Kinetic chain revisited: consensus expert opinion on terminology, clinical reasoning, examination, and treatment in people with shoulder pain.

BACKGROUND: The purpose of this study was to reach consensus on the most appropriate terminology and issues related to clinical reasoning, examination, and treatment of the kinetic chain (KC) in people with shoulder pain among an international panel of experts. METHODS: A 3-round Delphi study that involved an international panel of experts with extensive clinical, teaching, and research experience in the study topic was conducted. A search equation of terms related to the KC in Web of Science and a manual search were used to find the experts. Participants were asked to rate items across 5 different domains (terminology, clinical reasoning, subjective examination, physical examination, and treatment) using a 5-point Likert-type scale. An Aiken coefficient of validity (V) ≥0.7 was considered indicative of group consensus. RESULTS: The participation rate was 30.2% (n = 16), whereas the retention rate was high throughout the 3 rounds (100%, 93.8%, and 100%). A total of 15 experts from different fields and countries completed the study. After the 3 rounds, consensus was reached on 102 items: 3 items were included in the "terminology" domain; 17 items, in the "rationale and clinical reasoning" domain; 11 items, in the "subjective examination" domain; 44 items, in the "physical examination" domain; and 27 items, in the "treatment" domain. Terminology was the domain with the highest level of agreement, with 2 items achieving an Aiken V of 0.93, whereas the domains of physical examination and treatment of the KC were the 2 areas with less consensus. Together with the terminology items, 1 item from the treatment domain and 2 items from the rationale and clinical reasoning domain reached the highest level of agreement (V = 0.93 and V = 0.92, respectively). CONCLUSION: This study defined a list of 102 items across 5 different domains (terminology, rationale and clinical reasoning, subjective examination, physical examination, and treatment) regarding the KC in people with shoulder pain. The term "KC" was preferred and a agreement on a definition of this concept was reached. Dysfunction of a segment in the chain (ie, weak link) was agreed to result in altered performance or injury to distal segments. Experts considered it important to assess and treat the KC in particular in throwing or overhead athletes and agreed that no one-size-fits-all approach exists when implementing shoulder KC exercises within the rehabilitation process. Further research is now required to determine the validity of the identified items.

Effectiveness of exercise versus arthroscopic partial meniscectomy plus exercise in the management of degenerative meniscal tears at 5-year follow-up: a systematic review and meta-analysis.

INTRODUCTION: There are no meta-analytical data in the long term for comparing surgery and exercise for meniscal tear. The aim of this study is to compare the effectiveness of exercise versus arthroscopic partial meniscectomy (APM) plus exercise for degenerative meniscal tears (DMT) in knee function at 5-year follow-up. MATERIALS AND METHODS: A systematic search of Medline, EMBASE, Web of Science, SciELO, SPORTDiscus, Scopus, and Cochrane Library was performed. The studies were included if they were randomized controlled trials performed in patients aged ≥ 18 years with DMT, that compared physical therapy to APM at 5-year follow-up, and reported at least one outcome measure of knee function/disability. Risk of bias was analyzed with the Cochrane RoB-2 tool and certainty of evidence with GRADE recommendations. A random effects model meta-analysis was performed. RESULTS: 3743 articles were identified and 4 met the criteria. Three had low risk of bias and one had some concerns. There were no significant between-group differences, in within-group changes from baseline to 5-year, on the Knee Injury and Osteoarthritis Outcome Score pain (- 2.28; 95% CI - 5.41 to 0.84), symptoms (- 0.24; 95% CI - 4.13 to 3.64), activities of daily living (- 2.16; 95% CI - 6.16 to 1.83) and quality of life (- 3.98; 95% CI - 9.05 to 1.10). There was a significant difference in support of APM plus exercise for sport/recreation (- 9.28; 95% CI - 18.28 to - 0.29). Leave-one-out sensitivity analysis revealed a non-significant difference in sport/recreation (- 5.05; 95% CI - 12.04 to 1.94). There were no differences in other patient-reported outcome measures. CONCLUSION: Moderate certainty of evidence suggests that the addition of APM to an exercise program adds no benefits in knee function at 5-year follow-up.

Automated Cervical Spinal Cord Segmentation in Real-World MRI of Multiple Sclerosis Patients by Optimized Hybrid Residual Attention-Aware Convolutional Neural Networks.

