Exercise therapy improves pain and mouth opening in temporomandibular disorders: A systematic review with meta-analysis.

OBJECTIVE: To analyse the effectiveness of exercise therapy in improving pain and active or passive maximum mouth opening in patients with temporomandibular disorders. DATA SOURCES: PubMed Medline, Web of Science, Scopus, CINAHL Complete and Physiotherapy Evidence Database, until April 2022, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. REVIEW METHODS: We included randomized controlled trials evaluating the effect of exercise therapy on pain and on active and passive maximum mouth opening in patients with temporomandibular disorders. Effect size was calculated using Cohen's standardized mean difference (SMD) and their 95% confidence interval (95% CI) in a random-effects model. RESULTS: A total of 16 studies with 812 participants were included. Exercise therapy is effective in reducing pain (SMD: -0.58; 95% CI: -1.01 to -0.12) and increasing the pain pressure threshold (SMD: 0.45; 95% CI: 0.14-0.76), active and passive maximum mouth opening (SMD: 0.43; 95% CI: 0.14-0.71 and SMD: 0.4; 95% CI: 0.06-0.75, respectively). Subgroup analyses showed more effect of exercise therapy more splints versus splints on pain (SMD: -0.5; 95% CI: -0.73 to -0.26), active and passive maximum mouth opening (SMD: 1.14; 95% CI: 0.22-2.07 and SMD: 0.56; 95% CI: 0.06-1.06, respectively). On pain pressure threshold, exercise therapy was better than physiotherapy approach (manual therapy and electrotherapy) (SMD: 0.48; 95% CI: 0.09-0.87). CONCLUSIONS: Therapeutic exercise is an effective therapy to reduce pain and increase pain pressure threshold and active and passive maximum mouth opening in patients with temporomandibular disorders.

Manual Therapy Approach to the Extraocular Muscles in Migraine Treatment: A Preliminary Study.

The oculomotor system plays an important role in the development of migraines. This is an observational study that aims to investigate the rehabilitative efficacy of muscle energy therapy (MET) in reducing migraine symptoms. MET was based on post-isometric relaxation and reciprocal inhibition, targeting the extraocular muscles. Patients diagnosed with chronic migraines and positive results in the Smooth Pursuit Eye Movement Test were enrolled in the study. The effects of treatment were assessed using the following questionnaires: Migraine Disability Assessment (MIDAS), Neck Disability Index (NDI), Pittsburg Sleep Quality Index (PSQI), Dizziness Handicap Inventory (DHI), and the neck range of motion (ROM). Additionally, rheological parameters of neck muscles were assessed. We reported beneficial effects of MET on the amelioration of the frequency of headaches, neck pain and dizziness-related disabilities and disordered sleep. However, benefits concerning the neck motion and rheological properties of oculomotor structures were unconvincing. In conclusion, the study showed advantageous effects of manual oculomotor therapy consisting of reductions in migraine-related painful symptomatology. The results diminish the role of ocular muscle mechanical properties in the genesis of migraine, shifting attention to the modulatory role of the neuromuscular ocular component, likely involving trigeminal innervation, which can be subject to migraine manual therapy.

Corrective exercise-based therapy for adolescent idiopathic scoliosis: Systematic review and meta-analysis.

OBJECTIVE: to analyze the efficacy of Corrective exercise-based therapy in the improvement of deformity and quality of life in adolescent idiopathic scoliosis. DATA SOURCES: PubMed Medline, Scopus, Web of Science (WOS), Physiotherapy Evidence Database, CINAHL Complete and SciELO, until June 2021. REVIEW METHODS: Randomized controlled trials was selected, including participants diagnosed with adolescent idiopathic scoliosis, in which the experimental group received Corrective exercise-based therapy. Two authors independently searched the scientific literature in the data sources, extracted the data and assessed the risk of bias. A pairwise meta-analysis using the random-effects model was performed. RESULTS: Eight randomized controlled trials providing data from 279 adolescent idiopathic scoliosis patients were included. Seven randomized controlled trials including 236 patients showed moderate-quality evidence for a medium effect (SMD = -0.52, 95% CI -0.96 to -0.1), favoring corrective exercise-based therapy for spinal deformity reduction. Corrective exercise-based therapy was better than no intervention (SMD = -0.59, 95% CI -1.18 to -0.01) but similar to other intervention (SMD = -0.2, 95% CI -0.67 to 0.27), and a medium effect was found (SMD = -0.51, 95% CI -0.89 to -0.13) when corrective exercise-based therapy was used with other therapies. Four studies including 151 patients showed low-quality evidence of a large effect of Corrective exercise-based therapy on Scoliosis Research Society measurement (SRS-22) total score improvement (SMD = 1.16, 95% CI 0.36 to 1.95). CONCLUSION: In mild and moderate adolescent idiopathic scoliosis patients, corrective exercise-based therapy could be used to reduce spinal deformity and to improve quality of life as isolated treatment or as coadjuvant treatment combined with other therapeutic resources.

