Effect of botulinum toxin type a combined with physical therapy on functional capacity in children with spastic cerebral palsy: a randomized controlled clinical trial.

OBJECTIVE: Investigate the effects of botulinum toxin type A (BoNT-A) combined with physical therapy on functional capacity in children with spastic cerebral palsy (CP). METHODS: Twenty-four children with spastic CP were treated with either BoNT-A and physical therapy or physical therapy alone. RESULTS: Significant differences (p < 0.05) were found after 30 days of treatment for the Berg Scale, Timed Up and Go (TUG) test, Ashworth Scale and Pediatric Evaluation of Disability Inventory (PEDI) and after three months for the Berg Scale, TUG test and PEDI. No significant differences (p > 0.05) were found in the control group. DISCUSSION: BoNT-A combined with physical therapy leads to significant improvements in spasticity and functionality in children with CP within a period of three months from the onset of treatment.

Correlation Among Pain Intensity, Catastrophizing, and Falls in Older Individuals With Unilateral Knee Osteoarthritis: A Cross-Sectional Study.

OBJECTIVE: The purpose of this study was to investigate whether pain intensity and catastrophizing are associated with fear of falls and the number of falls in older persons with knee osteoarthritis (OA). METHODS: A cross-sectional study was conducted involving 100 volunteers (male and female participants), 60 to 80 years old, with a diagnosis of knee OA. Patients were recruited from a physical therapy clinic in the city of São Paulo, Brazil, from March 2019 to November 2019. The following measures were used for the evaluations: Numerical Rating Pain Scale (NRPS), Pain-Related Self-Statement Scale (PRSS), and Falls Efficacy Scale. In statistical analysis, histograms were created to determine the distribution of data. Spearman's correlation coefficients (rs) were then calculated to determine the strength of the associations among the variables. The receiver operating characteristic curve was used to identify the accuracy of PRSS and NRPS in differentiating participants with a history of falls from those without. RESULTS: No significant correlation was found among the pain intensity, pain catastrophizing, fear of falling, and number of falls (rs value ranging from -0.033 to -0.167; P value ranging from .096-.743). The accuracy of PRSS and NRPS in differentiating participants with falls from those without was insufficient, with area under the curve values of 0.46 and 0.42, respectively. CONCLUSION: Pain catastrophizing and intensity were not significantly associated with fear of falling and numbers of falls in older individuals with unilateral knee OA.

Ratio between maximum jaw opening and lateral excursion in brazilians with and without temporomandibular disorder / Razão entre abertura máxima e excursão lateral mandibular em brasileiros com e sem disfunção temporomandibular

Background: Mandibular movements (MM) can offer important information regarding temporomandibular joint health. Objective: Evaluate MM and the ratio between maximum jaw opening and mandibular lateral excursion in Brazilians with and without temporomandibular disorder (TMD). Methods: A cross-sectional study was conducted with 801 individuals between five and 80 years. All individuals answered a screening questionnaire; and MM were measured using digital calipers. The Mann-Whitney test was used to compare the differences between the sexes and groups with and without TMD. The Kruskal-Wallis test was used to determine differences in MM among age groups. Results: MM were smaller in individuals with TMD than in those without TMD. The ratio between jaw opening and lateral excursion was 5.23 in women without TMD and 5.59 in women with TMD. In males, the ratio was 4.75 and 5.52 in individuals without and with TMD, respectively. Conclusion: MM are smaller in Brazilians with TMD, whereas the ratio between jaw opening and lateral excursion is larger.

Introdução: Os movimentos mandibulares (MM) podem oferecer informações importantes sobre a articulação temporomandibular. Objetivo: Avaliar os MM e a relação entre abertura máxima e excursão lateral mandibular em brasileiros com e sem disfunção temporomandibular (DTM). Métodos: Estudo transversal com 801 brasileiros entre cinco e 80 anos. Os indivíduos responderam um questionário de triagem; e os MM foram medidos com paquímetro digital. O teste de Mann-Whitney foi utilizado para comparar diferenças entre sexos e grupos com e sem DTM. O teste de Kruskal-Wallis foi aplicado para determinar diferenças nos MM entre faixas etárias. Resultados: Os MM foram menores nos indivíduos com DTM. A razão entre abertura mandibular e excursão lateral foi de 5,23 em mulheres sem DTM e 5,59 em mulheres com DTM. Nos homens, a proporção foi de 4,75 e 5,52 em indivíduos sem e com DTM, respectivamente. Conclusão: Os MM são menores em brasileiros com DTM, enquanto que a relação entre abertura mandibular e excursão lateral é maior.

