Health Habits and Wearable Activity Tracker Devices: Analytical Cross-Sectional Study.

Wearable activity trackers are electronic devices that facilitate self-monitoring of information related to health. The purpose of this study was to examine the use of tracker devices to record daily activity (calories) and its associations with gender, generation, BMI, and physical activity behavior of United States of America resident adults; a cross-sectional study in 892 subjects recruited to participate in an anonymous online survey was performed. Being female increased the odds of using a tracker device by 2.3 times. Having low cardiovascular disease mortality risk related to time spent sitting increased the odds for using a tracker device by 2.7 times, and having medium risk 1.9 times, with respect to having high risk. For every 1-point increase in BMI, the odds for using a tracker device increased by 5.2%. Conclusions: Subjects who had ever used any tracker device had a higher BMI. The use of tracker devices was related to lower cardiovascular disease mortality risk related to sitting time. The amount of physical activity and the time spent walking were not associated with the usage of tracker devices. It is possible that the user of tracker devices should be supported by professionals to implement deep change in health habits.

Sensory function in headache: a comparative study among patients with cluster headache, migraine, tension-type headache, and asymptomatic subjects.

AIMS: Studies evaluating sensory function of the entire trigeminocervical region in patients with cluster headache (CH), migraine (MH), and tension-type headache (TH) are required. The purpose of the present study was to evaluate and compare sensory function in the trigeminocervical region in patients with CH, MH, and TH and healthy controls (HC). METHODS: Quantitative sensory testing (QST), including pressure pain threshold (PPT), tactile detection threshold (TDT), prick detection threshold (PDT), and two-point detection threshold (2PDT), was evaluated in 139 patients with headache (CH = 16, MH = 52, TH = 71) and 30 HC. Test sites included bilaterally the first, second, and third divisions of trigeminal nerve (V1, V2, and V3), cervical spine, and thenar eminence. RESULTS: TH presented significantly lower PPT values compared with CH (p < 0.015), MH (p < 0.048), and HC (p < 0.009), while MH demonstrated significantly lower values than HC (p = 0.001-0.023). When analyzing TDT, CH in the symptomatic side presented significantly higher values in V1 compared with MH (p = 0.001), TH (p < 0.001), and HC (p < 0.001) and in V2 compared with TH (p = 0.035). No statistically significant differences were found for PDT (p > 0.005). With regard to 2PDT, CH-s presented significantly higher values in V1 with respect to HC (p = 0.016) but lower values in V2 compared with MH (p < 0.001) and TH (p = 0.003). CONCLUSION: The results of the present study indicate specific and different altered mechanical sensory thresholds in CH, MH, and TH patients compared with HC subjects.

Thermal and non-thermal effects off capacitive-resistive electric transfer application on the Achilles tendon and musculotendinous junction of the gastrocnemius muscle: a cadaveric study.

BACKGROUND: Calf muscle strain and Achilles tendon injuries are common in many sports. For the treatment of muscular and tendinous injuries, one of the newer approaches in sports medicine is capacitive-resistive electric transfer therapy. Our objective was to analyze this in vitro, using invasive temperature measurements in cadaveric specimens. METHODS: A cross-sectional study designed with five fresh frozen cadavers (10 legs) were included in this study. Four interventions (capacitive and resistive modes; low- and high-power) was performed for 5 min each by a diathermy "T-Plus" device. Achilles tendon, musculotendinous junction and superficial temperatures were recorded at 1-min intervals and 5 min after treatment. RESULTS: With the low-power capacitive protocol, at 5 min, there was a 25.21% increase in superficial temperature, a 17.50% increase in Achilles tendon temperature and an 11.27% increase in musculotendinous junction temperature, with a current flow of 0.039 A ± 0.02. With the low-power resistive protocol, there was a 1.14% increase in superficial temperature, a 28.13% increase in Achilles tendon temperature and an 11.67% increase in musculotendinous junction temperature at 5 min, with a current flow of 0.063 A ± 0.02. With the high-power capacitive protocol there was an 88.52% increase in superficial temperature, a 53.35% increase in Achilles tendon temperature and a 39.30% increase in musculotendinous junction temperature at 5 min, with a current flow of 0.095 A ± 0.03. With the high-power resistive protocol, there was a 21.34% increase in superficial temperature, a 109.70% increase in Achilles tendon temperature and an 81.49% increase in musculotendinous junction temperature at 5 min, with a current flow of 0.120 A ± 0.03. CONCLUSION: The low-power protocols resulted in only a very slight thermal effect at the Achilles tendon and musculotendinous junction, but current flow was observed. The high-power protocols resulted in a greater temperature increase at the Achilles tendon and musculotendinous junction and a greater current flow than the low-power protocols. The high-power resistive protocol gave the greatest increase in Achilles tendon and musculotendinous junction temperature. Capacitive treatments (low- and high-power) achieved a greater increase in superficial temperature.