Vacuum myofascial therapy device for non-specific neck pain. A single blind randomized clinical trial.

OBJECTIVES: This study aimed to investigate the efficacy of a vacuum myofascial therapy device (VT) for improving pressure pain thresholds (PPTs), range of motion (ROM), neck pain-related disability, pain, and quality of life in patients with non-specific neck pain. METHODS: A randomized controlled trial in which thirty-eight participants with non-specific neck pain (NP) were randomly assigned to either an experimental (VT) or a comparison physical therapy program (PTP) group. The VT group (n = 19) received five sessions of treatment with a vacuum myofascial therapy device while the PTP group (n = 19) received five sessions of massage, ultrasound therapy (US), and transcutaneous electric nerve stimulation (TENS) over two weeks. The outcome measures were the numerical pain rating scale (NPRS), range of motion, quality of life (SF-12), neck disability Index (NDI), and PPTs at the end of treatment and at one-month follow-up. RESULTS: Although both groups experienced improvements in pain, neck disability, range of motion, and pressure pain, these only were statistically significant in the VT group. At one-month follow-up, the VT group still showed improvements in pain, neck disability, and range of motion. DISCUSSION: Vacuum myofascial therapy applied with a device offers similar results to other vacuum-based techniques such as cupping therapy. Moreover, in this device the parameters are digitally controlled, which allows for the precise reproduction of treatment.

Percutaneous Electrolysis in the Treatment of Lateral Epicondylalgia: A Single-Blind Randomized Controlled Trial.

Few studies have considered the effects of percutaneous electrolysis (PE) in the treatment of lateral epicondylalgia (LE). For this reason, the objective of this study was to compare the effects of PE with an evidence-based approach-trigger point dry needling (TDN)-in patients with LE. A randomized controlled trial was conducted in which 32 participants with LE were randomly assigned to two treatment groups, the PE group (n = 16) and the TDN group (n = 16). Both groups received four therapy sessions and an eccentric exercise program to be performed daily. The numerical pain rating scale (NPRS), pressure pain thresholds (PPT), quality of life, and range of motion were measured before treatment, at the end of treatment, and at one- and three-month follow-ups. Significant between-group mean differences were found after treatment for NPRS (p < 0.001) and flexion movement (p = 0.006). At one-month follow-up, significant mean differences between groups were found for NPRS (p < 0.001), PPT (p = 0.021), and flexion (p = 0.036). At three-months follow-up, significant mean differences between groups were found for NPRS (p < 0.001), PPT (p = 0.004), and flexion (p = 0.003). This study provides evidence that PE could be more effective than TDN for short- and medium-term improvement of pain and PPTs in LE when added to an eccentric exercise program.

Effectiveness of Percutaneous Electrolysis in Supraspinatus Tendinopathy: A Single-Blinded Randomized Controlled Trial.

Supraspinatus tendinopathy is one of the most common causes of shoulder pain. Many studies support conservative treatments such as exercise, trigger point dry needling or corticosteroid injections. Otherwise, a minimally invasive approach with percutaneous electrolysis (PE) has also been used successfully in shoulder pain, although evidence about its long-term effects is scarce. The aim of this trial was to determine the effects of PE on supraspinatus tendinopathy compared with trigger point dry needling (TDN). Thirty-six patients with supraspinatus tendinopathy were randomly assigned to either a PE group (n = 18) or a TDN group (n = 18). Both groups also performed eccentric exercises. The main outcome to be measured was the Numerical Pain Rating Scale (NPRS), but the shoulder range of motion (ROM) and trigger point pressure pain threshold (PPT) were also considered. A one-year follow-up was conducted. Significant differences favoring the PE group were found regarding pain at one-year follow-up (p = 0.002). The improvement achieved in the PE group was greater in the NPRS (p < 0.001), proximal PPT, middle PPT, distal PPT (all p < 0.001) and ranges of movement. PE seems to be more effective than TDN in relieving pain and improving ROM and PPT supraspinatus values in patients with supraspinatus tendinopathy, both right after treatment and at one-year follow-up.

