 = 80%). After the application of a sensitivity analysis with the PNE face-to-face interventions, the meta-analysis showed a significant decrease in pain intensity, with a moderate clinical effect at the post-intervention and follow-up assessments without evidence of significant heterogeneity (P < 0.05, I2 = 10%). CONCLUSIONS: There is low-quality evidence that in patients with fibromyalgia, PNE can decrease the pain intensity in the post-intervention period and the fibromyalgia impact in the follow-up period. However, it appears that PNE showed no effect on anxiety and pain catastrophizing.

Effectiveness of Neural Mobilization Techniques in the Management of Musculoskeletal Neck Disorders with Nerve-Related Symptoms: A Systematic Review and Meta-Analysis with a Mapping Report.

OBJECTIVE: The objective was to assess the effectiveness of neural mobilization (NM) techniques in the management of musculoskeletal neck disorders with nerve-related symptoms (MND-NRS). METHODS: We conducted a systematic review with meta-analysis, using pain intensity, disability, perceived function, cervical range of motion, and mechanosensitivity as the main outcome measures. RESULTS: The systematic review included 22 studies (n = 978). More favorable outcomes were observed for NM on pain intensity compared with control interventions (standardized mean differences (SMDs) -0.92; 95% CI -1.66-0.18), but not compared with other treatments (OTs) (SMD 1.06; 95% CI -0.02 to 2.15). Regarding neck pain intensity, no significant differences were found in favor of NM compared with OTs (SMD 0.37; 95% CI -0.35 to 1.1). However, between-treatment differences were found in favor of OT on arm-pain intensity (SMD 0.57; 95% CI 0.08-1.05). In addition, the grouped MA did not show statistically significant differences between NM and OT outcomes on the cervical range of motion (SMD 0.16; 95% CI -0.06 to 0.38). However, compared with no intervention, NM was associated with significantly improved outcomes in cervical rotation (SMD 0.91; 95% CI 0.61-1.22). Similar results were found regarding disability (SMD -0.08; 95% CI -0.36-0.20, and SMD -1.44; 95% CI -2.28-0.6, respectively). Finally, NM was associated with more favorable outcomes on mechanosensitivity compared with OT (SMD 0.79; 95% CI 0.15-1.42) and greater improvements in function compared with no intervention (SMD 0.89; 95% CI 0.16-1.62). CONCLUSIONS: NM appeared to be effective to improve overall pain intensity when embedded in a physiotherapy treatment in the management of MND-NRS. When compared with no intervention, it was effective to improve neck rotation, disability, and function. However, it was not superior to other types of treatments in improving overall pain intensity, neck pain intensity, arm pain intensity, cervical range of motion and disability, except for mechanosensitivity.

Effectiveness of HIIT in patients with cancer or cancer survivors: An umbrella and mapping review with meta-meta-analysis.

OBJECTIVE: To assess the available evidence on the effectiveness of high-intensity interval training (HIIT) in addition to first-choice cancer treatment on cardiorespiratory fitness (CRF), quality of life (QoL), adherence, and adverse effects of HIIT in patients with cancer or cancer survivors. METHODS: An umbrella review and meta-meta-analysis (MMA) was performed. A systematic search was conducted in MEDLINE, EMBASE, Cochrane Database, CINAHL, Scopus, SPORTDiscus, and Web of Science until August 2021. Article selection, quality assessment, and risk of bias assessment were performed by two independent reviewers. The MMA were performed with a random-effects model and the summary statistics were presented in the form of forest plot with a weighted compilation of all standardized mean differences (SMD) and corresponding 95% confidence interval (CI). RESULTS: Seven systematic reviews were included. Regarding CRF, the addition of HIIT to cancer treatment showed statistically significant differences with a small clinical effect, compared with adding other treatments (SMD = 0.45; 95% CI 0.24 to 0.65). There was no significant difference when compared with adding moderate-intensity continuous training (MICT) (SMD = 0.23; 95% CI -0.04 to 0.50). QoL showed positive results although with some controversy. Adherence to HIIT intervention was high, ranging from 54% to 100%. Regarding adverse effects, most of the systematic reviews reported none, and in the cases in which they occurred, they were mild. CONCLUSION: In conjunction with first-choice cancer treatment, HIIT has been shown to be an effective intervention in terms of CRF and QoL, as well as having optimal adherence rate. In addition, the implementation of HIIT in patients with cancer or cancer survivors is safe as it showed no or few adverse effects.