The Effect of Sodium Bicarbonate Supplementation on Electromyographic Muscle Activity in Healthy, Physically Active Individuals: A Systematic Review.

AIM: The aim of this systematic review was to investigate the effects of sodium bicarbonate supplementation on electromyographic (EMG) muscle activity in healthy, physically active individuals. METHODS: A systematic review of cross-sectional studies, crossover studies and randomized controlled trials was performed to investigate the effects of sodium bicarbonate supplementation on EMG muscle activity in healthy, physically active individuals. Potentially eligible for the systematic review were identified through searches conducted in the PubMed/MEDLINE, Science Direct and Scopus, considering publications from January 1980 to August 2019. The terms used in the search were: sodium bicarbonate, NaHCO3, alkalosis, alkaloses, electromyography, surface electromyography, electromyographies, electromyogram and EMG. Two independent assessors extracted data from the selected articles. Bias analysis was conducted using the Cochrane Risk of Bias tool and methodological quality was appraised using a checklist created based on the guidelines of the Consolidated Standards of Reporting Trials and the International Society of Electrophysiology and Kinesiology. RESULTS: A total of 67 studies were retrieved and seven were included in this review. Only two studies showed significant differences in muscle activity after sodium bicarbonate supplementation. The different EMG signal capturing, processing, and analysis methods used constitute an important limitation to the comparative analyses of the results reported in the studies selected for the present review. CONCLUSION: The results found do not allow us to affirm whether EMG may or may not be a safe tool to assess the effects of sodium bicarbonate supplementation on muscle activity.

Association between convergence insufficiency and temporomandibular disorder cross-sectional study.

OBJECTIVES: Evaluate whether there is an association between convergence insufficiency and temporomandibular disorder (TMD) and whether there is an association between pain and range of motion in different degrees of TMD. METHODS: We evaluated 138 individuals with TMD and 46 without TMD using the Research Diagnostic Criteria for temporomandibular disorders, the Fonseca Anamnestic Index (FAI), Numeric Pain Rating Scale, and the measurement of mandibular range of motion (ROM). Convergence insufficiency was diagnosed using the convergence test and Convergence Insufficiency Symptom Survey. Analysis of variance was used to compare age and mandibular ROM. The Kruskal-Wallis was used to compare mandibular ROM and pain between groups. The chi-square test was used to evaluate associations between TMD subgroups and the FAI, sex, and ocular convergence. RESULTS: The majority of individuals without TMD did not exhibit convergence insufficiency. The frequency convergence insufficiency was significantly higher among individuals with severe TMD (p < 0.003). Mean pain severity differed between individuals with and without TMD. Mandibular ROM diminished with the increase in TMD severity. CONCLUSIONS: Convergence insufficiency, age, the increase in pain, and the reduction in mandibular range of motion were associated with the degrees of TMD severity. Despite the significant associations between convergence insufficiency and both pain and TMD severity, these variables cannot be indicated as predictive factors due to the low variability in the linear regression analysis. CLINICAL RELEVANCE: The present findings can assist in decision making regarding the treatment of severe TMD and the evaluation of ocular convergence.

Correlation of pain sensitization with muscle strength and angular kinematics in women with patellofemoral pain.

BACKGROUND: Patellofemoral pain has a poor long-term prognosis, which can be explained by a pain sensitization process. The pain sensitization process may be related to the increase of stress in the patellofemoral joint that is already associated with kinematic alterations and weakness in the musculature of the hip and knee. METHODS: Were compared the pressure pain threshold, temporal summation, conditioned pain modulation, angular kinematics, and muscle strength between 26 patellofemoral pain and 24 asymptomatic women and then correlated pain sensitization variables with biomechanical variables in pain group. The pressure pain threshold was determined on seven points of the knee, tibialis anterior muscle, and elbow. Ten consecutive stimuli were performed for temporal summation, and cold water was used as the conditioning stimulus for conditioned pain modulation. The strength of hip and knee muscles was determined using a manual dynamometer. Three-dimensional kinematics were evaluated during the lateral step down, considering peak and excursion values of the movement and the Movement Deviation Profile. FINDINGS: The pressure pain threshold of the elbow (2.13 [1.84-2.41] vs. 1.63 [1.25-2] kg/cm2), all sites of the knee were lower, as well as the Movement Deviation Profile was higher (9.33 [9.20-9.46] vs. 12.43 [12.1-12.75]) in the pain group. No difference in temporal summation, conditioned pain modulation, muscle strength and discrete kinematic values were found. No significant correlation was found between the Movement Deviation Profile and pressure pain threshold. INTERPRETATION: Biomechanical factors, pain processing, and modulation in women with patellofemoral pain, when different from asymptomatic individuals, are not necessarily associated.