Magnetic resonance (MR) imaging is the most sensitive clinical tool in the diagnosis and monitoring of multiple sclerosis (MS) alterations. Spinal cord evaluation has gained interest in this clinical scenario in recent years, but, unlike the brain, there is a more limited choice of algorithms to assist spinal cord segmentation. Our goal was to investigate and develop an automatic MR cervical cord segmentation method, enabling automated and seamless spinal cord atrophy assessment and setting the stage for the development of an aggregated algorithm for the extraction of lesion-related imaging biomarkers. The algorithm was developed using a real-world MR imaging dataset of 121 MS patients (96 cases used as a training dataset and 25 cases as a validation dataset). Transversal, 3D T1-weighted gradient echo MR images (TE/TR/FA = 1.7-2.7 ms/5.6-8.2 ms/12°) were acquired in a 3 T system (Signa HD, GEHC) as standard of care in our clinical practice. Experienced radiologists supervised the manual labelling, which was considered the ground-truth. The 2D convolutional neural network consisted of a hybrid residual attention-aware segmentation method trained to delineate the cervical spinal cord. The training was conducted using a focal loss function, based on the Tversky index to address label imbalance, and an automatic optimal learning rate finder. Our automated model provided an accurate segmentation, achieving a validation DICE coefficient of 0.904 ± 0.101 compared with the manual delineation. An automatic method for cervical spinal cord segmentation on T1-weighted MR images was successfully implemented. It will have direct implications serving as the first step for accelerating the process for MS staging and follow-up through imaging biomarkers.

Transcultural adaptation of the neck disability index to mexican spanish and assessment of its psychometric properties.

PURPOSE: To transculturally adapt the Neck Disability Index to Mexican Spanish (NDI-Mx) and to evaluate its psychometric properties. METHODS: Translation and transcultural adaptation of the NDI were conducted according to published guidelines. The test-retest reliability of the NDI-Mx was assessed with intraclass correlation coefficient (ICC3,1), the student t-test, standard error of measurement, minimal detectable change and Bland-Altman plot. Cronbach's α coefficient was used to evaluate internal consistency. Floor and ceiling effects were also evaluated. Convergent validity was assessed by comparison of the NDI-Mx with the Northwick Park Neck Pain Questionnaire (NPQ) through the Spearman correlation coefficient. Finally, a confirmatory factor analysis (CFA) was conducted. RESULTS: The sample was composed of 113 subjects (38 men and 75 women) with a mean age of 30 (SD, 12.19) years. All items of the NDI-Mx showed good test-retest reliability (ICC3,1 = 0.86) and good internal consistency (Cronbach's α = 0.85). Floor and ceiling effects were not observed. There was good convergent validity with a high correlation between NDI-Mx and NPQ (ρ = 0.83). The CFA revealed that a one-factor solution fitted adequately the data (χ2(32) = 41.18, p = .13). CONCLUSION: The NDI-Mx seems to be a valid and reliable tool that can be used in clinical practice and research on Mexican populations with neck pain.

The Long-Term Maintenance of Upper Limb Motor Improvements Following Transcranial Direct Current Stimulation Combined with Rehabilitation in People with Stroke: A Systematic Review of Randomized Sham-Controlled Trials.

BACKGROUND: The effectiveness of transcranial direct current stimulation (tDCS) in the upper limb (UL) motor rehabilitation of stroke has been widely studied. However, the long-term maintenance of its improvements has not yet been proven. METHODS: A systematic search was conducted in MEDLINE/Pubmed, Web of Science, PEDRo, and Scopus databases from inception to April 2021. Randomized controlled trials were included if they performed a tDCS intervention combined with UL rehabilitation in stroke patients, performed several sessions (five or more), and assessed long-term results (at least three-month follow-up). Risk of bias and methodological quality were evaluated with the Cochrane RoB-2 and the Oxford quality scoring system. RESULTS: Nine studies were included, showing a high methodological quality. Findings regarding UL were categorized into (1) functionality, (2) strength, (3) spasticity. All the studies that showed significant improvements retained them in the long term. Baseline functionality may be a limiting factor in achieving motor improvements, but not in sustaining them over the long term. CONCLUSION: It seems that the improvements achieved during the application of tDCS combined with UL motor rehabilitation in stroke were preserved until the follow-up time (from 3 months to 1 year). Further studies are needed to clarify the long-term effects of tDCS.

