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AIM: To determine differences in physical examination findings between people with acute whiplash-associated disorders (WAD) with and without headache. METHODS: In this cross-sectional study, participants with acute WAD were evaluated to assess differences in the presence of physical impairments. The following were assessed: pain intensity on manual palpation the over spinous process of C1-C3, zygapophyseal joints of C0-C4, and trapezius, sternocleidomastoid, suboccipitalis, masseter and temporalis muscles; cervical range of motion (ROM); flexion-rotation test (FRT); forward head posture; cranio-cervical flexion test (CCFT); neck flexor and extensor endurance; pressure-pain thresholds (PPT) over neural structures and upper limb neural tests (ULNT) in addition to median UNLT + CCF. Correlation analyses were performed to assess the association between examination findings and headache intensity. Logistic regression and discriminant analyses were also performed. RESULTS: Forty-seven participants (26 men and 21 women; mean age = 38.9 years old) were included in the study. 60% of the participants presented with headache. Several examination findings were significantly different between groups. A group of examination findings composed of neck endurance, manual palpation over cervical and muscular structures, PPT, CCFT, ROM and FRT could discriminate between groups with a sensitivity of 86.7% and specificity of 90%. CONCLUSIONS: Several neuromusculoskeletal features are different between people with acute WAD with or without headache. A combination of features could distinguish between groups with high levels of sensitivity and specificity.

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BACKGROUND: Whiplash-associated headache (WAH) is one of the most common symptoms after a whiplash injury, leading to high disability. Nevertheless, the clinical characteristics of WAH have not been well described. OBJECTIVE: To synthesise the existing literature on the clinical characteristics of WAH. DESIGN: Scoping review. METHODS: The protocol for this scoping review was registered in Open Science Framework and the PRISMA extension for Scoping Reviews tool was used to ensure methodological and reporting quality. A systematic search was conducted in PubMed, EMBASE, CINAHL, Web of Science and Scopus. The search was performed by one author and the screening of articles was conducted by two authors independently. RESULTS: A total of 11363 articles were initially identified and finally 26 studies were included in the review. Headache intensity was the most commonly reported feature. Headache duration, frequency and location were also reported in at least four studies. Few studies reported physical impairments that may be related to the presence of WAH. A differentiation with concussion characteristics was only performed in eight studies. CONCLUSION: WAH appears to be of mild to moderate intensity, typically with episodes of short duration which is commonly experienced in the occipital region amongst other regions, and with a tendency to reduce in intensity over time.

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BACKGROUND: Provocation of headache on physical examination of the neck may reflect a role of cervical structures in the presence of acute whiplash-associated headache (WAH). OBJECTIVE: To determine differences in headache provocation during physical tests in people with and without WAH after a whiplash injury. DESIGN: Case-control study. METHODS: Forty-seven people with acute whiplash-associated disorders participated, 28 with WAH. Passive accessory intervertebral movement over the tubercle of C1, the spinous processes of C2-C3 and facet joints of C0-C4, the flexion-rotation test (FRT), manual palpation of cranio-cervical muscles and the upper limb neurodynamic test + cranio-cervical flexion were assessed bilaterally twice by a blinded examiner; headache provocation was determined. Cohen's kappa and Chi-squared were determined to evaluate the intra-rater reliability of test results and differences between groups, respectively. A logistic regression model was also performed. RESULTS: Intra-rater reliability of headache provocation was good or excellent for most tests. Significant differences between groups were found with higher positive tests in WAH for the assessment of C2 (68%), the most painful side of C0-C1 (57%), C1-C2 (75%) and C2-C3 (53%), most (79%) and least (25%) restricted sides of the FRT, and manual palpation of the most painful side for the trapezius (53%), masseter (50%) and temporalis (46%) muscles. Provocation of headache during the assessment of C2 and C1-C2 on the most painful side demonstrated the highest association with WAH. CONCLUSION: Mechanical provocation of headache is more frequent in people with WAH than in those without headache soon after a whiplash injury.