Photobiomodulation on trigeminal neuralgia: systematic review.

Trigeminal neuralgia is a recurrent episode of facial pain, that may be associated with other conditions such as multiple sclerosis, neoplasms, and nerve compromises or may occur due to an unknown cause. The available treatments are pharmacotherapy or surgery; however, both are susceptible to develop side effects. Photobiomodulation could be a promising alternative therapy for trigeminal neuralgia. A systematic review of literature was carried out using the PRISMA protocol, in the PubMed/MEDLINE, Embase, and Web of Science databases. Risk of bias by ROB 2.0 protocol was performed in included studies. Initially, 20 identified articles were collected varying between the years of 1983-2018, from which 6 were included. A total of 193 patients were evaluated; photobiomodulation was compared to conventional therapies, TENS, and therapy combinations with pharmacotherapy. The overall risk of bias was low, with some concerns in the randomization and double-blinding process; moreover, there are few reports in the literature. Photobiomodulation appears to be as effective as conventional therapies, being a coadjutant therapeutic opportunity for the treatment of trigeminal neuralgia.

Hábitos parafuncionais e sintomatologia de pacientes submetidos a intervenções buco-maxilo-faciais em uma clínica escola de fisioterapia: um estudo retrospectivo de 15 anos / PARAFUNCTIONAL HABITS AND SYMPTOMATOLOGY OF PATIENTS SUBMITTED TO BUCO-MAXILLO-FACIAL INTERVENTIONS IN A PHYSIOTHERAPY SCHOOL CLINIC: A RETROSPECTIVE STUDY OF 15 YEARS

Objetivo: Comparar clinicamente os pacientes com desordens buco-maxilo-faciais (DBMF) atendidos em uma clínica-escola de fisioterapia da cidade de Fortaleza. Materiais e métodos: Dentre 5.357 prontuários, foram coletados os dados de 315 prontuários referentes aos pacientes acometidos por DBMF, dentre eles, 62 homens e 253 mulheres. Resultados: O estudo adotou perfil predominante de pacientes do gênero feminino, solteiros, entre 21 a 30 anos, estudantes, que fizeram uso de relaxante muscular; mulheres sentiram dor irradiada, já homens, dor do tipo fina. Bruxismo/endentações/desgaste dentário foram prevalentes em ambos os sexos e os sintomas que apresentaram diferença estatística entre homens e mulheres foram cervicalgia (p=0,0051), cefaleia (p<0,0001), formigamento de membros superiores (p=0,0371) e dor corporal (p=0,0234). Conclusão: Bruxismo/endentações/desgaste dentário foram os prevalentes em ambos os sexos. Entre os homens, o sintoma mais prevalente foi a dor ou cansaço ao mastigar, já entre as mulheres foi a cefaleia.

Exercise program combined with electrophysical modalities in subjects with knee osteoarthritis: a randomised, placebo-controlled clinical trial.

BACKGROUND: It is not yet clear which of the various electrophysical modalities used in clinical practice is the one that contributes most positively when added to an exercise program in patients with knee osteoarthritis (OA). The aim of the present study was to analyze the clinical effects of the inclusion of interferential current therapy (ICT), shortwave diathermy therapy (SDT) and photobiomodulation (PHOTO) into an exercise program in patients with knee OA. METHODS: This prospective, five-arm, randomised, placebo-controlled trial was carried out with blinded participants and examiners. We recruited 100 volunteers aged 40 to 80 years with knee OA. Participants were allocated into five groups: exercise, exercise + placebo, exercise + ICT, exercise + SDT, and exercise + PHOTO. The outcome measures included Western Ontario and McMaster Universities (WOMAC), numerical rating pain scale (NRPS), pressure pain threshold (PPT), self-perceived fatigue and sit-to-stand test (STST), which were evaluated before and after 24 treatment sessions at a frequency of three sessions per week. RESULTS: In all groups, there was a significant improvement (p < 0.05) in all variables over time, except pressure pain threshold. We observed significant differences (p < 0.05) between the groups for WOMAC function (exercise vs. exercise + placebo, mean difference [MD] = 5.55, 95% confidence interval [CI] = 3.63 to 7.46; exercise vs. exercise + ICT, MD = 3.40, 95% CI = 1.46 to 5.33; exercise vs. exercise + SDT, MD = 4.75, 95% CI = 1.85 to 7.64; exercise vs. exercise + PHOTO, MD = 5.45, 95% CI = 3.12 to 7.77) and WOMAC pain, with better scores achieved by the exercise group. However, these differences were not clinically relevant when considering the minimum clinically important difference. CONCLUSION: The addition of ICT, SDT or PHOTO into an exercise program for individuals with knee OA is not superior to exercise performed in isolation in terms of clinical benefit. clinicaltrials.gov: NCT02636764, registered on March 29, 2014.