Treatment of Neck Pain With Myofascial Therapies: A Single Blind Randomized Controlled Trial.

OBJECTIVE: This study aimed to investigate the effects of myofascial release therapy vs a standard physical therapy program in patients with neck pain (NP). METHODS: This was a randomized controlled trial in which 54 participants with mechanical NP were randomly assigned into an experimental group (EG) or a comparison group (CG). The EG group (n = 27) received 5 therapy sessions of myofascial release therapy while the CG group (n = 27) received 10 sessions of massage, ultrasound therapy, and transcutaneous electric nerve stimulation over a 2-week period. Outcome measures were the numerical pain rating scale (NPRS), pressure pain thresholds (PPTs) and range of motion at the end of treatment and at 1-month follow-up. RESULTS: At 1-month follow-up, between-group differences in change scores were found in the NPRS (mean = -1.56, 95% confidence interval [CI] [-2.30 to -0.81]; P < .001), in the right thoracic PPT (mean = 0.35, 95% CI [0.03-0.66]; P = .031), and in both left (mean = 0.34, 95% CI [0.08-0.61]; P = .012) and right (mean = 0.29, 95% CI [0.04-0.54]; P = .026) suboccipital PPTs. The success rate was 63.0% in the CG and 92.6% in the EG. The number needed to treat was 3.38 (95% CI = 1.99-11.23). CONCLUSIONS: Myofascial release therapy could be better than a standard physical therapy program for improving pain and suboccipital PPTs in patients with NP. However, the difference between both treatments is less than the minimum detectable change of the NPRS.

Effects of Monopolar Dielectric Radiofrequency Signals on the Symptoms of Fibromyalgia: A Single-Blind Randomized Controlled Trial.

Monopolar dielectric radiofrequency (MDR) is a non-invasive treatment for pain based on the local application of electromagnetic signals. The study's goal was to analyze the effects of MDR on the symptoms of fibromyalgia. For this aim, a randomized controlled trial was conducted on 66 female participants (aged 47 17.7) diagnosed with fibromyalgia. Participants were randomly allocated to either an experimental group (n = 23), which received eight 20-minute sessions of MDR; a sham group, which received the same number of sessions of a sham MDR therapy (n = 22); or a control group (n = 21), which received usual care. The outcome variables included pain measured by the visual analogue scale (VAS), score on the hospital anxiety and depression scale (HADS) and quality of life measured by the combined index of fibromyalgia severity (ICAF). A large effect size was observed for the local pain (R2 = 0.46), total ICAF (R2 = 0.42) and ICAF physical factor scores (R2 = 0.38). Significant mean differences were found for the local pain (p = 0.025) and ICAF physical factor (p = 0.031) scores of the experimental group in comparison with the sham group. No statistically significant differences between groups were found in HADS. In conclusion, MDR is more effective than either sham treatment or usual care in the short-term improvement of pain and the physical wellbeing of participants with fibromyalgia.

Short-term effectiveness of the flexion-distraction technique in comparison with high-velocity vertebral manipulation in patients suffering from low-back pain.

OBJECTIVES: To determine the short-term effects of a modified Flexion-Distraction (FD) technique in comparison with a high-velocity low-back spinal manipulation (HVLA-SM) protocol on patients suffering from chronic low-back pain (CLBP). DESIGN AND METHODS: A randomized controlled trial. The sample was composed of 150 patients suffering from CLBP, who were randomly assigned to either a FD (n = 75) or a HVLA-SM (n = 75) group. The variables used to study pain were the scores of the Visual Analogue Scale (VAS) and the Pressure Pain Threshold (PPT) on trigger points (TrPs) of the quadratus lumborum. In addition, the Oswestry Disability Index (ODI) was used to measure disability, and Schober's test and the Finger Floor Distance test (FFDT) to measure changes in low-back spine motion. An Analysis of Covariance (ANCOVA) was used to measure group effect, and Number Needed to Treat (NNT) for effect size. RESULTS: Greater improvements occurred in the FD group, with a statistically significant group effect (p < 0.001) for all outcome variables. The ETA2 value was larger than 0.100 in the Schober's and FDD tests, larger than 0.200 in the case of ODI and PPT, and larger than 0.300 for VAS. OR = 0.07 [IC 95% = 0.03 to 0.18] and NNT = 2.08 [IC 95% = 1.64-2.84) yielded improved values for the FD group. CONCLUSION: For patients suffering from CLBP, greater improvements in pain and function were observed in the group receiving the modified FD treatment than in the HVLA-SM group.

