A Systematic Review on Spinal Asymmetries in Case Studies of Unilateral Nephroptosis from a Viscerosomatic Point of View.

The assessment of posture and asymmetries is common in musculoskeletal clinical practice, and correction is a frequent goal. In this setting, posture and asymmetries are usually interpreted in terms of musculoskeletal issues. This study aimed to evaluate spinal asymmetries in case studies of unilateral nephroptosis. A systematic review was performed using PubMed, CINAHL, Scopus and Web of Science. We included case reports and case series of nephroptotic patients which showed diagnostic imaging that allowed us to assess the presence of spinal asymmetries in the frontal plane. The methodological quality of the selected studies was assessed by using Case Report (CARE) checklist. Nineteen studies were included, with a total number of 78 reported patients (69 women) ranging 22 to 44 years old (mean: 29). Only one patient presented with medial nephroptosis, while the rest presented with caudal migration. Ninety-one percent of the cases affected to the right kidney. All cases but two showed homolateral flank closure (lower rib descent, iliac crest raise and/or homolateral side-bending). The correction of nephroptosis, either by supine position or surgical treatment, removed asymmetries in some cases while other cases improved only partly. Manual therapists must consider visceral implications while assessing body posture. Further, since the most common symptom of nephroptosis is loin pain, and it has been claimed that loin pain is underdiagnosed, manual therapists should consider its potential presence during clinical practice. Finally, being that nephroptosis shares several features with idiopathic lumbar scoliosis (type of patient, postural adaptation), more research is needed regarding any possible relation between them.

Effects of Osteopathic T9-T10 Vertebral Manipulation in Tonsillitis: A Randomized Clinical Trial.

This study aimed to determine whether osteopathic manipulation of the T9-T10 vertebrae improves the evolution of tonsillitis. A randomized, stratified, controlled clinical trial with blinded patients, evaluator and data analyst was performed. The patients in the control group (CG) underwent a "sham" manipulation. A high-speed, low-amplitude technique was applied to the T9-T10 vertebrae in the osteopathic manipulative group (OMG) patients. The number of days needed to resolve the tonsillitis was significantly lower (p = 0.025) in the OMG (2.03 ± 0.95 days) than the CG (2.39 ± 0.82 days). Additionally, the number of episodes of tonsillitis after the treatment decreased significantly more in the OMG (0.8 ± 1.88 episodes/year in total) than the CG (2 ± 2.12) (p = 0.005). In the OMG, 60.8% had no recurrences of tonsillitis, compared to 22.5% of the CG, in the following year (χ2 (1) = 15.57, p < 0.001). No patients reported adverse effects. It has been concluded that during an episode of tonsillitis, the number of days to resolution was significantly lower after the application of an osteopathic manipulation of the T9-T10 vertebrae, compared to a sham manipulation. The number of subsequent year tonsillitis episodes was greatly reduced in both groups, significantly more in the OMG than in the CG patients.

Immediate and Short-Term Effects of Upper Cervical High-Velocity, Low-Amplitude Manipulation on Standing Postural Control and Cervical Mobility in Chronic Nonspecific Neck Pain: A Randomized Controlled Trial.

This study aimed to determine the immediate and short-term effects of a single upper cervical high-velocity, low-amplitude (HVLA) manipulation on standing postural control and cervical mobility in chronic nonspecific neck pain (CNSNP). A double-blinded, randomized placebo-controlled trial was performed. Forty-four patients with CNSNP were allocated to the experimental group (n = 22) or control group (n = 22). All participants were assessed before and immediately after the intervention, with a follow-up on the 7th and 15th days. In each evaluation, we assessed global and specific stabilometric parameters to analyze standing postural balance and performed the cervical flexion-rotation test (CFRT) to analyze upper cervical mobility. We obtained statistically significant differences, with a large effect size, in the limited cervical rotation and global stabilometric parameters. Upper cervical HVLA manipulation produced an improvement in the global stabilometric parameters, significantly decreasing the mean values of velocity, surface, path length, and pressure in all assessments (p < 0.001; ƞ 2 p = 0.323-0.856), as well as significantly decreasing the surface length ratio (L/S) on the 7th (-0.219 1/mm; p = 0.008; 95% confidence interval (CI): 0.042-0.395) and 15th days (-0.447 1/mm; p < 0.001; 95% CI: 0.265-0.629). Limited cervical rotation values increased significantly immediately after manipulation (7.409°; p < 0.001; 95% CI: 6.131-8.687) and were maintained during follow-up (p < 0.001). These results show that a single upper cervical HVLA manipulation produces an improvement in standing postural control and increases the rotational range of motion (ROM) in the upper cervical spine in patients with CNSNP.