Comparative analysis of the autonomic nervous system response during movement representation in healthy individuals and patients with chronic low back pain: a prospective cohort study.

OBJECTIVE: The primary objective was to compare the difference in autonomic nervous system (ANS) response between motor imagery (MI) group and action observation (AO) group. Both consisted of two subgroups: the control subgroup (CG), which consisted of asymptomatic individuals, and the patient subgroup (PG), which consisted of patients with chronic low back pain (CLBP). The secondary objective was to assess ANS activity during AO and MI training according to the fear-of-movement levels of the PGs. METHODS: Sixty participants were randomly assigned. The autonomic outcome measures included skin conductance (SC), respiration rate (RR), and heart rate (HR). RESULTS: Results showed that intergroup differences in RR were higher in the PG, with a large effect size (p = .007, d = 1.71). Only the PGs showed intragroup differences in SC (p <.05). In terms of ANS activity during the training, there were no statistically significant intergroup differences (p <.05). However, the strongest intragroup differences were among the AOPG with greater levels of kinesiophobia. For the SC and HR variables, only this condition showed significant differences between baseline and the first and second movements, with a large effect size (p <.001 and p = .002, respectively, and d >.80). CONCLUSIONS: The results showed that AO and MI training in the PG and CG resulted in similar but not identical ANS activation, with slightly higher activation in the PG. The differences in the PG could be associated with kinesiophobia when visually exposed to low-back movements that could be interpreted as hazardous or unsafe.

Effects of neural mobilizations through movement representation techniques for the improvement of neural mechanosensitivity of the median nerve region: a randomized controlled trial.

PURPOSE: The main objective was to compare the effects of neural mobilization (NM), NM performed through mirror therapy (MT), NM performed through action observation (AO) training and finally classic rehabilitation program (mobility and strength) exercises on neural mechanosensitivity, widespread of proximal and distal pain and pressure pain thresholds (PPT). The second objective was to assess the effects of these interventions on handgrip strength, conditioned pain modulation, motor imagery ability and temporal summation. MATERIALS AND METHODS: Single-blinded randomized controlled trial. Fifty-four healthy subjects were randomly assigned to each group. Neural mechanosensitivity, widespread pain and PPT were the main variables. The secondary variables included handgrip strength, conditioned pain modulation, motor imagery ability and temporal summation. RESULTS: All groups showed significant differences in time*factor for neural mechanosensitivity (p = 0.001), PPT in the dermatome of the median nerve (p = 0.007), PPT at carpal tunnel (p < 0.05) and proximal widespread (p = 0.01). No differences were found for distal widespread, conditioned pain modulation, handgrip strength motor imagery ability or temporal summation (p > 0.05). There is an absence of statistically significant differences between groups. CONCLUSIONS: NM through movement representation techniques can reduce mechanosensitivity and mechanical hyperalgesia in the median nerve dermatome and forearm, although no differences were found between groups.

Psychological Factors Associated with Functional Disability in Patients with Hip and Knee Osteoarthritis.

Several studies have shown an association between psychosocial variables and functional capacity in chronic pain processes such as osteoarthritis. The aim of this study was to test a structural equations model that shows the predictive weight of certain variables such as catastrophizing, self-efficacy and kinesiophobia on functional pain and WOMAC subscales scores of pain and physical function of older patients diagnosed with hip and knee osteoarthritis. We also assessed the specific weight of age in terms of the factors. The study was conducted on a sample of 170 patients (142 women and 28 men mean age, 74.44 years range, 50-96 years). The main variables evaluated were WOMAC subscales scores of pain and physical function, self-efficacy, catastrophizing and kinesiophobia. To assess these variables, we used the Spanish validated version of the Western Ontario and McMaster Universities questionnaire, the Chronic Pain Self-Efficacy Scale, the Pain Catastrophizing Scale and the Tampa Scale for Kinesiophobia, respectively. We tested a structural equations model (IBM SPSS Amos version 22). The results showed the predominant predictive weight (both direct and indirect) of catastrophizing while simultaneously ruling out the relevance of age as a predictor of WOMAC subscales scores of pain and physical function. This study provides data of interest on the explanatory mechanisms that underlie the direct and inverse relationships between the studied psychological variables.

Auditory and visual distraction improve muscle endurance: a randomised controlled trial.

