Does combined individualized orofacial manual therapy, pain neuroscience education, and brain training change orofacial pain, chronic face dysfunction, (facial) body perception and pain? An observational mixed methods case series study.

BACKGROUND: Orofacial pain is a complex disabling condition. Multimodal physical therapy intervention may be helpful, yet studies of such approaches are not available and are the basis of this study. OBJECTIVE: To identify whether combined orofacial manual therapy, pain neuroscience education, graded motor imagery, and face emotional expression training has an impact on orofacial pain and associated features. DESIGN: Mixed-methods case series report. METHODS: Eight subjects (five females) with predominant chronic unilateral face pain (mean duration 7.3 years) were given six individualized treatment sessions and a home program. The primary outcome was orofacial pain, while secondary outcomes were depression, quality of life, alexithymia, 2-point discrimination (TPD), laterality and emotional recognition, as well as qualitative analysis were evaluated post intervention. RESULTS: Following the intervention orofacial pain intensity significantly reduced (p = 0.03) from 3.0 (0.53) to 2.2 (1.75) on the Graded Chronic Pain Status questionnaire. As well, secondary outcome measures depression, alexithymia, TPD, and quality of life also significantly improved. Changes were not significant in aspects of facial perception. Qualitative analysis of perception of therapy is discussed. CONCLUSION: Multimodal therapy had a positive outcome in terms of improvement in unilateral persistent facial pain, depression score, facial body perception and quality of life, and pain in people with chronic unilateral facial pain. Based on the qualitative analysis of their perception of the therapy, multimodal therapy had beneficial effects through increased motivation and joy to exercise.

Efficacy of foam rolling with additional vibration stimulation on the mobility of the thoracolumbar fascia. An observational study.

INTRODUCTION: Observations show that foam rolling improves joint movements. Likewise, it can be stated that a vibration stimulation of the tissue leads to improved joint mobility. METHOD: This study investigates whether the combination of foam rolling and vibrations (31 Hz) can influence the sliding of the thoracolumbar fascia more effectively than normal foam rolling. 45 subjects participated in the study and were divided into a foam roll with additional vibration group (FRV), a foam roll group (FR) and a control group (CG). The intervention groups rolled out the gluteal muscles, the lateral trunk and the upper and lower back. Mobility measures were taken pre and post the respective intervention. Subsequent cross correlation software analysis quantified the sliding of the fascia and calculated its shear strain mobility (SSM). RESULTS: The sliding of the thoracolumbar fascia improved significantly within the FRV by 2.83 mm (SD ± 1.08/p < .001), in the FR by 0.96 mm (SD ± 0.43/p < .001) and in the CG decreased the sliding by 0.1401 mm (SD ± 0.28/p = .076). The fascia/fascia SSM increased in the FRV by 22.61% (SD ± 15.64/p < .001), in the FR by 11.41% (SD ± 20.38/p = .056) and in the CG decreased the SSM by 0.9473% (SD ± 11.35/p < .751). The lumbar movement increased in both intervention groups, but showed no significant result. CONCLUSION: The use of a foam roll with additional vibration and standard intervention have increased thoracolumbar fascia sliding and lumbar movements. The improved shear strain mobility can be attributed to the multi-activity of mechanoreceptors, such as Pacini- and Ruffini-Bodies.

Outcome measures for assessing the effectiveness of non-pharmacological interventions in frequent episodic or chronic migraine: a Delphi study.