Visceral Origin: An Underestimated Source of Neck Pain. A Systematic Scoping Review.

The diagnosis of neck pain is challenging. Many visceral disorders are known to cause it, and clinical practice guidelines recommend to rule them out during neck pain diagnosis. However, the absence of suspicion of any cause impedes one from establishing that specific aetiology as the final diagnosis. To investigate the degree of consideration given to visceral aetiology, a systematic search of trials about neck pain was carried out to evaluate their selection criteria. The search yielded 309 eligible articles, which were screened by two independent reviewers. The PEDro scale score was used to assess the methodological quality of the studies. The following information was retrieved: number of authors affiliated to a clinical or non-clinical institution, number of citations in the Web of Science, study aims, characteristics of participants, and eligibility criteria. The top 15 most cited trials, and the 15 most recent studies about treatment efficacy in neck pain, published in first quartile journals of the Journal Citation Reports, were selected. Females represented 67.5% of participants. A single study was of poor methodological quality (4/10). Based on the eligibility criteria of the articles that were systematically reviewed, it would appear that visceral aetiology was not considered in eighty percent of the trials on neck pain, showing a low level of suspicion both in research and clinical settings.

Efectos inmediatos de la manipulación de la primera costilla sobre el tono muscular y la sensibilización del nervio trigémino en pacientes con latigazo cervical / No disponible

INTRODUCCIÓN: Tras un accidente de tráfico, se producen múltiples manifestaciones clínicas, entre las que se encuentran cefalea, dolor mandibular, dolor de cuello, fatiga, etc. Ello supone altos costes en el proceso de recuperación de los pacientes. OBJETIVOS: Determinar la eficacia de la manipulación de alta velocidad y corta amplitud de la primera costilla en pacientes con latigazo cervical, en el tono del músculo masetero y esternocleidomastoideo y en la algometría de las tres ramas del nervio trigémino y del masetero. MATERIAL Y MÉTODO: Se realizó un ensayo clínico experimental prospectivo, simple ciego con asignación aleatoria de los sujetos en dos grupos (intervención y control). La muestra estuvo compuesta por 53 individuos (N = 53), 26 para el grupo de control (n = 26) y 27 para intervención (n = 27), diagnosticados con whiplash grado I o II. A los individuos del grupo intervención se les realizó la manipulación de la primera costilla en sedestación, mientras que los individuos del grupo control fueron colocados en la posición de manipulación y se les aplicaron los mismos parámetros aunque sin llegar a realizar el impulso. RESULTADOS: Se obtuvieron cambios estadísticos significativos en la olgometría del nervio mentoniano (V3) (p = 0,041), no alcanzándose significación en el resto de variables estudiadas (p > 0,05). CONCLUSIONES: De las variables medidas, la manipulación de la primera costilla sólo mejora el umbral del dolor a la presión de la rama mandibular del nervio trigémino en los pacientes con latigazo cervical

No disponible

Effects of the Right Carotid Sinus Compression Technique on Blood Pressure and Heart Rate in Medicated Patients with Hypertension.

OBJECTIVES: To identify the immediate and middle-term effects of the right carotid sinus compression technique on blood pressure and heart rate in hypertensive patients. DESIGN: Randomized blinded experimental study. SETTINGS: Primary health centers of Cáceres (Spain). SUBJECTS: Sixty-four medicated patients with hypertension were randomly assigned to an intervention group (n = 33) or to a control group (n = 31). INTERVENTION: In the intervention group a compression of the right carotid sinus was applied for 20 sec. In the control group, a placebo technique of placing hands on the radial styloid processes was performed. OUTCOME MEASURES: Blood pressure and heart rate were measured in both groups before the intervention (preintervention), immediately after the intervention, 5 min after the intervention, and 60 min after the intervention. RESULTS: The intervention group significantly decreased systolic and diastolic blood pressure and heart rate immediately after the intervention, with a large clinical effect; systolic blood pressure remained reduced 5 min after the intervention, and heart rate remained reduced 60 min after the intervention. No significant changes were observed in the control group. CONCLUSIONS: Right carotid sinus compression could be clinically useful for regulating acute hypertension.