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BACKGROUND: People with whiplash-associated disorders (WAD) commonly present with a variety of physical impairments. However, the reliability of physical tests has not been established for patients with acute WAD. OBJECTIVE: To assess test-retest reliability of different physical tests in acute WAD. DESIGN: Intra-rater test-retest reliability. METHODS: Patients with acute WAD were recruited. Physical tests were used to evaluate articular, muscular and neural systems in two blocks of measurements separated by 10 min. Bland-Altman plots were performed to assess intrarater agreement, which included calculation of the mean difference (d) between rates, the 95% CI for d, the standard deviation of the differences and the 95% limits of agreement. Reliability was calculated via the standard error of measurement, the minimal detectable change, percent of agreement, the intraclass-correlation coefficient, and kappa coefficient. RESULTS: 47 patients participated. Test-retest reliability was excellent or good for almost all measures, except for extension ROM, ULTT for the radial nerve, and active cervical extension and upper cervical rotation performed in 4-point kneeling, which presented moderate reliability. Systematic bias was found in cervical ROM in flexion, left and right lateral-flexion, left and right rotation; left ULTT for radial nerve; right trapezius, suboccipitalis and temporalis muscles, left temporalis; C3, both sides of C1-C2, left C3-C4. CONCLUSION: The majority of physical tests achieved good or excellent test-retest intra-rater reliability when tested in patients with acute WAD. Findings must be considered with caution for those tests which demonstrated systematic bias. Additional research is warranted to evaluate inter-rater reliability.

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Introducción: La relación entre la postura y los trastornos temporomandibulares (TTM) ha sido abordada desde hace décadas, sin que se haya podido aportar fuerte evidencia en ningún sentido. El objetivo de este estudio fue revisar sistemáticamente y sintetizar de forma cuantitativa (vía metaanálisis) la evidencia existente sobre la relación entre postura y TTM. Material y método: Se realizó una búsqueda en los recursos electrónicos Pubmed, Lilacs, Sciencedirect, Scielo, Pedro y The Cochrane Library de estudios analíticos observacionales de cohortes, de casos y controles y/o transversales de asociación cruzada, que evaluaran la relación entre postura y TTM, publicados a partir de 2012, en inglés, español, portugués y francés. Dos revisores analizaron la calidad metodológica de los artículos incluidos. Resultados: Ocho artículos fueron seleccionados finalmente y evaluados. Cinco encontraron relación, mientras tres no la hallaron. El metanálisis tampoco arrojó resultados esclarecedores, aunque parece indicar que pueden existir diferencias en el ángulo "ojo-trago"-"plano horizontal", siendo ligeramente menor este ángulo en sujetos sanos en comparación con los sujetos con TTM. Conclusiones: no se puede establecer que haya una fuerte evidencia científica favorable a que exista relación entre postura y TTM, debido a la paridad del número de estudios con resultados en ambos sentidos y a la calidad metodológica que presentan los artículos incluidos

Introduction: The relationship between posture and temporomandibular disorders (TMD) has been studied for decades, and it has not been possible to provide strong evidence in any sense. The objective of this study was systemically reviewed and quantitatively synthesized (via meta-analysis) existing evidence on the posture and TMD relationship. Material and method: A search was made in the electronic resources Pubmed, Lilacs, Sciencedirect, Scielo, Pedro, and the Cochrane Library of analytical observational cohort, case and control and/or cross-sectional studies that assess the relationship between posture and TMD, published since 2012, in English, Spanish, Portuguese and French. Two reviewers checked the methodological quality. Results: Eight articles were finally selected and assessed. Five found relationship, while three did not find it. The meta-analysis did not yield enlightening results either, although it seems to indicate that there may be differences in the eye-tragus-"horizontal plane" angle, and this is slightly lower in healthy subjects compared to a group of TMD subjects. Conclusion: It cannot be established that there is strong scientific evidence on the relationship between posture and TTM, due to the parity of the number of studies with results in both senses and the methodological quality of the published articles