OBJECTIVES: The aim of this Delphi survey was to establish an international consensus on the most useful outcome measures for research on the effectiveness of non-pharmacological interventions for migraine. This is important, since guidelines for pharmacological trials recommend measuring the frequency of headaches with 50% reduction considered a clinically meaningful effect. It is unclear whether the same recommendations apply to complementary (or adjunct) non-pharmacological approaches, whether the same cut-off levels need to be considered for effectiveness when used as an adjunct or stand-alone intervention, and what is meaningful to patients. SETTING: University-initiated international survey. PARTICIPANTS: The expert panel was chosen based on publications on non-pharmacological interventions in migraine populations and from personal contacts. 35 eligible researchers were contacted, 12 agreed to participate and 10 completed all 3 rounds of the survey. To further explore how migraine patients viewed potential outcome measures, four migraine patients were interviewed and presented with the same measurement tools as the researchers. PROCEDURES: The initial Delphi round was based on a systematic search of the literature for outcome measures used in non-pharmacological interventions for headache. Suggested outcome measures were rated by each expert, blinded towards the other members of the panel, for its usefulness on a 5-point Likert scale ranging from definitely not useful to extremely useful. Results were combined using median values and IQRs. Tools rated overall as definitely or probably not useful were excluded from subsequent rounds. Experts further suggested additional outcome measures that were presented to the panel in subsequent rounds. Additionally, experts were asked to rank the most useful tools and provide information on feasible cut-off levels for effectiveness for the three highest ranked tools. RESULTS: Results suggest the use of the Migraine Disability Assessment (MIDAS), Headache Impact Test (HIT-6) and headache frequency as primary outcome measures. Patient experts suggested the inclusion of a measure of quality of life and evaluation of associated symptoms and fear of attacks. CONCLUSIONS: Recommendations are for the use of the MIDAS, the HIT-6 and headache frequency, in combination with an outcome measure for quality of life. Associated symptoms and fear of attacks should also be considered as secondary outcomes, if relevant for the individual target population. The cut-off level for effectiveness should be lower for non-pharmacological interventions, especially when used as an adjunct to medication. TRIAL REGISTRATION NUMBER: German Register of Clinical Trials (DRKS00011777).

Is there a difference in response to manual cranial bone tissue assessment techniques between participants with cervical and/or temporomandibular complaints versus a control group?

AIM: Manual cranial bone tissue techniques (CBTT) are used by physiotherapists as a tool for assessment and treatment of complaints in the craniocervical, face, and head regions. The goal of this study was to determine whether CBTT were able to discriminate between subjects with cervical and/or temporomandibular disorders (TMD) and a healthy group. In addition, the inter-rater reliability when applying CBTT was also investigated. METHODS: A cross-sectional study was conducted and included 60 participants. Six standardized passive techniques were applied and judged for resistance, compliance, and sensory answer. In order to evaluate the inter-rater reliability of these techniques a cohort of participants was measured twice (by two evaluators) prospectively. A logistic regression model and Receiver Operating Curve (ROC) analyses were used to determining the discriminative validity of these techniques. RESULTS: Logistic regression identified a significant difference for five techniques for resistance and/or compliance and/or the sensory answer between the groups. Based on the Area Under the Curve (AUC) analysis, the discriminative ability of the temporal rotation to distinguish between the groups was fair to good (for resistance AUC = 0.7775 and for compliance AUC = 0.8065). The highest agreement between the two assessors was for the resistance with occipital compression (73%) technique. CONCLUSION: This study highlights that some of the CBTT could be potentially useful in distinguishing subjects with cervical and/or TMD from healthy subjects. Inter-rater reliability was moderate. CBTT could be potentially integrated in the examination of participants with complaints in the craniofacial region.

Integration of a neurodynamic approach into the treatment of dysarthria for patients with idiopathic Parkinson's disease: A pilot study.

PURPOSE: Differences between standard dysarthria treatment and the same treatment with the integration of neurodynamic techniques tailored to the severity of dysarthria in patients with Parkinson's disease were examined. METHOD: In total, 10 subjects with idiopathic Parkinson's disease and rigid-hypokinetic dysarthria were enrolled in this quasi-randomized, controlled, single-blind, pre-post study. In each of 12 therapy sessions the control group (n = 5) received standard dysarthria treatment (usual care), while the intervention group (n = 5) received the same treatment with the addition of integrated neurodynamic treatment (special care). RESULTS: There was no significant difference between the two groups for either the pre-test (p = 0.739) or the post-test (p = 0.156) results. However, significant differences between the pre-test and post-test results within each group (intervention group p = 0.001; control group p = 0.003) were found. CONCLUSIONS: The significant differences in the pre-post comparison within the groups may indicate a high probability of a positive effect of standard dysarthria treatment on the severity of dysarthria. In between-group comparisons, the study results indicated no evidence of a significant difference between standard dysarthria treatment with or without neurodynamics. Due to the small sample size, the effectiveness of the integration of neurodynamics into speech therapy cannot be definitively concluded for now. In order to be able to have generalized applicability, future studies with larger numbers of participants are required.