No immediate changes on neural and muscular mechanosensitivity after first rib manipulation in subjects with cervical whiplash: A randomized controlled trial.

BACKGROUND: Upper rib manipulative therapy appears to be effective on primary complaint of shoulder pain, but its efficacy has not been evaluated in subjects with whiplash-associated disorders. OBJECTIVE: To assess the immediate changes on neural and muscular mechanosensitivity after first-rib manipulation in patients with neck or cervicobrachial pain secondary to cervical whiplash (CW). METHODS: A single-blind (evaluators were blinded to subject allocation) randomized trial was conducted. Fifty-three (N = 53) subjects, 34.7 (SD 10.8 years; 56.6% females), with cervical or cervicobrachial pain following CW, were distributed into two groups. The experimental group (n = 27) underwent a single first-rib high-velocity low-amplitude manipulation technique, while the control group (n = 26) received a sham placebo intervention. Outcome measures were taken at baseline and immediately after intervention, of the pressure pain threshold over the trigeminal, median and ulnar nerves, and over the area described for the location of tense bands in the upper trapezius, masseter, biceps brachii and triceps brachii muscles. RESULTS: No significant differences in mechanosensitivity values were observed after intervention in the between-groups comparison (p > 0.05). CONCLUSION: The use of a sole first-rib thrust technique has no immediate effect on neural or muscular mechanosensitivity, when compared to placebo, in subjects with cervical or cervicobrachial pain after CW.

Effectiveness of a Treatment Involving Soft Tissue Techniques and/or Neural Mobilization Techniques in the Management of Tension-Type Headache: A Randomized Controlled Trial.

OBJECTIVE: To evaluate the effects of a protocol involving soft tissue techniques and/or neural mobilization techniques in the management of patients with frequent episodic tension-type headache (FETTH) and those with chronic tension-type headache (CTTH). DESIGN: Randomized, double-blind, placebo-controlled before and after trial. SETTING: Rehabilitation area of the local hospital and a private physiotherapy center. PARTICIPANTS: Patients (N=97; 78 women, 19 men) diagnosed with FETTH or CTTH were randomly assigned to groups A, B, C, or D. INTERVENTIONS: (A) Placebo superficial massage; (B) soft tissue techniques; (C) neural mobilization techniques; (D) a combination of soft tissue and neural mobilization techniques. MAIN OUTCOMES MEASURES: The pressure pain threshold (PPT) in the temporal muscles (points 1 and 2) and supraorbital region (point 3), the frequency and maximal intensity of pain crisis, and the score in the Headache Impact Test-6 (HIT-6) were evaluated. All variables were assessed before the intervention, at the end of the intervention, and 15 and 30 days after the intervention. RESULTS: Groups B, C, and D had an increase in PPT and a reduction in frequency, maximal intensity, and HIT-6 values in all time points after the intervention as compared with baseline and group A (P<.001 for all cases). Group D had the highest PPT values and the lowest frequency and HIT-6 values after the intervention. CONCLUSIONS: The application of soft tissue and neural mobilization techniques to patients with FETTH or CTTH induces significant changes in PPT, the characteristics of pain crisis, and its effect on activities of daily living as compared with the application of these techniques as isolated interventions.

A Decade of Progress Using Virtual Reality for Poststroke Lower Extremity Rehabilitation: Systematic Review of the Intervention Methods.

OBJECTIVE: To develop a systematic review of the literature, to describe the different virtual reality (VR) interventions and interactive videogames applied to the lower extremity (LE) of stroke patients, and to analyse the results according to the most frequently used outcome measures. MATERIAL AND METHODS: An electronic search of randomized trials between January 2004 and January 2014 in different databases (Medline, Cinahl, Web of Science, PEDro, and Cochrane) was carried out. Several terms (virtual reality, feedback, stroke, hemiplegia, brain injury, cerebrovascular accident, lower limb, leg, and gait) were combined, and finally 11 articles were included according to the established inclusion and exclusion criteria. RESULTS: The reviewed trials showed a high heterogeneity in terms of study design and assessment tools, which makes it difficult to compare and analyze the different types of interventions. However, most of them found a significant improvement on gait speed, balance and motor function, due to VR intervention. CONCLUSIONS: Although evidence is limited, it suggests that VR intervention (more than 10 sessions) in stroke patients may have a positive impact on balance, and gait recovery. Better results were obtained when a multimodal approach, combining VR and conventional physiotherapy, was used. Flexible software seems to adapt better to patients' requirements, allowing more specific and individual treatments.