Effects of Myofascial Release on Pressure Pain Thresholds in Patients With Neck Pain: A Single-Blind Randomized Controlled Trial.

OBJECTIVE: This study aimed to investigate the efficacy of myofascial release therapy (MRT) for improving pressure pain thresholds (PPTs) and pain in patients with mechanical neck pain. DESIGN: Forty-one participants with neck pain were randomly allocated to either a MRT group (five sessions) or a physical therapy (PT) group (ten sessions) for 2 wks. The multimodal PT program included ultrasound therapy (US), transcutaneous electric nerve stimulation, and massage. Visual analog scale (VAS) and PPTs in suboccipital and upper trapezius muscles were measured at baseline, at the end of treatment, and at 1 month follow-up. RESULTS: At the end of treatment, significant mean differences in VAS (-0.99, 95% confidence interval [CI] = -1.82 to -0.16), in both left (0.28, 95% CI = 0.06 to 0.50) and right (0.40, 95% CI = 0.16 to 0.63) suboccipital PPTs and in the right trapezius PPT (0.38, 95% CI = 0.07 to 0.69) were observed. At 1-month follow-up, significant mean differences were found for VAS (-1.85, 95% CI = -2.76 to -0.94) and both left (0.46, 95% CI = 0.12 to 0.80) and right (0.38, 95% CI = 0.06 to 0.69) suboccipital PPTs. CONCLUSIONS: This study provides evidence that MRT could be better than a multimodal PT program for short-term improvement of pain and PPTs in patients with neck pain.

Tai Chi for Risk of Falls. A Meta-analysis.

OBJECTIVES: To analyze the effectiveness of tai chi for falls prevention. DESIGN: Systematic review and meta-analysis. SETTING: Pubmed, Scopus, CINHAL, and Physiotherapy Evidence Database (PEDro) were searched to May 26, 2016. PARTICIPANTS: Older adult population and at-risk adults. INTERVENTION: Randomized controlled trials analyzing the effect of tai chi versus other treatments on risk of falls. MEASUREMENTS: The incidence rate ratio (IRR) for falls incidence and hazard ratio (HR) for time to first fall. RESULTS: The search strategy identified 891 potentially eligible studies, of which 10 met the inclusion criteria. There was high-quality evidence of a medium protective effect for fall incidence over the short term (IRR = 0.57; 95% CI = 0.46, 0.70) and a small protective effect over the long term (IRR = 0.87; 95% CI = 0.77, 0.98). Regarding injurious falls, we found very low-quality evidence of a medium protective effect over the short term (IRR = 0.50; 95% CI = 0.33, 0.74) and a small effect over the long term (IRR = 0.72; 95% CI = 0.54, 0.95). There was no effect on time to first fall, with moderate quality of evidence (HR = 0.98; 95% CI = 0.69, 1.37). CONCLUSION: In at-risk adults and older adults, tai chi practice may reduce the rate of falls and injury-related falls over the short term (<12 months) by approximately 43% and 50%, respectively. Tai chi practice may not influence time to first fall in these populations. Due to the low quality of evidence, more studies investigating the effects of tai chi on injurious falls and time to first fall are required.

The Effect of Tai Chi on Reducing the Risk of Falling: A Systematic Review and Meta-Analysis.

Tai Chi has frequently been used as a preventive measure against falling in at-risk populations. However, studies have yielded contradictory results, and literature reviews have considered only a small number of trials and have not addressed some key aspects, such as sources of heterogeneity and publication bias. This study includes 13 controlled trials published before June 2015 that analyzed the effectiveness of Tai Chi in fall prevention in populations of frail and at-risk adults. The effect measure used in this meta-analysis was absolute risk reduction (ARR) with a 95% confidence interval (CI). According to our findings, practice of Tai Chi significantly prevents the risk of falling (ARR, [Formula: see text]; 95% CI: [Formula: see text], [Formula: see text]). The heterogeneity of results across the trials was low, with a reduced risk of publication bias, and no significant effect differences were observed between studies comparing Tai Chi with other interventions or non-treatment. We therefore conclude that Tai Chi is more effective than other measures, or no intervention, for fall prevention in at-risk populations. Further research is warranted to analyze the consequences of falls and to study the episodes rather than the cases of falls.