The Effect of Diacutaneous Fibrolysis on Patellar Position Measured Using Ultrasound Scanning in Patients With Patellofemoral Pain Syndrome.

CONTEXT: Tightness or lack of flexibility of several muscles of the thigh has been associated with patellofemoral joint pain. A tight iliotibial band can lead to laterally located patella and an abnormal patellar tracking pattern. Diacutaneous fibrolysis (DF) is commonly used to reduce muscle tightness, but no studies have evaluated the effects of this technique in the treatment of patients with patellofemoral pain syndrome. OBJECTIVE: To assess the effect of DF on patellar position in patients with patellofemoral pain syndrome. DESIGN: A single-group, pretest-posttest clinical trial. SETTING: University of Zaragoza. PARTICIPANTS: A total of 46 subjects with patellofemoral pain (20 males, 26 females; age: 27.8 [6.9] y). INTERVENTION: Three sessions of DF. MAIN OUTCOME MEASURES: Patellar position measurement using real-time ultrasound scanning; pain intensity measured with visual analog scale and function measured with the Anterior Knee Pain Scale. RESULTS: The application of 3 sessions of DF significantly increased the patellar position at posttreatment evaluation (P < .001) and at 1-week follow-up (P < .001). There was not a significant difference on patellar position between posttreatment and follow-up measurements (P = .28). There were also a statistically significant decrease in pain and increase in function at posttreatment and at 1-week follow-up measurements (P < .001). CONCLUSION: This study found that patellar position, pain intensity, and function were significantly improved after 3 sessions of DF and at 1-week follow-up.

Effectiveness of diacutaneous fibrolysis for the treatment of chronic lateral epicondylalgia: a randomized clinical trial.

OBJECTIVE: To assess the end of treatment and three months after treatment effects of diacutaneous fibrolysis as adjuvant of physical therapy for chronic lateral epicondylalgia. DESIGN: Double-blind (patient and evaluator) randomized controlled trial. SETTING: Primary Care Center of the Spanish NHS. SUBJECTS: A total of 54 people with 60 elbows affected with chronic lateral epicondylalgia, 33 women, mean (SD) age was 48.43 (8.69) years. INTERVENTIONS: All three groups (Intervention, Placebo and Control) received three weeks of physical therapy treatment and in addition Intervention Group received six sessions of real diacutaneous fibrolysis and Placebo Group received six sessions of sham diacutaneous fibrolysis. MAIN MEASURES: Pain intensity, pressure pain threshold, pain free grip strength, function and subjective assessment were assessed at baseline, at the end of treatment and three months after treatment. RESULTS: Between-group results at three months after treatment showed a statistically significant improvement of the Intervention Group in pain free grip strength (mean, 7.91 km/cm2; SD, 9.23) compared to the Placebo Group (mean, 1.47 km/cm2; SD, 7.86) and to the Control Group (mean, 2.09 km/cm2; SD, 4.45) ( P values <0.01 and <0.03, respectively) and also in function (mean, 20.87; SD, 14.25) compared to the Control Group (mean, 4.17; SD, 18.02) ( P < 0.01). Subjective assessment was statistically better in the Intervention Group both at the end of treatment ( P < 0.01) and three months after treatment ( P < 0.03). CONCLUSION: Diacutaneous fibrolysis added to physical therapy provides better results in the treatment of chronic lateral epicondylalgia, with greater clinical satisfaction among patients.