Técnica de Thrust para la disfunción posterior de la cabeza del radio / Thrust technique for posterior disfunction of the radial head

Las disfunciones osteopáticas en el codo pueden causar absentismo laboral, con el gasto económico que ello conlleva para la sociedad, debido a la alta incidencia con la que estas disfunciones se presentan. Una de las lesiones osteopáticas que se pueden dar en el codo, es la disfunción de cabeza de radio posterior, que provoca un aumento del tono del músculo supinador corto, que a su vez puede referir dolor en la región externa del brazo y antebrazo. El objetivo de la técnica de thrust para la cabeza de radio posterior con contacto indexial, será anteriorizar la cabeza del radio, para así poder recuperar la funcionalidad en la articulación del codo. Para realizar correctamente la técnica, previamente habrá que llegar a un diagnóstico adecuado basado en la inspección, palpación, pruebas de movilidad, pruebas musculares, pruebas ortopédicas y radiología (AU)

Osteopathic dysfunctions in the elbow can cause work absenteeism, and the economic expense that this entails for society, due to the high incidence with which these dysfunctions occur. One of the osteopathic injuries that can occur in the elbow is posterior radial head dysfunction, which causes an increase in tone of the short supinator muscle, which in turn may refer pain in the external region of the arm and forearm. The objective of the thrust technique for the posterior radial head with indexial contact will be to forward the radial head in order to recover the functionality at the elbow joint. In order to correctly perform the technique, a proper diagnosis based on inspection, palpation, mobility tests, muscle tests, orthopedic tests and radiology must be previously arrived at (AU)

Assessment of paraspinal muscle hardness in subjects with a mild single scoliosis curve: a preliminary myotonometer study.

OBJECTIVE: The purpose of this study was to evaluate the hardness of the paraspinal muscles in the convexity and concavity of patients with scoliosis curvatures and in the upper trapezius (UT) muscle in subjects with mild idiopathic scoliosis (IS) and to observe the correlation between the myotonometer (MYO) measurements and the value of body mass index (BMI) and the Cobb angle. METHODS: The sample included 13 patients with a single-curve mild IS (Risser sign ≤ 4) at thoracic, lumbar, or thoracolumbar level (mean Cobb angle of 11.53º). Seven females and 6 males were recruited, with a mean age of 12.84 ± 3.06 (9-18) years. A MYO was used to examine the differences in muscle hardness on both sides of the scoliosis curvature at several points: (a) apex of the curve, (b) upper and lower limits of the curve, and (c) the midpoint between the apex and the upper limit and between the apex and the lower limit. The UT was also explored. RESULTS: Although the MYO recorded lower values in all points on the concave side of the scoliosis, there were no significant differences in the comparison between sides (P > .05). No association was observed between BMI and MYO values, whereas the Cobb angle negatively correlated with muscle hardness only at 2 points on the convex side. CONCLUSION: The preliminary findings show that, in subjects with a single-curve mild IS, muscular hardness in the UT and paraspinal muscles, as assessed using a MYO, was not found to differ between the concave and the convex sides at different reference levels.

Técnica de inhibición de la musculatura suboccipital / Inhibition technique of the suboccipital musculature

Las técnicas de inhibición son procedimientos de tratamiento osteopático aplicado en los tejidos blandos, que buscan una inhibición en dichos tejidos, como elemento integrador del tratamiento, donde gracias a la aplicación constante de presión ejercida durante un tiempo establecido, consigue equilibrar y normalizar el tono muscular y la actividad refleja correspondiente al área lesionada. Concretamente en la musculatura suboccipital se busca la normalización del tono muscular en el segmento C0-C1-C2, para actuar directamente sobre las estructuras musculoesqueléticas del segmento cervical alto y el paquete vásculo-nervioso, teniendo gran repercusión sobre una multitud de síntomas que observamos a diario en nuestros pacientes, que describiremos, convirtiendo a esta técnica en una excelente herramienta para el tratamiento osteopático, la cual ha demostrado su utilidad (AU)

