The immediate effects of atlanto-occipital joint manipulation and suboccipital muscle inhibition technique on active mouth opening and pressure pain sensitivity over latent myofascial trigger points in the masticatory muscles

DESIGN: A randomized controlled trial.OB JECTIVE: To investigate the immediate effects on pressure pain thresholds over latent trigger points (TrPs) in the masseter and temporalis muscles and active mouth opening following atlanto-occipital joint thrust manipulation or a soft tissue manual intervention targeted to the suboccipital muscles. BACKGROUND : Previous studies have described hypoalgesic effects of neck manipulative interventions over TrPs in the cervical musculature. There is a lack of studies analyzing these mechanisms over TrPs of muscles innervated by the trigeminal nerve. METHODS: One hundred twenty-two volunteers, 31 men and 91 women, between the ages of 18 and 30 years, with latent TrPs in the masseter muscle, were randomly divided into 3 groups: a manipulative group who received an atlanto-occipital joint thrust, a soft tissue group who received an inhibition technique over the suboccipital muscles, and a control group who did not receive an intervention. Pressure pain thresholds over latent TrPs in the masseter and temporalis muscles, and active mouth opening were assessed pretreatment and 2 minutes posttreatment by a blinded assessor. Mixed-model analyses of variance (ANOVA) were used to examine the effects of interventions on each outcome, with group as the between-subjects variable and time as the within-subjects variable. The primary analysis was the group-by-time interaction. RESULTS: The 2-by-3 mixed-model ANOVA revealed a significant group-by-time interaction for changes in pressure pain thresholds over masseter (P<.01) and temporalis (P =.003) muscle latent TrPs and also for active mouth opening (P<.001) in favor of the manipulative and soft tissue groups. Between-group effect sizes were small. CONCLUSIONS: The application of an atlanto-occipital thrust manipulation or soft tissue technique targeted to the suboccipital muscles led to an immediate increase in pressure pain thresholds over latent TrPs in the masseter and temporalis muscles and an increase in maximum active mouth opening. Nevertheless, the effects of both interventions were small and future studies are required to elucidate the clinical relevance of these changes. LEVEL OF EVIDENCE : Therapy, level 1b. J Orthop Sports Phys Ther 2010;40(5):310-317. doi:10.2519/jospt.2010.3257. KEYWORDSDS: cervical manipulation, muscle trigger points, neck, TMJ, upper cervical.

Padrão de ativação de músculos do core abdominal e tilt pélvico no teste de extensão da anca, em indivíduos com e sem dor lombo- pélvica

Introdução: Os padrões de movimento podem sofrer alterações por atraso no timing de ativação e/ou modificações na sequência de recrutamento muscular, predispondo o indivíduo a disfunções, nomeadamente a dor lombo-pélvica. Objetivo: Investigar o timing e o padrão de ativação de músculos do core abdominal, durante o movimento de extensão da anca, do membro dominante, em indivíduos com e sem dor lombo- pélvica crónica inespecífica. Pretende-se, também, pesquisar a existência do padrão de ativação considerado “normal“ e verificar a relação entre o padrão de ativação e o tilt pélvico, em ambos os indivíduos. Métodos: Estudo transversal, com 64 estudantes universitários, divididos em dois grupos: 31 sem e 33 com dor lombo-pélvica. Através de eletromiografia de superfície foi recolhida a atividade muscular dos Eretores da Espinha ipsilateral e contralateral, Glúteo Máximo e Bicípite Femoral ipsilaterais. Foi analisado o timing de ativação muscular e as respetivas ordens de ativação. Adicionalmente foi medido o tilt pélvico. Resultados: O grupo com dor lombo-pélvica apresentou um atraso significativo no timing de ativação dos músculos Glúteo Máximo ipsilateral (t=-3,171;p=0,002) e Bicípite Femoral ipsilateral (t=-2,092;p=0,041), em comparação com o grupo sem dor. Verificou-se uma associação significativa entre as 5 ordens de ativação mais frequentes e a presença de dor lombo-pélvica (xf2=11,54;p=0,015). A ordem de ativação "normal" – Glúteo Máximo ipsilateral>Bicípite Femoral ipsilateral>Eretor da Espinha contralateral>Eretor da Espinha ipsilateral – não foi utilizada. Verificou-se que o Bicípite Femoral ipsilateral foi maioritariamente o primeiro a ativar-se e o Glúteo Máximo ipsilateral o último em ambos os grupos. Verificou-se um tilt pélvico significativamente superior nos indivíduos que ativam primeiro o Bicípite Femoral ipsilateral nos grupos com (U=51;p=0,001) e sem dor (U=41p=0,001). Conclusão: Os indivíduos com dor lombo-pélvica apresentaram um atraso no timing de ativação dos músculos do core abdominal. Os resultados parecem refutar a ordem de ativação "normal" que tem sido proposta. Não foi possível apoiar nem contestar a teoria de que um atraso na ativação do Glúteo Máximo está associado com dor lombo-pélvica.

