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BACKGROUND AND PURPOSE: The lack of clear knowledge about the etiology of nonspecific neck pain (NS-NP) strengthens the need for other mechanisms, still poorly described in the literature, to be investigated. Therefore, a quantitative analysis of two cases of NS-NP in subjects with functiona dyspepsia was conducted in order to verify the immediate and seven-day postintervention effects of visceral manipulation (VM) to the stomach and liver on neck pain, cervical range of motion (ROM), and electromyographic (EMG) activity of the upper trapezius muscle. CASE DESCRIPTION: Case A was an 18-year-old female with a complaint of nonspecific neck pain for one year, with reported pain on waking, momentary intermittent pain, and occasional symptoms of paresthesia in the upper limbs. Case B was a 25-year-old female with a complaint of cervical pain for one year, accompanied by pain in the unilateral temporomandibular joint, and medial thoracic region. Both cases presented functional dyspepsia. OUTCOMES: The results demonstrated (subjects A and B, respectively) a general increase in cervical ROM (range: 12.5% to 44.44%) and amplitude of the EMG signal (immediately postintervention: 57.62 and 20.78; post seven days: 53.54% and 18.83%), and an increase in muscle fiber conduction velocity immediately postintervention (4.44% and 7.44%) and a decrease seven days postintervention (25.25% and 21.18%). For pain, a decrease was observed immediately postintervention (23.07% and 76.92%) and seven days postintervention (100% for both subjects). DISCUSSION: A single VM provided important clinical improvement in neck pain, cervical spine range of motion, and EMG activity of the upper trapezius muscle, immediately and seven days postintervention in two NS-NP subjects with functional dyspepsia.
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OBJECTIVE: To investigate the clinical effects of incorporation of phototherapy in a therapeutic exercise program for individuals with knee osteoarthritis (OA) when compared to a group that received exercise alone and to a group that received exercise + placebo phototherapy. MATERIALS AND METHODS: This is a randomized, blinded and placebo-controlled trial. Thus, sixty male and female individuals aged 40-80 years with knee pain in the previous 6 months participated of the study, with diagnosis of unilateral knee OA based on the criteria established by the American College of Rheumatology and radiographic confirmation and Grades 2 or 3 of the Kellgren-Lawrence Classification. The individuals were equally divided in the groups exercise alone, exercise + active phototherapy (nine-diode cluster device: one 905 nm super-pulsed diode laser, four 875 nm LED and four 640 nm LED; energy per quadrant: 7.85 J; total energy: 23.55 J per session), or exercise + placebo phototherapy. Treatments were performed twice a week for 5 consecutive weeks. Patients were evaluated before and after the sessions of treatment. The outcome measures were: Western Ontario and McMaster University Osteoarthritis Index (WOMAC), Lower Extremity Functional Scale (LEFS), Numerical Rating Pain Scale (NRPS), pressure pain threshold (PPT) in two points of knee, muscle strength, and the Functional Reach Test (FRT). RESULTS: Exercise + active phototherapy was significantly more effective than exercise alone (mean difference [MD] = 2.75, 95% confidence interval [CI] = 3.17 to 2.32) and exercise + placebo phototherapy (MD = 2.38, 95% CI = 2.79 to 1.96) only with regard to the NRPS, considering minimal clinically important difference. No clinical significant results were found for function, the pressure pain threshold, muscle strength or balance. CONCLUSIONS: The combination of phototherapy and an exercise program is effective at reducing pain intensity among individuals with knee osteoarthritis than exercise alone or exercise + placebo phototherapy in a short-term protocol. Lasers Surg. Med. 50:819-828, 2018. © 2018 Wiley Periodicals, Inc.