Do exercises with the Foam Roller have a short-term impact on the thoracolumbar fascia? - A randomized controlled trial.

Due to new research results in the past few years, interest in the fascia of the human body has increased. Dysfunctions of the fascia are indicated by various symptoms, amongst others, musculoskeletal pain. As a result stronger focus has been put on researching therapeutic approaches in this area. The main aim of this study was to investigate the effect of Foam Roll exercises on the mobility of the thoracolumbar fascia (TLF). Study has been conducted in a randomized and controlled trial which sampled 38 healthy athletic active men and women. The subjects were randomly assigned to a Foam Roll Group (FMG), a Placebo Group (PG) and a Control Group (CG). Depending on the assigned group the volunteers were either instructed to do exercises with the Foam Roll, received a pseudo treatment with the Foam Roll or received no treatment. A total of three measurements were carried out. The most important field of research was the mobility of the TLF, which was determined using a sonographic assessment. In addition the lumbar flexion and the mechanosensivity of relevant muscles were determined. After the intervention, the FMG showed an average increase of 1.7915 mm for the mobility of the TLF (p < 0.001/d = 0.756). In contrast, only an average improvement of 0.1681 mm (p = 0.397) was shown in the PG, while the CG showed a slight improvement of 0.0139 mm (p = 0.861). However, no significant changes were observed with regard to the lumbar flexion and mechanosensivity of the treated muscles. Thus, evidence is that the use of Foam Roll exercises significantly improves the mobility of the thoracolumbar fascia in a healthy young population.

Activity- vs. structural-oriented treatment approach for frozen shoulder: a randomized controlled trial.

OBJECTIVE: To compare the short- and long-term effects of a structural-oriented (convential) with an activity-oriented physiotherapeutic treatment in patients with frozen shoulder. DESIGN: Double-blinded, randomized, experimental study. SETTING: Outpatient clinic. SUBJECTS: We included patients diagnosed with a limited range of motion and pain in the shoulder region, who had received a prescription for physiotherapy treatment, without additional symptoms of dizziness, a case history of headaches, pain and/or limited range of motion in the cervical spine and/or temporomandibular joint. INTERVENTIONS: The study group received treatment during the performance of activities. The comparison group was treated with manual therapy and proprioceptive neuromuscular facilitation (conventional therapy). Both groups received 10 days of therapy, 30 minutes each day. MAIN MEASURES: Range of motion, muscle function tests, McGill pain questionnaire and modified Upper Extremity Motor Activity Log were measured at baseline, after two weeks of intervention and after a three-month follow-up period without therapy. RESULTS: A total of 66 patients were randomized into two groups: The activity-oriented group ( n = 33, mean = 44 years, SD = 16 years) including 20 male (61%) and the structural-oriented group ( n = 33, mean = 47 years, SD = 17 years) including 21 male (64%). The activity-oriented group revealed significantly greater improvements in the performance of daily life activities and functional and structural tests compared with the group treated with conventional therapy after 10 days of therapy and at the three-month follow-up ( p < 0.05). CONCLUSIONS: Therapy based on performing activities seems to be more effective for pain reduction and the ability to perform daily life activities than conventional treatment methods.

Ear pain following temporomandibular surgery originating from the temporomandibular joint or the cranial nervous tissue? A case report.

A patient presenting with local pain and limitation of movement in the temporomandibular region following surgery of the left temporomandibular joint (TMJ) is described. Manual techniques like distraction of the TMJ combined with motor control exercises to restore TMJ function were not sufficient to relieve the patient's symptoms and her orofacial functions. However, during manual assessment and treatment of cranial nervous tissue, in this case the auriculotemporal nerve and its interface, pain was relieved and orofacial functions improved.

Orofacial manual therapy improves cervical movement impairment associated with headache and features of temporomandibular dysfunction: a randomized controlled trial.