Effects of diacutaneous fibrolysis in patients with mild to moderate symptomatic carpal tunnel syndrome: a randomized controlled trial.

OBJECTIVE:: To compare the effects of diacutaneous fibrolysis with sham in patients with mild to moderate carpal tunnel syndrome. DESIGN:: Double-blind (patient and evaluator) randomized controlled trial. SETTING:: Miguel Servet University Hospital, Zaragoza, Spain. SUBJECTS:: A total of 52 patients (72 wrists) with carpal tunnel syndrome, 41 women and 11 men, mean age was 46.9 (8.8) years. They were divided into two groups: diacutaneous fibrolysis group and sham group. INTERVENTIONS:: Real diacutaneous fibrolysis in diacutaneous fibrolysis group and sham diacutaneous fibrolysis in sham group. Both groups received five sessions in the forearm, wrist and hand. MAIN MEASURES:: Neurophysiological parameters assessed at baseline and at the end of the treatment. Intensity of nocturnal symptoms (visual analogue scale (VAS)) and upper limb functional capacity (Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire) at baseline, at the end of the treatment and one month after treatment. RESULTS:: Diacutaneous fibrolysis group (n = 30 wrists) improved in nerve conduction distal motor latency (mean difference: -0.26, 95% confidence interval (CI): -0.49/-0.26), sensory conduction velocity (mean difference: 6.52, 95% CI: 3.52/9.51), intensity of nocturnal symptoms (mean difference: -2.24, 95% CI: -4.08/-2.04) and upper limb functional capacity (mean difference: -19, 95% CI: -26.1/-11.9) compared to the sham group (n = 30 wrists) ( P < 0.02, P < 0.01, P < 0.01 and P < 0.01, respectively). At one-month follow-up, improvements in the nocturnal symptoms and upper limb functional capacity were maintained compared to the sham group ( P < 0.01). CONCLUSION:: Diacutaneous fibrolysis provides short-term and one-month follow-up, improvements in sensory conduction velocity, motor distal latency, symptoms and functional capacity in patients with mild to moderate carpal tunnel syndrome.

Immediate Effects of Upper Cervical Translatoric Mobilization on Cervical Mobility and Pressure Pain Threshold in Patients With Cervicogenic Headache: A Randomized Controlled Trial.

OBJECTIVE: The purpose of this study was to evaluate the immediate effects of upper cervical translatoric spinal mobilization (UC-TSM) on cervical mobility and pressure pain threshold in subjects with cervicogenic headache (CEH). METHODS: Eighty-two volunteers (41.54 ± 15.29 years, 20 male and 62 female) with CEH participated in the study and were randomly divided into the control and treatment groups. The treatment group received UC-TSM and the control group remained in the same position for the same time as the UC-TSM group, but received no treatment. Cervical mobility (active cervical mobility and flexion-rotation test), pressure pain thresholds over upper trapezius muscles, C2-3 zygapophyseal joints and suboccipital muscles, and current headache intensity (visual analog scale) were measured before and immediately after the intervention by 2 blinded investigators. RESULTS: After the intervention, UC-TSM group exhibited significant increases in total cervical mobility (P = .002, d = 0.16) and the flexion-rotation test (P < .001, d = 0.81-0.85). No significant difference in cervical pressure pain thresholds were observed between groups (P > .05). Nevertheless, there was a significantly lower intensity of headache in the UC-TSM group (P = .039, d = 0.57). CONCLUSIONS: Upper cervical translatoric spinal mobilization intervention increased upper, and exhibited a tendency to improve general, cervical range of motion and induce immediate headache relief in subjects with CEH.