Benefits of Adding Gluteal Dry Needling to a Four-Week Physical Exercise Program in a Chronic Low Back Pain Population. A Randomized Clinical Trial.

OBJECTIVE: To determine if adding dry needling to a four-week exercise program has an additional benefit compared with adding sham dry needling to the same exercise program in subjects with chronic low back pain. DESIGN: Randomized clinical trial. SETTING: Physiotherapy and Pain Clinic of Alcala University. SUBJECTS: Forty-six patients with chronic low back pain. METHODS: Subjects were randomized to two groups: the dry needling group (N = 23) or sham dry needling group (N = 23). Both groups received a four-week exercise program and before the exercise started a session of dry needling or sham dry needling. Pain (visual analog scale), disability (Roland-Morris Questionnaire), and fear avoidance beliefs (Fear Avoidance Beliefs Questionnaire) were assessed at baseline, after treatment, and at three-month follow-up. Pressure pain thresholds (algometer) were measured at baseline, after the dry needling or the sham dry needling, and after treatment. RESULTS: Both groups showed significant improvements for all variables. In the between-group comparison, the dry needling group improved significantly in pain at three-month follow-up and pressure pain thresholds at the end of treatment for all measures, and at three-month follow-up there was no improvement in gluteus medium. CONCLUSIONS: In chronic low back patients, adding dry needling to a four-week exercise program has an additional benefit in pain and sensitivity compared with adding sham dry needling to the same exercise program.

Inter-and Intra-Examiner Reliability of Supraspinatus Muscle Tendon Palpation: A Cross-Sectional Study by Ultrasonography.

BACKGROUND AND OBJECTIVES: Palpation is an inherent and basic skill of health professionals-particularly manual therapists who base their diagnosis and treatment in a clinical environment. Many authors have previously described multiple palpation positions for supraspinatus muscle tendon (SMT); however, there are no current studies that evaluate palpation concordance reliability for the SMT in this particular position. This study aimed to investigate the intra- and inter-rater reliabilities of supraspinatus muscle tendon (SMT) palpation. MATERIALS AND METHODS: Thirty-six healthy participants (14 females; aged 22-35 years) were recruited. Musculoskeletal ultrasound was used to measure the SMT localization after two physiotherapists performed the SMT palpation at two different times. The distance between the two marked points was used to analyze the analysis of true agreement between examiners. Finally, we analyzed if the demographic variables influenced the palpation procedure. RESULTS: The intra-examiner reliability showed a high percentage of concordance for examiner 1 (E.1) (first palpation procedure (P.1) = 91.7%: second palpation procedure (P.2) = 95.8%) and examiner 2 (E.2) (P.1 = 91.6%; P.2 = 97.2%) and high percentage of inter-palpation agreement for E.1 (87.5%) and E.2 (88.9%). The inter-examiner reliability showed a high total concordance for the right shoulder (E.1 = 94.4%; E.2 = 95.8%) and left shoulder (E.1 = 93.05%; E.2 = 95.05%). The agreement (%) according to both examiners was 93.05% for the right shoulder and 94.4% for the left shoulder. The agreement between both examiners and the ultrasound (% of true agreement) was 92.9% for the right shoulder and 92.8% for the left shoulder. A statistically significant association (p = 0.02) was found for weight regarding concordance reliability; this was not seen for dominant arm, age, gender, body mass index, height, and tendon depth (p > 0.05). CONCLUSIONS: The SMT palpation technique showed a high level of concordance and reproducibility.

Cross-domain comparison and the politics of difference.

This paper makes the case for cross-domain comparison as an undertheorized form of comparative analysis. The units of analysis in such comparisons are not (as in most comparative analysis) predefined units within a domain or system of formally similar yet substantively different categories or entities; they are the domains or systems of categorically organized differences themselves. Focusing on domains of categorical difference that are central to the contemporary politics of difference, we consider two examples of cross-domain comparison. The first compares sex/gender and race/ethnicity as systems of ascribed identities that are increasingly, yet to differing degrees and in differing ways, open to choice and change. The second compares religion and language as domains of categorically organized cultural difference that are centrally implicated in the politics of cultural pluralism. We situate these cross-domain comparisons, premised on a logic of 'different differences', between generalizing and particularizing approaches to the politics of difference, arguing that these domains are similar enough to make comparison meaningful yet different enough to make comparison interesting. We outline five analytical focal points for cross-domain comparison: the criteria of membership and belonging, the categorical versus gradational structure of variation within domains of difference, the consolidation or proliferation of categories of difference, the procedures for dealing with mixed or difficult-to-classify instances, and the relation between categories of difference and the production and reproduction of inequality. We conclude by considering several potential objections to cross-domain comparison.