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Terapia por Exercício , Terapia com Luz de Baixa Intensidade , Osteoartrite do Joelho/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do TratamentoRESUMO
OBJECTIVE: The aim of this study was to evaluate the reliability of different dynamometric variables of the pelvic floor muscles (PFM) in healthy women during different periods of menstrual cycle. MATERIALS AND METHODS: Vaginal dynamometric equipment was developed by the authors and its reproducibility was tested. The PFM contractions of 20 healthy women were collected by two independent examiners over three consecutive weeks, always on the same day, with a seven-day interval between readings, starting from the first day after the end of the menstrual period. For the measurements, the branch of the dynamometer was positioned first on the sagittal plane and then on the frontal plane. Baseline, peak time, maximum PFM strength, impulse contraction, and average contraction force were calculated. Reproducibility was tested using the intra-class correlation coefficient (ICC) and standard error of measurement. Repeated-measures ANOVA was used to compare the data from different days. RESULTS: For intra-day and inter-day reliability between examiners, all the parameters collected on the sagittal plane presented good and excellent reproducibility (ICC2,1 = 0.60 to 0.98), whereas reproducibility on the frontal plane was respectively poor and excellent (ICC2,1 = 0.23 to 0.97). The ANOVA revealed significant differences between sessions only for the impulse of contraction for the sagittal (P = 0.005) and frontal (P = 0.03) planes. CONCLUSIONS: Time and contraction force parameters of the PFM are not influenced by hormonal alterations that occur during the menstrual cycle. The impulse of contraction was the only variable to demonstrate a significant difference between the first and second week of the data collection protocol. The baseline, maximum strength value, impulse of contraction, and average contraction force variables presented good to excellent reproducibility and can be safely used as a method of PFM evaluation.
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Ciclo Menstrual/fisiologia , Contração Muscular/fisiologia , Diafragma da Pelve/fisiologia , Adulto , Feminino , Voluntários Saudáveis , Humanos , Dinamômetro de Força Muscular , Reprodutibilidade dos Testes , Adulto JovemRESUMO
BACKGROUND: Temporomandibular disorder (TMD) is considered multifactorial and is defined as a group of pain conditions characterized by functional stomatognathic system alterations, which may be affected by or related disrupted postural control. OBJECTIVE: Assess the immediate effect of nonspecific mandibular mobilization (NMM) on the postural control of subjects diagnosed or not with TMD. METHOD: A simple-blind, randomized, controlled clinical trial was performed involving 50 subjects of both genders assigned to two groups: the TMD group and the control group. TMD was diagnosed according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). A stabilometric assessment was performed by testing subjects in a quiet stance on a dual force platform under two visual conditions (eyes open and eyes closed). The Center of Pressure (CoP)-related variables analyzed were displacement, amplitude, speed of anterior-posterior (AP) and medial-lateral (ML) displacements and CoP sway area. The mean values of each variable were compared, considering the accepted significance value of p<0.05. RESULTS: A significant difference between the pre- and post-NMM means could be observed in subjects diagnosed with TMD under the closed-eyes visual condition. There was a statistically significant difference in the CoP sway area (p<0.03) in the ML displacement COPML (p<0.006) and ML amplitude COPML (p<0.01) and in the variable speed in the AP COPAP (p<0.03) and ML COPML (p<0.03) directions, simultaneously. CONCLUSION: These results indicate that nonspecific temporomandibular joint mobilization contributes to the immediate improvement of postural control in patients with TMD.
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Transtornos da Articulação Temporomandibular/terapia , Adulto , Feminino , Humanos , Masculino , Modalidades de Fisioterapia , Postura , Método Simples-Cego , Fatores de TempoRESUMO
BACKGROUND: Temporomandibular disorder (TMD) is considered multifactorial and is defined as a group of pain conditions characterized by functional stomatognathic system alterations, which may be affected by or related disrupted postural control. OBJECTIVE: Assess the immediate effect of nonspecific mandibular mobilization (NMM) on the postural control of subjects diagnosed or not with TMD. METHOD: A simple-blind, randomized, controlled clinical trial was performed involving 50 subjects of both genders assigned to two groups: the TMD group and the control group. TMD was diagnosed according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). A stabilometric assessment was performed by testing subjects in a quiet stance on a dual force platform under two visual conditions (eyes open and eyes closed). The Center of Pressure (CoP)-related variables analyzed were displacement, amplitude, speed of anterior-posterior (AP) and medial-lateral (ML) displacements and CoP sway area. The mean values of each variable were compared, considering the accepted significance value of p<0.05. RESULTS: A significant difference between the pre- and post-NMM means could be observed in subjects diagnosed with TMD under the closed-eyes visual condition. There was a statistically significant difference in the CoP sway area (p<0.03) in the ML displacement COPML (p<0.006) and ML amplitude COPML (p<0.01) and in the variable speed in the AP COPAP (p<0.03) and ML COPML (p<0.03) directions, simultaneously. CONCLUSION: These results indicate that nonspecific temporomandibular joint mobilization contributes to the immediate improvement of postural control in patients with TMD. .