Optimizing physical therapy for ankylosing spondylitis: a case study in a young football player.

[Purpose] Ankylosing spondylitis is prevalent in men. Modern and expert consensus documents include physical therapy among the strategies for the treatment of ankylosing spondylitis. This study aimed to describe the physical therapy approach in an athlete with ankylosing spondylitis. [Subject and Methods] The patient, refractory to treatment with anti-inflammatory medication, showed pelvic and lumbar pain and joint, muscle, and functional disorders, which were treated with orthopedic joint mobilization, dry needling, exercise, and whole-body hyperthermia. [Results] After the treatment, pain relief, normal joint mobility, improved muscle function, and return to activities of daily living and competitive sporting activities were recorded. [Conclusion] The literature provides evidence for the use of joint mobilization techniques; however, no previous studies have used the same techniques and methods. There is no previous evidence for the use of dry needling in this pathology. Exercise therapy has a higher level of evidence, and guidelines with scientific support were followed. This research confirms the effectiveness of hyperthermia for arthritis. The early stage of ankylosing spondylitis, and the young age, good overall condition, and cooperative attitude of the patient led to positive outcomes. In conclusion, a favorable response that promoted the remission of the disease was observed.

Effects of Dry Needling on Active Myofascial Trigger Points and Pain Intensity in Tension-Type Headache: A Randomized Controlled Study.

Tension-type headache is the most prevalent type of headache and is commonly associated with myofascial pain syndrome and the presence of active myofascial trigger points. This randomized controlled trial aimed to assess the impact of dry needling on the total number of active trigger points, pain intensity, and perceived clinical change in tension-type headache subjects. Thirty-two subjects were randomly assigned to the control and dry needling groups. The presence of active trigger points in 15 head and neck muscles, the headache intensity, and the perceived clinical change were evaluated. A single dry needling technique was administered at each active trigger point across three sessions. Significant differences were observed in the post-treatment measures favouring the dry needling group, including reductions in the headache intensity scores (p = 0.034) and the total number of active trigger points (p = 0.039). Moreover, significant differences in the perception of clinical change were found between the control and treatment groups (p = 0.000). Dry needling demonstrated positive effects in reducing the number of active trigger points and improving the short-term headache intensity in tension-type headache patients. A single dry needling session applied in the cranio-cervical area resulted in a self-perceived improvement compared to the control subjects.

Motor Imagery and Mental Practice in the Subacute and Chronic Phases in Upper Limb Rehabilitation after Stroke: A Systematic Review.

Introduction: Motor imagery and mental practice can be defined as a continuous mechanism in which the subject tries to emulate a movement using cognitive processes, without actually performing the motor action. The objective of this review was to analyse and check the efficacy of motor imagery and/or mental practice as a method of rehabilitating motor function in patients that have suffered a stroke, in both subacute and chronic phases. Material and Methods. We performed a bibliographic search from 2009 to 2021 in the following databases, Medline (PubMed), Scopus, WOS, Cochrane, and OTSeeker. The search focused on randomized clinical trials in which the main subject was rehabilitating motor function of the upper limb in individuals that had suffered a stroke in subacute or chronic phases. Results: We analysed a total of 11 randomized clinical trials, with moderate and high methodological quality according to the PEDro scale. Most of the studies on subacute and chronic stages obtained statistically significant short-term results, between pre- and postintervention, in recovering function of the upper limb. Conclusions: Motor imagery and/or mental practice, combined with conventional therapy and/or with other techniques, can be effective in the short term in recovering upper limb motor function in patients that have suffered a stroke. More studies are needed to analyse the efficacy of this intervention during medium- and long-term follow-up.

Diacutaneous Fibrolysis: An Update on Research into Musculoskeletal and Neural Clinical Entities.