There is evidence that temporomandibular disorder (TMD) may be a contributing factor to cervicogenic headache (CGH), in part because of the influence of dysfunction of the temporomandibular joint on the cervical spine. The purpose of this randomized controlled trial was to determine whether orofacial treatment in addition to cervical manual therapy, was more effective than cervical manual therapy alone on measures of cervical movement impairment in patients with features of CGH and signs of TMD. In this study, 43 patients (27 women) with headache for more than 3-months and with some features of CGH and signs of TMD were randomly assigned to receive either cervical manual therapy (usual care) or orofacial manual therapy to address TMD in addition to usual care. Subjects were assessed at baseline, after 6 treatment sessions (3-months), and at 6-months follow-up. 38 subjects (25 female) completed all analysis at 6-months follow-up. The outcome criteria were: cervical range of movement (including the C1-2 flexion-rotation test) and manual examination of the upper 3 cervical vertebra. The group that received orofacial treatment in addition to usual care showed significant reduction in all aspects of cervical impairment after the treatment period. These improvements persisted to the 6-month follow-up, but were not observed in the usual care group at any point. These observations together with previous reports indicate that manual therapists should look for features of TMD when examining patients with headache, particularly if treatment fails when directed to the cervical spine.

Does mobilization of the upper cervical spine affect pain sensitivity and autonomic nervous system function in patients with cervico-craniofacial pain?: A randomized-controlled trial.

OBJECTIVES: The aims were to investigate the effects of anterior-posterior upper cervical mobilization (APUCM) on pain modulation in craniofacial and cervical regions and its influence on the sympathetic nervous system. METHODS: Thirty-two patients with cervico-craniofacial pain of myofascial origin were randomly allocated into experimental or placebo groups. Each patient received 3 treatments. Outcome measures included bilateral pressure pain thresholds assessed at craniofacial and cervical points preintervention, after the second intervention and after the final treatment. Pain intensity and sympathetic nervous system variables (skin conductance, breathing rate, heart rate, and skin temperature) were assessed before and immediately after each intervention. RESULTS: The pressure pain thresholds in the craniofacial and cervical regions significantly increased (P<0.001) and pain intensity significantly decreased (P<0.001) in the treatment group compared with placebo. APUCM also produced a sympathoexcitatory response demonstrated by a significant increase in skin conductance, breathing rate, and heart rate (P<0.001), but not in skin temperature (P=0.071), after application of the technique compared with placebo. DISCUSSION: This study provided preliminary evidence of a short-term hypoalgesic effect of APUCM on craniofacial and cervical regions of patients with cervico-craniofacial pain of myofascial origin, suggesting that APUCM may cause an immediate nociceptive modulation in the trigeminocervical complex. We also observed a sympathoexcitatory response, which could be related to the hypoalgesic effect induced by the technique, but this aspect should be confirmed in future studies.

Influence of different upper cervical positions on electromyography activity of the masticatory muscles.

OBJECTIVE: The aim of this study was to determine the activity of the masseter and anterior temporalis muscles in relation to different positions of the upper cervical spine during maximal voluntary isometric clenching by surface electromyography (EMG). METHODS: This was a cross-sectional study with a repeated-measures design performed using 25 asymptomatic subjects (13 female and 12 male; mean age, 31 years; SD, 8.51). The EMG activity of the masseter and anterior temporalis muscles was recorded bilaterally during maximal clenching at neutral position and during extension, flexion, ipsilateral lateral flexion, contralateral lateral flexion, and ipsilateral and contralateral rotations in maximal flexion. In addition, the upper cervical range of motion and mandibular excursions were assessed. The EMG activity data were analyzed using a 3-way analysis of variance in which the factors considered were upper cervical position, sex (male and female), and side (right and left), and the hypothesis of importance was the interaction side x position. RESULTS: The 3-way analysis of variance detected statistically significant differences between the several upper cervical positions (F = 13.724; P < .001) but found no significant differences for sex (F = 0.202; P = .658) or side (F = 0.86; P = .53) regarding EMG activity of the masseter muscle. Significant differences were likewise observed for interaction side x position for the masseter muscle (F = 12.726; P < .001). The analysis of the EMG activity of anterior temporalis muscle did not produce statistically significant differences (P > .05). CONCLUSION: This preliminary study suggests that the upper cervical movements influence the surface EMG activity of the masseter muscle. These findings support a model in which there are interaction between the craniocervical and the craniomandibular system.