CONTEXTUALIZAÇÃO: A disfunção temporomandibular (DTM) é considerada multifatorial e se define como um grupo de condições dolorosas que se caracteriza por apresentar alterações funcionais do sistema estomatognático que podem estar relacionadas à perturbação ou a uma contribuição em relação ao controle da postura. OBJETIVO: Verificar o efeito imediato da mobilização mandibular inespecífica (MMI) sobre o controle postural em indivíduos com e sem diagnóstico de DTM. MÉTODO: Realizou-se um ensaio clinico controlado, randomizado, simples cego, com 50 indivíduos de ambos os gêneros, alocados em dois grupos: grupo DTM e grupo controle, diagnosticados segundo o RDC/TMD. Realizou-se uma avaliação estabilométrica com os indivíduos sobre uma plataforma de força, em duas condições visuais: olhos abertos e fechados. As variáveis referentes ao centro de oscilação do corpo (COP) analisadas foram: deslocamento, amplitude, velocidade de deslocamentos ântero-posterior (AP) e médio-lateral (ML) e área de oscilação do centro de pressão (COP). Os valores médios de cada variável foram comparados, considerando o nível de significância aceito de p<0,05. RESULTADOS: Foi possível verificar diferença significativa entre as médias pré e pós-MMI nos indivíduos diagnosticados com DTM na condição visual olhos fechados. Houve diferença estatisticamente significante na área de oscilação do COP (p<0,03) no deslocamento médio-lateral COPML (p<0,006), na amplitude médio-lateral COPML (p<0,01) e na variável velocidade nas direções ântero-posterior, COPAP (p<0,03) e médio-lateral ...
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Adulto , Feminino , Humanos , Masculino , Transtornos da Articulação Temporomandibular/terapia , Modalidades de Fisioterapia , Postura , Método Simples-Cego , Fatores de TempoRESUMO
Posturas inadequadas durante atividades diurnas ou noturnas causam alterações oclusais e nas articulações têmporo-mandibulares, devido às pressões anormais produzidas pela posição incorreta e prolongada. Desta forma, o objetivo desta pesquisa foi verificar a relação entre decúbitos de dormir com presença de disfunção têmpero-mandibulares. Para isso, foram entrevistados 174 estudantes universitários por meio de questionários específicos. Observou-se a maior prevalência de disfunção nos voluntários que adotavam o decúbito ventral para dormir. Portanto, neste estudo, houve uma relação entre disfunção têmpero-mandibulares e o posicionamento adotado durante o sono principalmente o decúbito ventral
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Humanos , Masculino , Feminino , Adulto , Postura , Decúbito Ventral , Sono , Decúbito Dorsal , Síndrome da Disfunção da Articulação Temporomandibular/etiologia , Inquéritos e QuestionáriosRESUMO
O objetivo deste estudo foi avaliar a atividade de eletromiográfica dos músculos temporal anterior e masseter de sete pacientes com seqüela de acidente vascular encefálico isquêmico, capazes de entenderem instruções verbais, sem sinais ou sintomas de disfunção têmporo-mandibular, oclusãonormal e idades entre 46 a 75 anos (média 60,6 anos). Foram feitos registros da atividade eletromiográfica durante posição postural de repouso mandibular e contração isotônica. Para o registro da atividade eletromiográfica dos músculos estudados foram utilizados eletrodos de superfície ativos (Lynx EletronicsLtda.) colocados bilateralmente sobre temporal anterior e masseter. A atividade elétrica foi analisada em RMS (ôrootmean-squareö) e expressa em microvolts (μV) para as fases de repouso e contração isotônica de cada músculo. O teste não paramétrico de Wilcoxon T foi empregado para comparar a atividade de elétrica entre os lados afetados e não dos músculos avaliados. Ficou demonstrado que não houve diferença significante nos valores da atividade elétrica em RMS para os músculos avaliados entre o lado afetado pelo acidente vascular encefálico isquêmico e o não afetado, embora tenha havido predomínio de masseter e temporal anterior contralateral ao lado afetado