Is there a difference in the electromyographic activity of the masticatory muscles between individuals with temporomandibular disorder and healthy controls? A systematic review with meta-analysis.

The diagnosis of temporomandibular disorders (TMD) is complex, and it is not yet clear in the literature whether the clinical changes associated with these disorders are also reflected in the electromyographic (EMG) activity of the muscles of mastication. To determine whether there is a difference in the electromyographic activity of the masticatory muscles between individuals with TMD and healthy controls. ScienceDirect, EMBASE, MEDLINE, PEDro, SciELO, CINAHL and LILACS databases from January 2000 to February 2019. Cross-sectional studies, crossover studies and randomised controlled trials evaluating EMG activity of right and left masseter and anterior temporal muscles in patients with TMD and healthy controls. Two independent assessors extracted data from the selected articles. The risk of bias was determined using a checklist for assessing methodological quality created based on the guidelines of the Strengthening the Reporting of Observational Studies in Epidemiology and International Society of Electrophysiology and Kinesiology. Mean differences and 95% confidence intervals were calculated and combined in meta-analyses. A total of 51 267 studies were retrieved, and 12 were included in this review. Only two studies enabled the comparative analysis of the results. The different EMG signal capturing, processing and analysis methods used constitute an important limitation to the comparative analyses of the results reported in the studies selected for the present review. This systematic review did not demonstrate evidence of significant differences in the EMG activity of the masticatory muscles between individuals with TMD and healthy controls.

Intraoral photobiomodulation diminishes pain and improves functioning in women with temporomandibular disorder: a randomized, sham-controlled, double-blind clinical trial : Intraoral photobiomodulation diminishes pain in women with temporomandibular disorder.

The aim of the present study was to evaluate the effect of intraoral photobiomodulation involving super-pulsed laser (905 nm) combined with red (640 nm) and infrared (875 nm) light-emitting diodes on pain, mandibular range of motion, and functioning in women with myogenous temporomandibular disorder. A randomized, sham-controlled, double-blind clinical trial was conducted involving 30 women with myogenous temporomandibular disorder diagnosed using the Research Diagnostic Criteria for Temporomandibular Disorders. The participants were randomly allocated to two groups (active and sham photobiomodulation). The evaluations involved this use of the visual analog scale, digital calipers, and a functional scale. Photobiomodulation was administered intraorally in the region of the pterygoid muscles, bilaterally, in all participants for a total of six sessions. Evaluations were performed on five occasions: prior to the intervention, immediately after the first session, 24 h and 48 h after the first session, and after the six sessions. Significant differences between groups were found regarding pain (p ≤ 0.01) and functioning (p ≤ 0.04). However, no statistically significant difference was found regarding range of mandibular motion. The findings demonstrate that intraoral photobiomodulation involving super-pulsed laser (905 nm) combined with red (640 nm) and infrared (875 nm) light-emitting diodes diminishes pain and improves functioning but does not exert an influence on mandibular range of motion in women with temporomandibular disorder.Trial registration: NCT02839967.

Biofeedback for pelvic floor muscle training in women with stress urinary incontinence: a systematic review with meta-analysis.