Climate refugia: joint inference from fossil records, species distribution models and phylogeography.

Climate refugia, locations where taxa survive periods of regionally adverse climate, are thought to be critical for maintaining biodiversity through the glacial-interglacial climate changes of the Quaternary. A critical research need is to better integrate and reconcile the three major lines of evidence used to infer the existence of past refugia - fossil records, species distribution models and phylogeographic surveys - in order to characterize the complex spatiotemporal trajectories of species and populations in and out of refugia. Here we review the complementary strengths, limitations and new advances for these three approaches. We provide case studies to illustrate their combined application, and point the way towards new opportunities for synthesizing these disparate lines of evidence. Case studies with European beech, Qinghai spruce and Douglas-fir illustrate how the combination of these three approaches successfully resolves complex species histories not attainable from any one approach. Promising new statistical techniques can capitalize on the strengths of each method and provide a robust quantitative reconstruction of species history. Studying past refugia can help identify contemporary refugia and clarify their conservation significance, in particular by elucidating the fine-scale processes and the particular geographic locations that buffer species against rapidly changing climate.

Assessing the use of the frequency, etiology, direction, and severity classification system for shoulder instability in physical therapy research - A scoping review.

OBJECTIVE: The aim of this study is to review the implementation of the Frequency, Etiology, Direction, and Severity (FEDS) classification for shoulder instability by the physical therapy scientific community since its publication in 2011. METHODS: A systematic search was conducted on January 10, 2024 in the MEDLINE, EMBASE, SPORTDiscus, Scopus, Web of Science, Cochrane, and SciELO databases, as well as Google Scholar. Studies investigating physical therapy interventions in people with shoulder instability, and reporting selection criteria for shoulder instability were considered eligible. A narrative synthesis was conducted. RESULTS: Twenty-six studies were included. None reported using the FEDS classification as eligibility criteria for shoulder instability. Only 42% of the studies provided data of all four criteria of the FEDS classification. The most reported criterion was direction (92%), followed by etiology (85%), severity (65%), and frequency (58%). The most common reported descriptor for profiling shoulder instability was "dislocation" (83.3%), followed by "first-time" (66.7%), "anterior" (62.5%), and "traumatic" (59.1%). Regarding other instability classifications, only one study (4%) used the Thomas & Matsen classification, and two (8%) the Stanmore classification. CONCLUSIONS: The FEDS classification system has not been embraced enough by the physical therapy scientific community since its publication in 2011.

Effectiveness of non-surgical management in rotator cuff calcific tendinopathy (the effect trial): protocol for a randomised clinical trial.

INTRODUCTION: Rotator cuff calcific tendinopathy (RCCT) involves calcific deposits in the rotator cuff. Non-surgical interventions such as extracorporeal shockwave therapy (ESWT) and ultrasound-guided percutaneous irrigation of calcific tendinopathy (US-PICT) are recommended for its early management. Exercise therapy (ET) has shown to be an effective intervention for people with rotator cuff tendinopathy, but it has not been formally tested in RCCT. The main objective of this study is to compare the effectiveness of an ET programme with ESWT and US-PICT in people with RCCT. As a secondary aim, this study aims to describe the natural history of RCCT. METHODS AND ANALYSIS: A randomised, single-blinded four-group clinical trial will be conducted. Adults from 30 to 75 years diagnosed with RCCT who accomplish eligibility criteria will be recruited. Participants (n=116) will be randomised into four groups: ET group will receive a 12-week rehabilitation programme; ESWT group will receive four sessions with 1 week rest between sessions during 1 month; US-PICT group will receive two sessions with 3 months of rest between sessions; and (actual) wait-and-see group will not receive any intervention during the 12-month follow-up. The primary outcome will be shoulder pain assessed with the Shoulder Pain and Disability Index at baseline, 2 weeks, 4 months, 6 months and 12 months from baseline. The primary analysis will be performed at 12 months from baseline. Secondary outcomes will include pain, range of motion, patient satisfaction and imaging-related variables. Moreover, the following psychosocial questionnaires with their corresponding outcome measure will be assessed: Central Sensitization Inventory (symptoms related to central sensitization); Pain Catastrophizing Scale (pain catastrophizing); Tampa Scale for Kinesiophobia 11 items (fear of movement); Fear Avoidance Belief Questionnaire (fear avoidance behaviour); Hospital Anxiety and Depression Scale (anxiety and depression); Pittsburgh Sleep Quality Index (sleep quality); and the EuroQol-5D (quality of life). An intention-to-treat analysis will be performed to reduce the risk of bias using a worst-case and best-case scenario analysis. ETHICS AND DISSEMINATION: Ethics committee approval for this study has been obtained (reference number: 1718862). The results of the main trial will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: NCT05478902.