The main aim was to investigate the influence of various distracting stimuli on the endurance-strength and fatigue of the lumbar region in asymptomatic participants. Fifty-four healthy individuals were randomised to three groups: auditory distraction group (ADG), visual distraction group (VDG) and control group without distraction (CG). Lumbar muscle endurance and perceived fatigue were the outcome measures. Lumbar muscle endurance was assessed with the Biering-Sorensen test, and perceived fatigue was assessed with the modified Borg scale, once baseline and second with the distraction intervention. Lumbar muscle endurance showed significant changes over time, and there were intragroup differences for VDG and ADG. The direct comparison did show significant differences between both distraction groups with respect to the control group with a large effect size (ΔVDG-CG: p < 0.001, d = 1.55 and, ΔADG-CG: p = 0.008, d = 1.07) but not between the two distraction groups (ΔVDG-VDG: p = 0.56). Fatigue showed significant changes over time but not for group*time interaction, revealing intragroup differences for VDG and ADG. There were no intragroup differences in the CG for muscle resistance or fatigue, and there were no between-group differences. Auditory and visual distractors might produce a significant increase in muscle resistance during the Biering-Sorensen test. Both techniques are valid for increasing lumbar muscle endurance but also both stimuli produced a higher level of fatigue or perception of effort once the test was completed when compared with CG. Finally, we were unable to demonstrate that one type of stimulus produces superior results to the other.

Hypoalgesic Effects of Aerobic and Isometric Motor Imagery and Action Observation Exercises on Asymptomatic Participants: A Randomized Controlled Pilot Trial.

OBJECTIVES: The objective was to explore whether action observation (AO) and motor imagery (MI) of aerobic and isometric exercise could induce hypoalgesic responses in asymptomatic individuals compared with placebo observation (PO). METHODS: A randomized controlled pilot trial was designed. Twenty-four healthy participants (mean age = 21.9 ± 2.1 years) were randomized into three groups: AO+MI (N = 8), AO, (N = 8), and PO (N = 8). All participants performed an actual aerobic running exercise (three series of 90 seconds at 85% of their VO2max and 30 seconds at 65% of their VO2max) and an isometric exercise protocol (isometric squats). A day later, they all performed the mental intervention, observing or imagining exercise execution performed the day before, according to their allocated group. Pressure pain thresholds (PPTs) of the quadriceps and epicondyle regions were assessed at baseline, postintervention, and 15 minutes postintervention. RESULTS: Analysis of variance revealed statistically significant differences in the group*time interaction for PPT in the quadriceps. The AO group showed a statistically significant increase at postintervention and at 15 minutes postintervention. The AO+MI group obtained a statistically significant increase in the two PPT regions compared with the PO group at Δpre-post. The AO group obtained a greater increase in the PPT in the quadriceps femoris than the PO group at Δpre-post and Δpre-post 15 minutes. CONCLUSIONS: AO and MI induce hypoalgesic responses compared with PO. AO isolated training showed pain modulation responses in the PPTs of the quadriceps region in young physically active adults. These findings highlight the potential role of brain training in pain management.

Effect of Manual Therapy and Therapeutic Exercise Applied to the Cervical Region on Pain and Pressure Pain Sensitivity in Patients with Temporomandibular Disorders: A Systematic Review and Meta-analysis.

OBJECTIVE: To assess the effectiveness of cervical manual therapy (MT) on patients with temporomandibular disorders (TMDs) and to compare cervico-craniomandibular MT vs cervical MT. DESIGN: Systematic review and meta-analysis (MA). METHODS: A search in PubMed, EMBASE, PEDro, and Google Scholar was conducted with an end date of February 2019. Two independent reviewers performed the data analysis, assessing the relevance of the randomized clinical trials regarding the studies' objectives. The qualitative analysis was based on classifying the results into levels of evidence according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE). RESULTS: Regarding cervical MT, MA included three studies and showed statistically significant differences in pain intensity reduction and an increase in masseter pressure pain thresholds (PPTs), with a large clinical effect. In addition, the results showed an increase in temporalis PPT, with a moderate clinical effect. MA included two studies on cervical MT vs cervico-craniomandibular MT interventions and showed statistically significant differences in pain intensity reduction and pain-free maximal mouth opening, with a large clinical effect. CONCLUSIONS: Cervical MT treatment is more effective in decreasing pain intensity than placebo MT or minimal intervention, with moderate evidence. Cervico-craniomandibular interventions achieved greater short-term reductions in pain intensity and increased pain-free MMO over cervical intervention alone in TMD and headache, with low evidence.