BACKGROUND: Several clinical effects have been attributed to the use of biofeedback (BF) as an adjuvant in the treatment of women with stress urinary incontinence (SUI). OBJECTIVES: To determine whether BF is more effective than other interventions for women with SUI in terms of quantification of urine leakage, episodes of urinary loss, quality of life and muscle strength. DATA SOURCES: Science Direct, Embase, MEDLINE, Pedro, SciELO, CINAHL and LILACS from January 2000 to February 2017. STUDY SELECTION: Randomised controlled trials (RCTs) addressing the effects of pelvic muscle floor training (PFMT) with BF for the conservative treatment of women with SUI. DATA EXTRACTION AND DATA SYNTHESIS: Two independent assessors extracted data from articles. The risk of bias for individual studies was assessed using the Jadad scale and Physiotherapy Evidence Database (PEDro) scale. Mean differences (MD) and 95% confidence intervals were calculated and combined in meta-analyses. RESULTS: In total, 1194 studies were retrieved and 11 were included in this review. Only two RCTs demonstrated a low risk of bias according to the PEDro scale. The results demonstrated that PFMT with BF was no better than alternative interventions in terms of muscle strength measured using a perineometer. LIMITATIONS: Low methodological quality of studies, heterogeneity of outcomes, and differences in implementation of intervention protocols and BF modalities. CONCLUSIONS: PFMT with BF does not offer therapeutic benefits over alternative interventions (no training, PFMT alone and vaginal electrical stimulation) for the treatment of female SUI. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO: CRD42017060780.

Age-Related Changes in Postural Control in Physically Inactive Older Women.

BACKGROUND AND PURPOSE: The maintenance of postural control is influenced by the complexity of a given task. Tasks that require greater attention and cognitive involvement increase the risk of falls among older adults. The aim of the present study was to evaluate the adaptation of the postural control system to different levels of task complexity in physically inactive young and older women. METHODS: A cross-sectional study was conducted with adult women classified as physically inactive based on the results of the International Physical Activity Questionnaire. The participants were 27 young (20-30 years of age) and 27 older (60-80 years of age) women. Sway velocity of the center of pressure in the anterior-posterior and medial-lateral directions was calculated using a force plate under 6 conditions: standing directly on the force plate or on a foam placed over the force plate, eyes open or closed, and dual-task complexity with and without the foam. RESULTS AND DISCUSSION: A 2-way analysis of variance revealed that sway velocity increased in both groups when the task conditions were altered. The older women exhibited significantly greater sway velocity compared with the young women on all tasks. However, the patterns of postural control adaptation to the different levels of complexity were similar among all participants. CONCLUSIONS: In this study, the adaption of the postural control system to different levels of task complexity did not differ between physically inactive young and physically inactive older women. However, the physically inactive older women exhibited greater sway velocity compared with the young women.

Effect of Osteopathic Visceral Manipulation on Pain, Cervical Range of Motion, and Upper Trapezius Muscle Activity in Patients with Chronic Nonspecific Neck Pain and Functional Dyspepsia: A Randomized, Double-Blind, Placebo-Controlled Pilot Study.

Previous studies have reported that visceral disturbances can lead to increased musculoskeletal tension and pain in structures innervated from the corresponding spinal level through viscerosomatic reflexes. We designed a pilot randomised placebo-controlled study using placebo visceral manipulation as the control to evaluate the effect of osteopathic visceral manipulation (OVM) of the stomach and liver on pain, cervical mobility, and electromyographic activity of the upper trapezius (UT) muscle in individuals with nonspecific neck pain (NS-NP) and functional dyspepsia. Twenty-eight NS-NP patients were randomly assigned into two groups: treated with OVM (OVMG; n = 14) and treated with placebo visceral manipulation (PVMG; n = 14). The effects were evaluated immediately and 7 days after treatment through pain, cervical range, and electromyographic activity of the UT muscle. Significant effects were confirmed immediately after treatment (OVMG and PVMG) for numeric rating scale scores (p < 0.001) and pain area (p < 0.001). Significant increases in EMG amplitude were identified immediately and 7 days after treatment for the OVMG (p < 0.001). No differences were identified between the OVMG and the PVMG for cervical range of motion (p > 0.05). This study demonstrated that a single visceral mobilisation session for the stomach and liver reduces cervical pain and increases the amplitude of the EMG signal of the UT muscle immediately and 7 days after treatment in patients with nonspecific neck pain and functional dyspepsia.

Combined Use of Diadynamic Currents and Manual Therapy on Myofascial Trigger Points in Patients With Shoulder Impingement Syndrome: A Randomized Controlled Trial.