Diacutaneous Fibrolysis (DF) is an instrumentally assisted manual therapy technique defined as "a specific instrumental intervention for normalizing the musculoskeletal system function after a precise diagnosis and preserving the skin's integrity". The aim of this technique is soft tissue mobilization with the assistance of specially designed, hook-shaped steel instruments in different musculoskeletal structures, such as the myofascia, aponeurosis, tendons, ligaments and scar tissues. Due to discrepant results between previous reviews and the quite abundant new evidence provided by recently published randomized clinical trials, we propound this narrative review to provide an update on the scientific evidence related to the fundamentals and clinical efficacy of DF. Current evidence primarily supports the mechanical effect of DF on connective soft tissues. Diminished deep tendon reflex and rigidity have been registered after the implementation of DF in healthy subjects. Though there is still much to uncover, scientific evidence supports the use of the technique for the clinical treatment of subacromial impingement syndrome, chronic lateral epicondylalgia, chronic patellofemoral pain syndrome, mild to moderate carpal tunnel syndrome, hamstring shortening, temporomandibular disorders, tension-type headache and chronic low back pain. Additional data are essential for better recommendations in the clinical practice of DF.

Effects of occipital-atlas stabilization on the upper cervical spine rotation combinations: an in vitro study.

The purpose of this study is to compare axial rotation range of motion for the upper cervical spine during three movements: axial rotation, rotation + flexion + ipsilateral lateral bending and rotation + extension + contralateral lateral bending before and after occiput-atlas (C0-C1) stabilization. Ten cryopreserved C0-C2 specimens (mean age 74 years, range 63-85 years) were manually mobilized in 1. axial rotation, 2. rotation + flexion + ipsilateral lateral bending and 3. rotation + extension + contralateral lateral bending without and with a screw stabilization of C0-C1. Upper cervical range of motion and the force used to generate the motion were measured using an optical motion system and a load cell respectively. The range of motion (ROM) without C0-C1 stabilization was 9.8° ± 3.9° in right rotation + flexion + ipsilateral lateral bending and 15.5° ± 5.9° in left rotation + flexion + ipsilateral lateral bending. With stabilization, the ROM was 6.7° ± 4.3° and 13.6° ± 5.3°, respectively. The ROM without C0-C1 stabilization was 35.1° ± 6.0° in right rotation + extension + contralateral lateral bending and 29.0° ± 6.5° in left rotation + extension + contralateral lateral bending. With stabilization, the ROM was 25.7° ± 6.4° (p = 0.007) and 25.3° ± 7.1°, respectively. Neither rotation + flexion + ipsilateral lateral bending (left or right) or left rotation + extension + contralateral lateral bending reached statistical significance. ROM without C0-C1 stabilization was 33.9° ± 6.7° in right rotation and 28.0° ± 6.9° in left rotation. With stabilization, the ROM was 28.5° ± 7.0° (p = 0.005) and 23.7° ± 8.5° (p = 0.013) respectively. The stabilization of C0-C1 reduced the upper cervical axial rotation in right rotation + extension + contralateral lateral bending and right and left axial rotations; however, this reduction was not present in left rotation + extension + contralateral lateral bending or both combinations of rotation + flexion + ipsilateral lateral bending.

Determinants of Consumption of Vegetables among the Spanish Population: A Cross-Sectional Study.