Content reporting and effectiveness of therapeutic exercise in the management of massive rotator cuff tears: A systematic review with 490 patients.

Background: Massive rotator cuff tears (MRCT) account for a substantial fraction of tears above the age of 60 years. However, there are no clear criteria for prescription parameters within therapeutic exercise treatments. The aim of this study was to evaluate the effects and characteristics of therapeutic exercise treatments in patients with MRCT. Methods: A systematic search was conducted in MEDLINE/PubMed, Web of Science, SPORTDiscus, SciELO, Scopus and EMBASE from inception to August 2022. Studies were included if they evaluated the effects of exercise on patients with MRCT. The risk of bias was evaluated and the Consensus on Exercise Reporting Template (CERT) was also used. A narrative synthesis without meta-analysis was performed. Results: One randomized controlled trial, two non-randomized studies, six non-controlled studies, one case series and four retrospective studies were included. They ranged from serious to moderate risk of bias. The CERT reflected a poor description of the exercise programmes. Studies showed a pattern of improvements in most patient-reported outcome measures (PROM) surpassing the MCID, and active elevation range of motion. Conclusions: There is limited evidence that exercise and co-interventions are effective in the management of some patients with MRCT, based on a systematic review without meta-analysis. Future research should improve content reporting. Level of evidence: IV.

International physical therapists consensus on clinical descriptors for diagnosing rotator cuff related shoulder pain: A Delphi study.

BACKGROUND: There is a lack of standardized criteria for diagnosing rotator cuff related shoulder pain (RCRSP). OBJECTIVE: To identify the most relevant clinical descriptors for diagnosing RCRSP. METHODS: A Delphi study was conducted through use of an international physical therapists expert panel. A 3-round Delphi survey involving an international panel of physical therapists experts with extensive clinical, teaching, and research experience was conducted. A search query was performed in Web of Science, along with a manual search, to find the experts. The first round was composed of items obtained from a previous pilot Delphi study along with new items proposed by the experts. Participants were asked to rate items across six clinical domains using a five-point Likert scale. An Aiken's Validity Index ≥ 0.7 was considered indicative of group consensus. RESULTS: Fifteen experts participated in the Delphi survey. After the three rounds, consensus was reached on 18 clinical descriptors: 10 items were included in the "subjective examination" domain, 1 item was included in the "patient-reported outcome measures" domain, 3 items in the "diagnostic examination" domain, 2 items in the "physical examination" domain", and 2 items in the "functional tests" domain. No items reached consensus within the "special tests" domain. The reproduction of symptoms in relation to the application of load, the performance of overhead activities, and the need of active and resisted movement assessment were some of the results with greatest consensus. CONCLUSION: In this Delphi study, a total of 18 clinical descriptors across six clinical domains were agreed upon for diagnosing RCRSP.

Effects of Microwave Heating and Long-Term Aging on the Rheological and Chemical Properties of Recovered Bitumen.