Is aerobic exercise helpful in patients with migraine? A systematic review and meta-analysis.

PURPOSE: To assess the effects of aerobic exercise (AE) on patients with migraine in terms of pain intensity, frequency and duration of migraine, and quality of life. METHODS: A systematic review and meta-analysis of randomized controlled trials were conducted. Standardized mean differences (SMDs) and 95% confidence intervals (CIs) were calculated for relevant outcomes and were pooled in a meta-analysis using the random-effects model. RESULTS: A total of 10 articles from 1950 to 2019 were included, involving 508 patients. The meta-analysis showed statistically significant differences in the decrease in pain intensity (five studies, n = 166; SMD = 1.25; 95% CI 0.47-2.04), frequency (six studies, n = 214; SMD = 0.76; 95% CI 0.32-1.2) and duration of migraine (four studies, n = 106; SMD = 0.41; 95% CI 0.03-0.8), in the short-term. In addition, the meta-analysis showed statistically significant differences in the increase in quality of life (four studies, n = 150; SMD = 2.7; 95% CI 1.17-4.24), even though the Egger's test suggested significant evidence of publication bias for the analysis of quality of life (intercept = 5.81; t = 6.97; P = .02). CONCLUSIONS: There is low- and moderate-quality evidence that in patients with migraine AE can decrease the pain intensity, frequency and duration of migraine and can also increase quality of life.

Tactile trigeminal region acuity in temporomandibular disorders: A reliability and cross-sectional study.

BACKGROUND: Two-point discrimination (2-PD) is a valuable test for measuring tactile acuity that provides relevant information about cortical reorganisation and somatosensory function. OBJECTIVES: The main objectives of the present study were to assess intra- and interexaminer reliability of the 2-PD test in the trigeminal region in asymptomatic individuals and only intra-examiner reliability in patients with temporomandibular disorders (TMD). The secondary objective was to observe the correlations of the 2-PD test with regard to pain intensity and psychological and disability variables. METHODS: Intra- and interexaminer reliability of 2-PD in the trigeminal region was assessed in 40 asymptomatic individuals and 54 patients with TMD. Each clinician received training in the assessment of 2-PD using an esthesiometer and following a standardised protocol for the three branches of trigeminal nerve. RESULTS: In the asymptomatic participants, interexaminer (intra-class correlation coefficient (ICC .64-.88) and test-retest (ICC .70-.87) values were obtained. Given similar test-retest values were shown in the group of patients with TMD (ICC .72-.86), the reliability were considered good-moderate. Statistically significant differences (P < .001) were obtained between the asymptomatic participants and the patients with TMD regarding the mean values from trials of the three trigeminal branch measurements, with a large effect size. CONCLUSION: Reliability of the 2-PD test was considered good-moderate. Patients with TMD showed greater distances in the 2-PD test, suggesting that tactile acuity in the trigeminal region is impaired in patients with TMD. Assessment of tactile acuity with 2-PD test in patients with TMD should be considered clinically.

Effect of brain training through visual mirror feedback, action observation and motor imagery on orofacial sensorimotor variables: A single-blind randomized controlled trial.

OBJECTIVES: The main objective was to evaluate the effects of action observation (AO), visual mirror feedback (VMF) and motor imagery (MI), combined with an oro-facial exercise programme, on sensorimotor variables in asymptomatic participants. METHODS: We designed a randomised, single-blind, controlled trial that included 52 asymptomatic participants who were randomly assigned to 4 groups, 13 to each of the VMF, MI and AO groups and 13 to the control group (CG), which only performed the exercise programme. The primary outcomes were pain pressure sensitivity and tongue muscle strength. The secondary outcomes were maximum mouth opening, tongue length and the ability to generate mental motor images. Each group underwent a 3-session intervention using their respective exercise. Measurements were performed before starting the intervention and after each of the 3 sessions (pre, mid1, mid2 and post). RESULTS: ANOVA revealed significant changes in PPTs in the masseter muscle region in the MI and AO groups in the pre-post and mid1-post changes. ANOVA revealed significant differences in tongue muscle strength in the anterior direction only in the AO group in the pre-mid2 and pre-post changes. CONCLUSIONS: AO and MI, in conjunction with exercise, could induce changes in PPTs for the masseter muscle. In addition, only AO produced changes in tongue muscle strength. More research is needed to determine the role of brain representation techniques in the oro-facial region and transferring this exercise to the rehabilitation setting.