The consumption of vegetables is one of the fundamentals of a healthy diet. The purposes of the present study were to describe the frequency of consumption of vegetables in the general Spanish population and to explore the relations between the consumption of vegetables and sex, age, cohabitation circumstances, educational level, and body mass index (BMI). METHODS: An analytical cross-sectional study was accomplished based on data from the European Health Survey in Spain (2020). RESULTS: A total of 20,745 (52.1% women) subjects with a median age of 54 years old were included. Only 2.8% of them ate vegetables at least three times a day. The adjusted generalized linear model showed that being a woman increased the odds of consuming vegetables at least three times a day by 1.666 times (p < 0.001). Not cohabiting as a couple decreased the odds by 0.783 (p < 0.001). Having studied at a university increased the odds by 1.812 times (p < 0.001) and possessing a certificate of higher education by 1.408 (p = 0.030). Being overweight decreased the odds by 0.924 (p = 0.006). For every additional year of age, the odds of consuming vegetables at least three times a day increased by 1.3% (p < 0.001). CONCLUSIONS: The vast majority of the general Spanish population did not consume an optimal amount of vegetables. Women, people with higher levels of education, and older individuals reported having a more frequent intake of vegetables. Not cohabiting as a couple and being overweight were related to a less frequent intake of vegetables.

Diagnostics Using the Change-of-Direction and Acceleration Test (CODAT) of the Biomechanical Patterns Associated with Knee Injury in Female Futsal Players: A Cross-Sectional Analytical Study.

The primary aim of this study was to identify kinematic differences at initial contact between female futsal players with and without previous knee injury, using a functional motor pattern test. The secondary aim was to determine kinematic differences between the dominant and non-dominant limb in the whole group, using the same test. A cross-sectional study was performed in 16 female futsal players allocated into two groups: eight females with a previous knee injury, i.e., affected by the valgus collapse mechanism without surgical intervention, and eight with no previous injury. The evaluation protocol included the change-of-direction and acceleration test (CODAT). One registration was made for each lower limb, i.e., the dominant (the preferred kicking limb) and non-dominant limb. A 3D motion capture system (Qualisys AB, Göteborg, Sweden) was used to analyze the kinematics. The Cohen's d effect sizes between the groups demonstrated a strong effect size towards more physiological positions in the non-injured group in the following kinematics in the dominant limb: hip adduction (Cohen's d = 0.82), hip internal rotation (Cohen's d = 0.88), and ipsilateral pelvis rotation (Cohen's d = 1.06). The t-test for the dominant and non-dominant limb in the whole group showed the following differences in knee valgus: dominant limb (9.02 ± 7.31 degrees) and non-dominant limb (1.27 ± 9.05 degrees) (p = 0.049). Conclusions: The players with no previous history of knee injury had a more physiological position for avoiding the valgus collapse mechanism in the hip adduction and internal rotation, and in the pelvis rotation in the dominant limb. All the players showed more knee valgus in the dominant limb, which is the limb at greater risk of injury.

Effectiveness of Dry Needling in Improving Pain and Function in Comparison with Other Techniques in Patients with Chronic Neck Pain: A Systematic Review and Meta-Analysis.

The purpose of this systematic review and meta-analysis was to assess the short-, mid-, and long-term effectiveness of dry needling in improving pain and functional capacity of patients with chronic neck pain. Search strategy was performed on PubMed, Web of Science, Scopus, PEDro, and Cochrane Library Plus biomedical databases. The risk of bias was assessed using the RoB2 tool. Randomised controlled clinical trials in which at least 1 of the groups received dry needling were included. 662 studies were found; 14 clinical trials were selected for qualitative analysis and 13 for quantitative analysis. The quality of most of the studies included was "high." All the studies reported improvements in cervical pain and/or disability, regardless of the protocol followed and the muscles targeted. No serious adverse effects were reported. Dry needling showed to be more effective when compared with other therapies in both women and men, without differences by sex. When the analysis was carried out by age, patients over 40 years old benefitted more than those below 40 years old. Our meta-analysis supports the use of dry needling to improve pain and functional capacity in patients with chronic neck pain at short- and mid-term intervals.

Effects of Contralateral Hip Flexion Angle on the Ober Test.