OBJECTIVE: The purpose of this study was to evaluate the effect of combined manual therapy (MT) and diadynamic (DD) currents on myofascial trigger points of the upper trapezius muscle in individuals with a diagnosis of unilateral shoulder impingement syndrome. METHODS: A randomized clinical trial was conducted involving 60 individuals with shoulder impingement syndrome who were allocated to the following 3 groups: (1) MT and DD currents (MTDD), (2) MT alone, and (3) DD currents alone. The participants were submitted to 16 treatment sessions over an 8-week period and were evaluated using the Numerical Rating Pain Scale as well as the pain and disability subscales of the Shoulder Pain and Disability Index. RESULTS: Differences in Numerical Rating Pain Scale scores (secondary outcome) between MTDD and MT groups (mean difference 2.25 points, 95% confidence interval 1.07-3.42) and between MTDD and DD groups (mean difference 2.30 points, 95% confidence interval 1.42-3.17) were clinically relevant. No clinical gains were observed in the comparisons between groups of Shoulder Pain and Disability Index scores. CONCLUSION: The combination of MT and DD currents on myofascial trigger points was more effective at reducing pain intensity but not disability than each therapy performed individually for patients with unilateral shoulder impingement syndrome.

Female PFP patients present alterations in eccentric muscle activity but not the temporal order of activation of the vastus lateralis muscle during the single leg triple hop test.

This study aimed to compare the concentric and eccentric activity and the temporal order of peak activity of the hip and knee muscles between women with patellofemoral pain (PFP) and healthy women during the single leg triple hop test (SLTHT). Electromyographic (EMG) and Kinematic data were collected from 14 healthy women (CG) and 14 women diagnosed with PFP (PFG) during a single session of the single leg triple hop test. Integral surface electromyography (iEMG) data of the hip and knee muscles in eccentric and concentric phases and the length of time that each muscle needed to reach the maximal peak of muscle activity were calculated. The iEMG in the eccentric phase was significantly higher (p < 0.05) than the concentric phase, for the gluteus maximus and gluteus medius muscles (CG and PFG) and for the vastus lateralis muscle (PFG). The vastus lateralis muscle was the first muscle to reach the highest peak of activity in the PFG, and the third to reach this peak in the CG. In the present study, the activity of the vastus lateralis muscle during the eccentric phase of the jump was greater than concentric phase, as a temporal anticipation of its peak in activity among women with PFP.

Evaluation of pain threshold upon palpation of the masticatory muscles in women with temporomandibular disorder according to the Research Diagnostic Criteria of Temporomandibular Disorders / Avaliação do limiar de dor a palpação dos músculos mastigatórios em mulheres com disfunção temporomandibular de acordo com o Research Diagnostic Criteria of Temporomandibular Disorders

ABSTRACT Purpose: to evaluate the pain threshold upon palpation of the masticatory muscles in women with temporomandibular disorder (TMD) according to the Research Diagnostic Criteria of Temporomandibular Disorders (RDC/TMD). Methods: a cross-sectional study was conducted involving the evaluation of pain threshold upon palpation of the extraoral muscles (temporal, masseter, posterior mandibular region, submandibular region) and intraoral muscles (lateral pterygoid area and temporal tendon) in women using the RDC/TMD clinical examination. Results: 60 women were evaluated. Statistically significant differences were found among the muscles evaluated regarding the pain threshold. The lateral pterygoid area, bilaterally, had the lowest pain threshold, followed by the masseter and temporal muscles. Conclusion: this study suggests that the lateral pterygoid muscle, bilaterally, has the lowest pain threshold upon palpation among the masticatory muscles, followed by masseter and temporal muscles, in women with TMD, according to the RDC/TMD evaluation.

RESUMO Objetivo: avaliar o limiar de dor a palpação dos músculos mastigatórios em mulheres com Disfunção Temporomandibular de acordo com o questionário do Research Diagnostic Criteria of Temporomandibular Disorders (RDC/TMD). Métodos: realizou-se um estudo transversal utilizando a avaliação do limiar de dor a palpação dos músculos mastigatórios extraorais (temporal, masseter, região mandibular posterior, região submandibular) e intraorais (área do pterigoideo lateral e tendão do temporal), em mulheres, segundo o exame clínico do RDC/TMD. Resultados: foram avaliadas 60 mulheres, foi encontrada diferença estatisticamente significante para o limiar de dor a palpação entre os músculos avaliados segundo o RDC/TMD. Com destaque para a área do pterigoideo lateral, bilateralmente, seguido pelos músculos masseter e temporal. Conclusão: esse estudo sugere que a área do músculo pterigoideo lateral, bilateralmente, apresenta menor limiar de dor a palpação entre os músculos mastigatórios, seguido pelos músculos masseter e temporal segundo RDC/TMD.