Age-period-cohort effects in the incidence of hip fractures: political and economic events are coincident with changes in risk

Introduction: Healthcare improvements have allowed prevention but have also increased life expectancy, resulting in more people being at risk. Our aim was to analyse the separate effects of age, period and cohort on incidence rates by sex in Portugal, 2000–2008. Methods: From the National Hospital Discharge Register, we selected admissions (aged ≥49 years) with hip fractures (ICD9-CM, codes 820.x) caused by low/moderate trauma (falls from standing height or less), readmissions and bone cancer cases. We calculated person-years at risk using population data from Statistics Portugal. To identify period and cohort effects for all ages, we used an age–period–cohort model (1-year intervals) followed by generalised additive models with a negative binomial distribution of the observed incidence rates of hip fractures. Results: There were 77,083 hospital admissions (77.4 % women). Incidence rates increased exponentially with age for both sexes (age effect). Incidence rates fell after 2004 for women and were random for men (period effect). There was a general cohort effect similar in both sexes; risk of hip fracture altered from an increasing trend for those born before 1930 to a decreasing trend following that year. Risk alterations (not statistically significant) coincident with major political and economic change in the history of Portugal were observed around birth cohorts 1920 (stable–increasing), 1940 (decreasing–increasing) and 1950 (increasing–decreasing only among women). Conclusions: Hip fracture risk was higher for those born during major economically/politically unstable periods. Although bone quality reflects lifetime exposure, conditions at birth may determine future risk for hip fractures.

Immediate effects of hip mobilization with movement in patients with hip osteoarthritis: A randomised controlled trial

Background Mobilization with movement (MWM) has been shown to reduce pain, increase range of motion (ROM) and physical function in a range of different musculoskeletal disorders. Despite this evidence, there is a lack of studies evaluating the effects of MWM for hip osteoarthritis (OA). Objectives To determine the immediate effects of MWM on pain, ROM and functional performance in patients with hip OA. Design Randomized controlled trial with immediate follow-up. Method Forty consenting patients (mean age 78 ± 6 years; 54% female) satisfied the eligibility criteria. All participants completed the study. Two forms of MWM techniques (n = 20) or a simulated MWM (sham) (n = 20) were applied. Primary outcomes: pain recorded by numerical rating scale (NRS). Secondary outcomes: hip flexion and internal rotation ROM, and physical performance (timed up and go, sit to stand, and 40 m self placed walk test) were assessed before and after the intervention. Results For the MWM group, pain decreased by 2 points on the NRS, hip flexion increased by 12.2°, internal rotation by 4.4°, and functional tests were also improved with clinically relevant effects following the MWM. There were no significant changes in the sham group for any outcome variable. Conclusions Pain, hip flexion ROM and physical performance immediately improved after the application of MWM in elderly patients suffering hip OA. The observed immediate changes were of clinical relevance. Future studies are required to determine the long-term effects of this intervention.