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INTRODUCTION: This article is part of the Focus Theme of Methods of Information in Medicine on "Methodologies, Models and Algorithms for Patients Rehabilitation". OBJECTIVES: To identify support of a virtual reality system in the kinematic assessment and physiotherapy approach to gait disorders in individuals with stroke. METHODS: We adapt Virtual Reality Rehabilitation System (VRRS), software widely used in the functional recovery of the upper limb, for its use on the lower limb of hemiplegic patients. Clinical scales have been used to relate them with the kinematic assessment provided by the system. A description of the use of reinforced feedback provided by the system on the recovery of deficits in several real cases in the field of physiotherapy is performed. Specific examples of functional tasks have been detailed, to be considered in creating intelligent health technologies to improve post-stroke gait. RESULTS: Both participants improved scores on the clinical scales, the kinematic parameters in leg stance on plegic lower extremity and walking speed > Minimally Clinically Important Difference (MCID). CONCLUSION: The use of the VRRS software attached to a motion tracking capture system showed their practical utility and safety in enriching physiotherapeutic assessment and treatment in post-stroke gait disorders.

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BACKGROUND: The correlation between orthodontics and the development of signs and symptoms of temporomandibular disorders (TMD) is a major concern in the physical rehabilitation field. AIM: The aim of the study was to observe whether subjects with a history of orthodontics use show differences from subjects who have never used orthodontics in: 1) masseter and temporalis muscle mechanosensitivity; 2) maximal vertical mouth opening (VMO); and 3) the impact of headache on their quality of life. DESIGN: Cross-sectional study. SETTING: The study was carried out in the Faculty of Nursing, Physiotherapy and Podiatry of the University of Sevilla, Spain. POPULATION: All participants were pre graduate students from the University of Sevilla, Spain. The final sample comprised 65 subjects (N.=65) with a mean age of 21 ± 2.46 years (18-29) divided into two groups; orthodontics group (N.=31) and non-orthodontics group (N.=34). METHODS: All students followed the same testing protocol. Measurements were taken of the pressure pain threshold (PPT) in two locations of the masseter (M1, M2) and temporalis (T1, T2) muscles, the maximal VMO, and the incidence of headache (Headache Impact Test-6; HIT-6, Spanish version). RESULTS: The measured values of the masticatory muscle PPTs were lower in the non-orthodontics group. Besides, the maximal VMO and HIT-6 scores were better in the orthodontics group. Nevertheless, none of these intergroup differences were statistically significant (ANOVA test): (M1 P=0.790); (M2 P=0.329); (T1 P=0.249); (T2 P=0.440); (HIT-6 P=0.443); (VMO P=0.626). CONCLUSION: A previous history of orthodontics use does not seem to lead to any greater sensitivity of the masticatory muscles, limitations of vertical mouth opening, or greater impact of headache on the subject's quality of life. CLINICAL REHABILITATION IMPACT: There is no evidence enough to support either a positive or negative correlation between orthodontics and signs and symptoms of TMD. Pain is a subjective perception and it is influenced by several factors. It remains uncertain if the use of orthodontics might be one of them.