Immediate Effect of Acupuncture on Electromyographic Activity of the Upper Trapezius Muscle and Pain in Patients With Nonspecific Neck Pain: A Randomized, Single-Blinded, Sham-Controlled, Crossover Study.

OBJECTIVE: The objective of this study was to assess changes in upper trapezius myoelectric activity and pain in patients with nonspecific neck pain after a single session of acupuncture (ACP). METHODS: A blinded randomized clinical trial was conducted. Fifteen patients with nonspecific neck pain and 15 healthy participants were enrolled in a randomized, single-blinded, crossover study. Each participant was subjected to a single session of ACP and sham acupuncture (SACP). The electromyography (EMG) signal of the upper trapezius muscle was recorded during different step contractions of shoulder elevation force (15%-30% maximal voluntary contraction) before and after ACP treatment. RESULTS: Significant effects were confirmed after the treatment (ACP and SACP) for Numeric Rating Scale scores (F1,28 = 51.61; P < .0001) and pain area (F1,2 = 32.03; P < .0001). Significant decreases in the EMG amplitude were identified for the nonspecific neck pain group (NPG) (F1,112 = 26.82; P < .0001) and the healthy participant group (HPG) (F1,112 = 21.69; P < .0001) after ACP treatment. No differences were identified between the ACP and SACP treatment protocols for Numeric Rating Scale score (NPG: F1,28 = 0.95; P = .33), pain area (NPG: F1,28 = 1.97; P = .17), or EMG amplitude (NPG: F1,112 = 0.47; P = .49; HPG: F1,112 = 0.75; P = .38). CONCLUSION: The effect of ACP at acupoints triple energizer 5 and large intestine 11 triple energizer 5, or in close proximity, contributes to pain relief among patients with nonspecific neck pain. The electromyographic analysis indicated a greater resistance to muscle fatigue and decrease of activity of the upper trapezius muscle among healthy participants and patients with nonspecific neck pain.

Immediate and short-term effects of phototherapy on pain, muscle activity, and joint mobility in women with temporomandibular disorder: a randomized, double-blind, placebo-controlled, clinical trial.

OBJECTIVES: The aim of the present study was to evaluate the immediate and short-term effects of phototherapy on pain intensity, the pressure pain threshold (PPT), maximum vertical mandibular movement, and the electrical activity of the masseter and temporal muscles in women with temporomandibular disorder (TMD). METHODS: Sixty women were randomly allocated to four different groups and submitted to phototherapy with a combination of super-pulsed laser (905 nm), red (640 nm), and infrared (875 nm) light emitting diodes in the same equipment on the masseter (three points) and temporal (two points) muscles bilaterally in a single session. The following doses were used in each point of application: Group 1 - 2.62 J; Group 2 - 5.24 J; Group 3 - 7.86 J; placebo group. Pain intensity was determined using the visual analog scale. The PPT was analyzed using a digital algometer. Vertical mandibular movement was measured using digital calipers. Myoelectrical activity of the masseter and temporal muscles was measured using electromyography. Four evaluations were performed: pre-intervention, immediately after, 24 and 48 hours after phototherapy. OUTCOMES: A significant reduction in pain intensity during the post-treatment evaluations in comparison to the pretreatment evaluation was observed in group 1 (Median difference = 2.60 [95% CI = 1.35-3.85]) and group 2 (Median difference = 2.2 [95% CI = 0.98-3.42]) especially after 48 hours and group 3 (Median difference = 2.50 [95% CI: 0.56-4.46]) especially after 24 hours, with a moderate effect size, but no effect was found regarding the other variables. CONCLUSIONS: A single session of combined phototherapy was capable of reducing pain intensity in individuals patients with TMD. ClinicalTrials.gov (NCT02018770). Implications for Rehabilitation Phototherapy device combining two light sources (LED and laser), and different densities in the same device is a novelty in the rehabilitation market, and has proved to be a useful intervention for people with temporomandibular disorders. This mode of phototherapy is another option that assists in the rapid intervention in pain symptoms, promoting a considerable degree of comfort to the patient moments after its application.