The Ober test is an orthopedic evaluation procedure used to assess for tightness of the tensor fascia latae (TFL) and iliotibial band (ITB). Multiple versions of this test have been described using different degrees of contralateral hip joint flexion to stabilize the pelvis. The aim of this study was to analyze the hip range of motion (ROM) in the frontal plane and perceived tension produced during the Ober test using four different angles of contralateral hip flexion prepositioning. The secondary objective was to analyze the differences in the Ober test with different contralateral hip flexion angles according to limb dominance. This cross-sectional study included healthy individuals aged 18 years or older. The Ober test was performed on the right and left leg of each participant with the contralateral hip joint stabilized at 0° flexion, 45° flexion, 90° flexion, and maximal flexion. Hip range of motion in the frontal plane (abduction or adduction) was measured using a digital inclinometer. Three measurements were performed on each limb for every angle of contralateral prepositioning, using the average of the three measurements for statistical analysis. Participants were asked to report the location of any perceived tension and the intensity of tension using a Numeric Rating Scale during the test. Twenty-eight participants (17 men and 11 women) were examined. Significant differences in the Ober test hip ROM in the frontal plane (p < 0.01) were observed when comparing different angles of contralateral hip flexion prepositioning. Significant differences between tests were also present for intensity of perceived tension (p ≤ 0.001), except for the intensity of perceived tension between 0° and 45°. No statistically significant differences were observed related to limb dominance (p > 0.05) or gender (p > 0.05), except for the Ober test at 0° (p < 0.001) which was higher in men (9.61° ± 5.01°) than in women (5.05° ± 2.87°). Greater contralateral hip flexion prepositioning during the Ober test results in decreased hip adduction ROM in the tested limb and greater perceived tension in the region of tensor fascia latae-iliotibial band.

Short-term effects of the traction-manipulation protocol in dizziness intensity and disability in cervicogenic dizziness: a randomized controlled trial.

PURPOSE: Analyse the short-term effects of traction-manipulation protocol in dizziness and pain intensity and disability, cervical mobility and postural instability. MATERIALS AND METHODS: Randomized controlled assessor-blind clinical trial. The traction-manipulation protocol was carried out in the intervention group and compared with a control group where the subjects were kept supine. The intervention protocol follows the IFOMPT safety recommendations. Dizziness and pain intensity, Dizziness Handicap Inventory (DHI), cervical mobility and balance were measured after 48 h and a one-month follow-up. RESULTS: Forty subjects with cervicogenic dizziness were randomly assigned to an intervention or control group. Significant differences were found in favour of the intervention protocol group in: dizziness intensity (p < 0.001; d = 1.31), DHI (p < 0.001; d = 0.76) pain intensity (p < 0.007; d = 0.92), upper cervical flexion (p < 0.032; d = 0.30) and extension (p < 0.012; d = 0.80) at 48 h follow up. At one-month follow up there were significant differences in favour of the intervention group in: dizziness intensity (p < 0.001; d = 0.95), DHI (p < 0.001; d = 0.0.92) pain intensity (p < 0.001; d = 1.38) and upper cervical extension (p < 0.005; d = 0.92). Postural instability improved in mediolateral displacement static with eyes closed (p < 0.032; d = 0.79) and in dynamic with eyes open (p = 0.003; d = 0.55) at one-month follow-up in the intervention group. CONCLUSION: The traction-manipulation protocol reduces the dizziness and pain intensity, ameliorates disability and improves upper cervical mobility and postural instability.IMPLICATIONS FOR REHABILITATIONThe intervention protocol reduces the dizziness and pain intensity, and improves self-perceived disability in patients with cervicogenic dizziness.Manual therapy improves the cervical range of motion and the postural instability in the cervicogenic dizziness.The intervention protocol follows the safety recommendations of the International Federation of Orthopaedic Manipulative Physical Therapists.

Nutrition-Related Content on Instagram in the United States of America: Analytical Cross-Sectional Study.