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BACKGROUND: Tension-type headache (TTH) is the most common type of primary headache however there is no clear evidence as to which specific treatment is most effective or whether combined treatment is more effective than individual treatments. AIM: To assess the effectiveness of manual therapy techniques, applied to the suboccipital region, on aspects of disability in a sample of patients with tension-type headache. DESIGN: Randomized Controlled Trial. SETTING: Specialized centre for headache treatment. POPULATION: Seventy-six (62 women) patients (age: 39.9 ± 10.9 years) with episodic chronic TTH. METHODS: Patients were randomly divided into four treatment groups: 1) suboccipital soft tissue inhibition; 2) occiput-atlas-axis manipulation; 3) combined treatment of both techniques; 4) control. Four sessions were applied over 4 weeks and disability was assessed before and after treatment using the Headache Disability Inventory (HDI). Headache frequency, severity and the functional and emotional subscales of the questionnaire were assessed. Photophobia, phonophobia and pericranial tenderness were also monitored. RESULTS: Headache frequency was significantly reduced with the manipulative and combined treatment (P<0.05), and the severity and functional subscale of the HDI changed in all three treatment groups (P<0.05). Manipulation treatment also reduced the score on the emotional subscale of the HDI (P<0.05). The combined intervention showed a greater effect at reducing the overall HDI score compared to the group that received suboccipital soft tissue inhibition and to the control group (both P<0.05). In addition, photophobia, phonophobia and pericranial tenderness only improved in the group receiving combined therapy (P<0.05). CONCLUSION: When given individually, suboccipital soft tissue inhibition and occiput-atlas-axis manipulation resulted in changes in different parameters related to the disability caused by TTH. However, when the two treatments were combined, effectiveness was noted for all aspects of disability and other symptoms including photophobia, phonophobia and pericranial tenderness. CLINICAL REHABILITATION IMPACT: Although individual manual therapy treatments showed a positive change in headache features, measures of photophobia, photophobia and pericranial tenderness only improved in the group that received the combined treatment suggesting that combined treatment is the most appropriate for symptomatic relief of TTH.

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OBJECTIVES: To assess the immediate effect of a suboccipital muscle inhibition (SMI) technique on: (a) neck pain, (b) elbow extension range of motion during the upper limb neurodynamic test of the median nerve (ULNT-1), and (c) grip strength in subjects with cervical whiplash; and determine the relationships between key variables. DESIGN: Randomised, single-blind, controlled clinical trial. SETTING: Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Spain. PARTICIPANTS: Forty subjects {mean age 34 years [standard deviation (SD) 3.6]} with Grade I or II cervical whiplash and a positive response to the ULNT-1 were recruited and distributed into two study groups: intervention group (IG) (n=20) and control group (CG) (n=20). INTERVENTIONS: The IG underwent the SMI technique for 4minutes and the CG received a sham (placebo) intervention. Measures were collected immediately after the intervention. MAIN OUTCOME MEASURES: The primary outcome was elbow range of motion during the ULNT-1, measured with a goniometer. The secondary outcomes were self-perceived neck pain (visual analogue scale) and free-pain grip strength, measured with a digital dynamometer. RESULTS: The mean baseline elbow range of motion was 116.0° (SD 10.2) for the CG and 130.1° (SD 7.8) for the IG. The within-group comparison found a significant difference in elbow range of motion for the IG [mean difference -15.4°, 95% confidence interval (CI) -20.1 to -10.6; P=0.01], but not for the CG (mean difference -4.9°, 95% CI -11.8 to 2.0; P=0.15). In the between-group comparison, the difference in elbow range of motion was significant (mean difference -10.5°, 95% CI -18.6 to -2.3; P=0.013), but the differences in grip strength (P=0.06) and neck pain (P=0.38) were not significant. CONCLUSION: The SMI technique has an immediate positive effect on elbow extension in the ULNT-1. No immediate effects on self-perceived cervical pain or grip strength were observed.

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Objetivo. En la presente investigación hemos planteado como objetivos principales, por un lado, valorar el efecto del ejercicio físico y el entrenamiento vibratorio sobre la amplitud de movimiento en mujeres con fibromialgia (FM) y, por otro, determinar si existe alguna relación entre dicha variable y el dolor y la rigidez. Método. La muestra estuvo constituida por un total de cuarenta y seis mujeres (edad: 58,2 ± 8,5 años; peso: 72,1 ± 9,6 kg; altura: 156,9 ± 6,1 cm) diagnosticadas con FM. Los participantes fueron divididos aleatoriamente en tres grupos: ejercicio físico y entrenamiento vibratorio (WBV + EJ; n = 15); ejercicio físico sin vibraciones (EJ; n = 15) y un grupo control (GC; n = 16). Los grupos WBV + EJ y EJ realizaron dos sesiones semanales de ejercicio físico durante 8 semanas. Además, los integrantes de WBV + EJ realizaron 3 sesiones semanales de entrenamiento vibratorio (30 Hz, 4 mm). Las pruebas de evaluación incluyeron el test de sit and reach (variable principal), la valoración del número de tender points (TP) y una escala analógica visual (VAS) para determinar la rigidez. Resultados. Los resultados derivados del análisis intra e intergrupo no mostraron diferencias significativas en la rigidez o el número de TP, si bien, la prueba de sit and reach mostró una mejora estadísticamente significativa en WBV + EJ (58%; p < 0,05). El análisis correlacional mostró una relación inversa (r = -0,55; p < 0,05) entre el sit and reach y el número de TP. Conclusión. Como conclusión, podemos indicar que los datos obtenidos en la presente investigación han mostrado los efectos significativos del entrenamiento vibratorio sobre la amplitud de movimiento en mujeres con FM, aunque el número de TP o la rigidez no se vieron afectados en ningún caso(AU)