Inhibition techniques are methods of osteopathic treatmente applied to soft tissues, seeking the inhibition of these tissues, as an integral element of treatment, where, thanks to the constant application of pressure exerted during a set time, muscle tone and corresponding reflex activity are balanced and normalized. Specifically, normalization of muscle tone in the C0-C1-C2 segment is sought in the suboccipital musculature in order to act directly on the musculoskeletal structures of the high cervical segment and the vascular-nervous package, having a great effect on a multitude of symptoms that we see every day in our patients, which will be described, making this technique an excellent tool for osteopathic treatment, which has proved its usefulness (AU)

Abordajes terapéuticos no farmacológicos para el tratamiento de la cefalea tensional. Revisión bibliográfica / Non-pharmacological therapeutic approaches for the treatment of tension-type headache. Bibliographic review

Introducción: La cefalea tensional (CT) es la más prevalente dentro de las cefaleas primarias. Representa un impacto económico alto y una repercusión importante en la vida de los pacientes que las sufren y en el sistema público de salud. Objetivos: Conocer el número y fechas de publicación de los estudios realizados en el tratamiento de la CT. Material y Métodos: Se procedió a una búsqueda bibliográfica en PubMed recurriendo al uso de las palabras clave contenidas en dichas publicaciones referidas específicamente a CT y se realizó una búsqueda incluyendo los términos tension-type headache y manual therapy, manipulation therapy, physical therapy, vertebral manipulation, cervical manipulation, osteopathy, osteopathic treatment, osteopathic medicine, osteopathic manipulative treatment, osteopathic manipulative. Se encontraron y analizaron un total de 5 estudios que cumplieron los criterios de selección. Resultados: Los resultados encontrados tras la revisión mostraron que respecto a la cefalea tensional (Tension-type headache) existen 2.506 estudios desde 1947 hasta la actualidad. Los resultados mostraron hasta 15 estudios que comenzaron en 1977 hasta el 2009 cuando se asoció a osteopatía (osteopathy) como concepto general resultaron; con tratamiento osteopático (osteopathic treatment) 14 estudios desde 1993 hasta 2011; con medicina osteopática (osteopathic medicine) resultaron 8 estudios desde 1993 hasta 2009; con tratamiento osteopático manipulativo (osteopathic manipulative treatment) 11 estudios desde 1993 hasta 2009; y con osteopatía manipulativa (osteopathic manipulative) 8 estudios desde 1993 hasta 2011. Conclusiones: Existe escasez de estudios que relacionen la terapia osteopática y la CT. Respecto a la aplicación del tratamiento osteopático, junto y por separado, resulta eficaz, pero es necesario que los estudios tengan mayor calidad metodológica (AU)

Introduction: Tension-type headache (TTH) is the most predominant primary headache. It has a high economic impact and a significant consequence for patients whom suffer from it and for the public health system. Objectives: To know how many studies for treating the TTH were performed and when they were published. Material and methods: A bibliographical search was carried out in PubMed, using keywords included in these publications that strictly refer to TTH. This search included terms such as tension-type headache and manual therapy, manipulation therapy, physical therapy, vertebral manipulation, cervical manipulation, osteopathy, osteopathic treatment, osteopathic medicine, osteopathic manipulative treatment, osteopathic manipulative. Five studies were found and analysed that fulfilled the selection criteria. Results: Results that were found after the review showed that regarding the tension-type headache, there are 2,506 studies since 1947 until now. Results showed until 15 studies that started in 1977 until 2009, when osteopathy was associated as general concept; there were 14 studies of osteopathic treatment since 1993 until 2011; 8 studies of osteopathic medicine since 1993 until 2009; 11 studies of osteopathic manipulative treatment since 1993 until 2009 and 8 studies of osteopathic manipulative since 1993 until 2011. Conclusions: There is a lack of studies that link the osteopathic therapy with the TTH. As for the application of an osteopathic treatment, either singly or in conjunction, it is effective, but it is necessary to have more methodological quality in these studies (AU)