BACKGROUND: The Internet is today the largest platform for food distribution, and there are concerns about the impact that digital marketing has in the field of nutrition by promoting non-evidence-based recommendations. The purpose of this study was to describe the user profile that draws on Instagram to follow nutrition-related content versus not, and to analyze the frequency and type of content of the information provided by nutritional influencers. METHODS: A cross-sectional study involving randomly selected United States residents having an Instagram account was performed. Participants completed an anonymous online survey link. RESULTS: From 898 respondents, 78.7% were women, and 75.6% were Millennials. Scientific evidence present in the posts was 14.3%. Influencers promoted a product or a brand in more than 90% of posts. Women followed more nutrition-related content than men (p < 0.001). Millennials, followed by Generation-Z, followed more nutrition-related content (p < 0.001). There were no significant relationships between the following status of nutrition-related content with BMI, type of job, household income, education degree, or smoking habits. CONCLUSIONS: Women and Millennials followed more nutrition-related content. Scientific evidence was scarce and commercial interest in the network was evident. The vast majority of the posts were not based on scientific evidence and instead promoted a product/supplement.

Impact of Fitness Influencers on the Level of Physical Activity Performed by Instagram Users in the United States of America: Analytical Cross-Sectional Study.

BACKGROUND: Physical activity positively influences the general population's health. Social media networks may promote changes in physical activity habits. This study aimed to analyze the relation between being encouraged to perform physical activity by fitness influencers on Instagram and the level of physical activity performed. METHODS: An analytical cross-sectional study was performed in 890 United States residents with an Instagram account. The sample was made up of 79.2% females and of 75.4% millennials (born between 1981-1996). Physical activity was measured with the International Physical Activity Questionnaire. Sociodemographic characteristics were registered. RESULTS: The percentage of females (p = 0.001), millennials (p < 0.001), students (p < 0.001), participants with normal BMI (p = 0.001), and participants performing more than 150 min per week of moderate physical activity (p = 0.014) was significantly higher in the group that felt encouraged to perform physical activity by the information posted by fitness influencers. This group spent a median of 2 h per week on Instagram checking for nutrition or exercise (p < 0.001). CONCLUSIONS: United States residents who felt encouraged to perform physical activity by fitness influencers on Instagram achieved more the World Health Organization recommendations for substantial health benefit for moderate physical activity. They were predominantly females and millennials with normal weight and spent more time on Instagram checking for nutrition or exercise.

In vitro upper cervical spine kinematics: Rotation with combined movements and its variation after alar ligament transection.

Previous studies indicate that maximum upper cervical axial rotation occurs only through a combination of transverse, frontal, and sagittal plane motions. This study explores the relationship between transection of the alar ligament and combined upper cervical axial rotation movements. Ten cryopreserved upper cervical spines were manually mobilized in bilateral axial rotation and two different motion combinations with simultaneous motion in the three anatomical planes: rotation in extension (extension + axial rotation + contralateral lateral bending) and rotation in flexion (flexion + axial rotation + ipsilateral lateral bending). These three motions were performed before and after right alar ligament transection. The occiput-axis axial rotation was measured using an optical motion capture system while measuring the applied load. With intact alar ligament, the axial rotation in flexion showed the lowest range of motion (right, R: 9.81 ± 3.89°; left, L: 15.54 ± 5.89°). Similar results were found between the other two mobilizations: axial rotation (R: 33.87 ± 6.64°; L: 27.99 ± 6.90°) and rotation in extension (R: 35.15 ± 5.97°; L: 28.96 ± 6.47°). After right alar ligament transection, rotation in flexion (particularly in left rotation) showed the largest increase in motion: rotation in flexion (R: 13.78 ± 9.63°; L: 23.04 ± 5.59°), rotation in extension (R: 36.39 ± 7.10°; L: 31.71 ± 7.67°), and axial rotation (R: 38.50 ± 9.47°; L: 31.59 ± 6.55°). Different combinations of movements should be evaluated when analyzing the maximum axial rotation of the upper cervical spine, as axial rotation alone and rotation in extension showed a larger range of motion than rotation in flexion. After unilateral alar ligament injury, rotation to the non-injured side in flexion demonstrates the most movement increase.