Microwave heating of asphalt pavement is a promising technique to reduce the maintenance and increase the service life of materials through self-healing of cracks. Previous studies have shown that microwave heating technology at high temperatures could damage the bitumen of asphalt mixture, which is an unwanted effect of the crack-healing technique. In this study, the effects of microwave heating and long-term aging on the rheological and chemical properties of recovered bitumen were quantified using a frequency sweep test and Fourier Transform Infrared Spectrometry analysis, respectively. The main results indicate that microwave heating has no significant effect on the aging performance of G* and δ for aged asphalt mixtures. However, for newer bitumens, the rheological properties G* and δ show minor changes after microwave heating was applied. Overall, this study confirms that microwave heating is a potential alternative for maintenance of asphalt pavements, without severely affecting the rheological and chemical properties of bitumen.

Interaction between Pain, Disability, Mechanosensitivity and Cranio-Cervical Angle in Subjects with Cervicogenic Headache: A Cross-Sectional Study.

The relationship between the forward head posture and mechanosensitivity in subjects with a cervicogenic headache (CGH) remains uncertain. The aim of the study was to evaluate if there was a relationship between the tissue mechanosensitivity and cranio-cervical angle (CCA) that was moderated by pain intensity and/or disability in subjects with CGH. A convenience sample of 102 subjects was recruited. The CCA was measured with photographs, using a postural assessment software. The pain intensity was measured with a visual analogue scale (VAS), and the disability was measured with the Northwick Park Questionnaire. The pressure pain threshold (PPT) was measured at the spinous process of C2, the upper trapezius and splenius capitis muscles, and the median nerve. Simple moderation multiple regression analyses were constructed. There was a positive relationship between PPT at C2 and CCA, but a nonsignificant relationship for the PPT measured at the muscles and median nerve. The effect of PPT at C2 over CCA was moderated by pain intensity (R2 = 0.17; R2 change = 0.06; p < 0.05) but not disability. The Johnson-Neyman analysis revealed a cut-off point for the statistical significance of 4.66 cm in VAS. There seems to be a positive relationship between PPT at C2 and CCA, which is positively moderated by pain intensity in subjects with CGH.

Relationship between Neuromuscular Mechanosensitivity and Chronic Neck Pain in Guitarists: A Cross-Sectional Study.

Musicians frequently complain of musculoskeletal pain due to high mechanical demands, with the cervical spine being the most affected. Increased neuromuscular mechanosensitivity due to repetitive mechanical stress over time has been described in neck pain patients. Nevertheless, the association between musculoskeletal pain and neuromuscular mechanosensitivity in musicians is unknown. Therefore, the aim of this study was to analyze the relationship between neuromuscular tissue mechanosensitivity and neck pain in guitarists. Guitarists with chronic neck pain (n = 70) and without pain (n = 70) were enrolled. Pain and disability were measured by the visual analogue scale and the Neck Disability Index, respectively. The pressure pain threshold (PPT) was bilaterally measured for the upper trapezius and median nerve. Finally, the Upper limb neural test one (ULNT1) was bilaterally measured. The analyses included a 2-by-2 mixed analysis of variance, pairwise comparisons with Bonferroni correction, linear regression model, and multiple linear regression. Our data showed that chronic neck pain guitarists have a lower PPT at all locations compared to healthy guitarists. They also showed a bilateral main effect for pain for ULNT1 compared to healthy guitarists. These results were not affected by the mediator variables. Finally, a relationship between upper trapezius PPT and median nerve PPT was found.

Ice-age persistence and genetic isolation of the disjunct distribution of larch in Alaska.

Larix laricina (eastern larch, tamarack) is a transcontinental North American conifer with a prominent disjunction in the Yukon isolating the Alaskan distribution from the rest of its range. We investigate whether in situ persistence during the last glacial maximum (LGM) or long-distance postglacial migration from south of the ice sheets resulted in the modern-day Alaskan distribution. We analyzed variation in three chloroplast DNA regions of 840 trees from a total of 69 populations (24 new sampling sites situated on both sides of the Yukon range disjunction pooled with 45 populations from a published source) and conducted ensemble species distribution modeling (SDM) throughout Canada and United States to hindcast the potential range of L. laricina during the LGM. We uncovered the genetic signature of a long-term isolation of larch populations in Alaska, identifying three endemic chlorotypes and low levels of genetic diversity. Range-wide analysis across North America revealed the presence of a distinct Alaskan lineage. Postglacial gene flow across the Yukon divide was unidirectional, from Alaska toward previously glaciated Canadian regions, and with no evidence of immigration into Alaska. Hindcast SDM indicates one of the broadest areas of past climate suitability for L. laricina existed in central Alaska, suggesting possible in situ persistence of larch in Alaska during the LGM. Our results provide the first unambiguous evidence for the long-term isolation of L. laricina in Alaska that extends beyond the last glacial period and into the present interglacial period. The lack of gene flow into Alaska along with the overall probability of larch occurrence in Alaska being currently lower than during the LGM suggests that modern-day Alaskan larch populations are isolated climate relicts of broader glacial distributions, and so are particularly vulnerable to current warming trends.