Objective. The main aim of this investigation was twofold: first to evaluate the effects of exercise and whole body vibration training on flexibility in women with fibromyalgia (FM) and determine whether these improvements are related to symptom severity (stiffness and bodily pain). Method. Forty-six women (mean ± sd, age: 58.2 ± 8.5 years; weight: 72.1 ± 9.6 kg; height: 156.9 ± 6.1 cm) with FM were randomized into one of three groups: exercise and whole body vibration (WBV) training group (WBV + EX; n = 15), exercise training group (EX), and usual-care control group (CG). WBV + EX and EX groups carried out two sessions per week of exercise training for 8 weeks. In addition, WBV + EX group performed 3 vibration-training (30 Hz, 4 mm) sessions per week. Outcome assessed included sit and reach test (primary outcome), tender points (TP) evaluation, and a visual analog scale (VAS) was used to determine the stiffness level. Results. Results showed no statistical intra and intergroup differences in stiffness or the number of TP. However, a significant increment in the sit and reach performance was observed in WBV + EX (58%; p < 0.05). Moreover, correlation analysis showed an inverse and significant relationship (r = -0.55; p < 0.05) between sit and reach and number of TP in WBV+EX group. Conclusion. In conclusion, exercise and WBV seems to be effective on flexibility in women with FM. However, the number of TP and stiffness was not modified after the intervention(AU)

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La escoliosis idiopática, más allá de una simple desviación lateral de la columna vertebral, es una deformidad que abarca los tres planos del espacio presentando, además de la citada inclinación lateral, rotación vertebral y traslación. Estas alteraciones pueden repercutir, en mayor o menor medida, en la caja torácica, siendo el defecto estético que produce uno de los motivos habituales de consulta. A pesar de los muchos trabajos de investigación que se han llevado a cabo sobre la escoliosis, todavía sigue siendo una patología discutida. Con el desarrollo de las técnicas de imagen, sobre todo la RMN, se han podido desarrollar trabajos de autores que creían que una disfunción en algún nivel del sistema nervioso podía producir la deformidad espinal en la escoliosis idiopática. Así la siringomielia es la alteración neurológica encontrada como hallazgo casual más frecuente en pacientes asintomáticos (AU)

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OBJECTIVE: Review of the literature shows that, for the moment, the cause of idiopathic scoliosis remains unknown. It has been attributed to a wide variety of conditions, including genetics. The aim of this paper was to determine the frequency of antecedents and family prevalence of idiopathic scoliosis in first and second degree relatives. PATIENTS AND METHODS: During 1994-1995, the families, including first and second degree relatives, of 100 schoolchildren with idiopathic scoliosis were surveyed for scoliosis. The screening was done initially by clinical examination, the test of Adams and subsequently the diagnosis was confirmed by roentgenography. RESULTS: Our study showed the following results. Twenty-five percent of patients investigated had one or more affected individuals in their family. Prevalence of idiopathic scoliosis in first degree relatives was 5.16% and in second degree relatives 4.31%. It was more frequent in females than in males (p < 0.05). This prevalence is larger than that in the general population (1-2%). CONCLUSIONS: Our conclusion is that the mechanism of inheritance is most likely multifactorial. In view of the predominance of females, an X-linked inheritance is suggested.

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