Evaluation of the Lower Trapezius Muscle Using Ultrasound Panoramic View (a Novel Approach): An Intra- and Inter-Rater Reliability Study.

The panoramic view ultrasound remains uncommon in clinical practice, probably because of its difficulty, high-cost, and lack of research. Morphological changes in muscles have been demonstrated to be related to symptomatology and provide data of interest for clinical assessment. Thus, the aim of this study was to evaluate the measurement reliability of the length of the lower trapezius muscle with the panoramic view ultrasound using a novel tool, SIG_VIP®. Twenty healthy volunteers were measured by two expert sonographers using the SIG_VIP® tool with a novel approach. Statistical analyses were performed with the R software. The intraclass correlation coefficient (ICC), standard error of measurement (SEM), minimal detectable change (MDC), and Bland-Altman plots were calculated. All the results indicated good intra-rater reliability (ICC3,1, 0.92 to 0.96; SEM, 0.59 to 0.85; MDC, 1.64 to 2.35) and inter-rater reliability (ICC3,2, 0.84 to 0.89; SEM, 1.22 to 1.53; MDC, 3.39 to 4.25). The novel system used with the described methodology can reliably measure the length of the inferior fibers of the trapezius muscle. Further research must be conducted to evaluate the reliability in patients and how pathology is related to the length of the lower trapezius muscle.

Relationship between Forward Head Posture and Tissue Mechanosensitivity: A Cross-Sectional Study.

The relationship between forward head posture (FHP) and neck pain is not clear. FHP could possibly increase the mechanosensitivity of cervical tissues, which could lead to the development of pain depending on the adaptation capability of the central nervous system. The purpose of this study was to analyse the influence of FHP in the mechanosensitivity of articular, muscular, and neural tissues related to the cervical spine. The pressure pain threshold was bilaterally measured in different muscles and nerves and the second cervical vertebrae. The cervical spine's range of movement was also examined. The measurements were obtained from people with (n = 32) and without (n = 64) FHP. The analyses included a 2-by-2 mixed analysis of variance (ANOVA), pairwise comparisons with Bonferroni correction, and point-biserial correlation coefficients. Subjects with FHP showed a less pressure pain threshold (PPT) in all locations except for the upper trapezius and scalenus medius muscles. They also showed less extension and right-rotation range of motion. There was no association between FHP, neck pain, disability, and headache. Nevertheless, more research is needed to evaluate the relationship between FHP, tissue mechanosensitivity, and neck pain.

Short-Term Effects of PENS versus Dry Needling in Subjects with Unilateral Mechanical Neck Pain and Active Myofascial Trigger Points in Levator Scapulae Muscle: A Randomized Controlled Trial.

Procedures such as dry needling (DN) or percutaneous electrical nerve stimulation (PENS) are commonly proposed for the treatment of myofascial trigger points (MTrP). The aim of the present study is to investigate if PENS is more effective than DN in the short term in subjects with mechanical neck pain. This was an evaluator-blinded randomized controlled trial. Subjects were recruited through announcements and randomly allocated into DN or PENS groups. Pain intensity, disability, pressure pain threshold (PPT), range of motion (ROM), and side-bending strength were measured. The analyses included mixed-model analyses of variance and pairwise comparisons with Bonferroni correction. The final sample was composed of 44 subjects (22 per group). Both groups showed improvements in pain intensity (ηp2 = 0.62; p < 0.01), disability (ηp2 = 0.74; p < 0.01), PPT (ηp2 = 0.79; p < 0.01), and strength (ηp2 = 0.37; p < 0.01). The PENS group showed greater improvements in disability (mean difference, 3.27; 95% CI, 0.27-6.27) and PPT (mean difference, 0.88-1.35; p < 0.01). Mixed results were obtained for ROM. PENS seems to produce greater improvements in PPT and disability in the short term.