Inter-rater Accuracy and Reliability of a Palpation Protocol of the C7 Spinous Process Comprising a Combination of 3 Traditional Palpation Techniques

ObjectiveThe purpose of this study was to determine the accuracy and intrarater reliability of a palpatory protocol based on a combination of 3 palpatory methods to identify both the C7 spinous process (C7 SP) and the factors that affect the errors and inaccuracy of palpation.MethodsTwenty-five women between the ages of 18 and 60 years were submitted to a palpation protocol of the C7 SP, and a radiopaque marker was fixed on the skin at the possible location of the vertebrae. A radiograph and a photograph of the cervical spine were obtained in the same posture by a first rater. A second rater performed the same palpation protocol and took a second photograph. The accuracy and measurement error of the palpation protocol of C7 SP were assessed through radiographic images. The inter-rater reliability was estimated by the interclass correlation coefficient and assessed using photographs of each rater. The Pearson's correlation coefficients (r), the Fisher exact test, and the χ² test were used to identify the factors associated with the error and inaccuracy of palpation.ResultsAccuracy of the C7 palpation was 76% with excellent reliability (interclass correlation coefficient = 0.99). There was a moderate correlation between weight and the measurement of palpation error (r = –0.6; P = .003). One hundred percent of inaccuracy palpation was related to the increased soft-tissue thickness (P = .005) in the cervical region.ConclusionThe palpation protocol described in this study was accurate and presented excellent reliability in identifying the C7 SP. Increased weight and dorsocervical fat pad were associated to error and palpation inaccuracy, respectively.     

Accuracy of rib palpation for dry needling of deep periscapular musculature,measured with ultrasound

IntroductionDry needling of the periscapular musculature is a procedure commonly performed by physical therapists. Needling of the deep musculature may be challenging, and use of a thoracic rib as a “backstop” is often applied to prevent inadvertent puncture of the pleura. The aim of this study was to: 1) To examine the accuracy rate of experienced physical therapists in identifying a mid-scapular thoracic rib using palpation, 2) to understand patient characteristics that affect the accuracy rate, and 3) to examine if therapist confidence levels were associated with palpatory accuracy.MethodsTwo experienced physical therapists attempted to palpate a thoracic rib in the mid-scapular region of healthy participants (n = 101 subjects, 202 ribs), and self-reported their level of confidence in an accurate palpation. Their accuracy was verified with ultrasonography.ResultsThe two physical therapists were accurate on 73.3% of palpations and did not differ in accuracy (72.0% vs. 75.0%, p = 0.747). The only ultrasonographic or subject characteristic measurement that correlated with improved accuracy was a reduced muscle thickness (p = 0.032). Therapists’ self-reported confidence levels did not correlate to actual accuracy (p = 0.153).DiscussionPhysical therapists should be aware that palpation of a thoracic rib may not be as accurate as it may seem. The greater thickness of muscle in the area reduces the accuracy of accurate palpation.ConclusionDry needling of the periscapular muscles should be done with caution if using a rib as a “blocking” technique.     

Masseter Muscle Thickness And Elasticity in Bruxism After Exercise Treatment: A Comparison Trial

ObjectiveThe purpose of this study was to evaluate the effects of Rocabado's 6 × 6 exercises on masseter muscle thickness, muscle elasticity, and pain scores in patients with bruxism.MethodsA total of 58 participants with bruxism were divided into 2 groups as the exercise group (EG) and control group (CG). A self-care program was applied for the participants in the CG. For those in the EG, in addition to the self-care program, an exercise treatment was performed for 6 days per week for a total of 8 weeks. Using ultrasonography, bilateral masseter muscle thickness and elasticity were assessed before and after treatment. Pain was measured using a visual analog scale. Changes over time within the groups and group–time interactions for continuous variables were assessed using mixed 2-way repeated measures analysis of variance.ResultsThe improvement in muscle elasticity (P = .015; P = .004) and pain values (P = .049; P = .040) were greater in the EG compared with the CG. There was no significant difference between the 2 groups for masseter muscle thickness (P > .05).ConclusionThis study suggests that Rocabado's 6 × 6 exercises are effective in the treatment of muscle elasticity and pain values in participants with bruxism.     

How do spine instrumentation parameters influence the 3D correction of thoracic adolescent idiopathic scoliosis? A patient-specific biomechanical study

BackgroundPatient-specific models promises to support the surgical decision-making process, particularly in adolescent idiopathic scoliosis. The present computational biomechanical study investigates how specific instrumentation parameters impact 3D deformity correction in thoracic scoliosis.Methods1080 instrumentation simulations of a representative patient were run. The independent instrumentation parameters were: screw pattern, upper and lower instrumented vertebrae, rod curvature and rod stiffness. ANOVA and correlation analyses analyzed how the instrumentation parameters influenced the 3D correction.FindingsCoronal plane correction was affected by the lower instrumented vertebra and rod stiffness (explaining 84% and 11%, respectively, of its overall variance). The sagittal profile was controlled by rod curvature and the upper vertebra (56% and 36%). The transverse plane vertebral rotation was influenced by lower, upper instrumented vertebra and screw pattern (35%, 32% and 19%). The Cobb angle correction was strongly correlated with the number of fused vertebrae, particularly when grouped by the upper instrumented vertebra (r = −0.91) and rod stiffness (r = −0.73). Thoracic kyphosis was strongly correlated with the number of fused vertebrae grouped by rod curvature (r = 0.84). Apical vertebral rotation was moderately correlated with the number of fused vertebrae grouped by upper/lower instrumented vertebra (r = 0.55/0.58), although variations were minimal.InterpretationInstrumenting the last vertebra touching the central sacral vertical line improves 3D correction. A trade-off between a more cranial vs. caudal upper instrumented vertebra, respectively beneficial for coronal/sagittal vs. transverse plane correction, is required. High rod stiffness, differential rod contouring, and screw pattern were effective for coronal correction, thoracic kyphosis, and axial vertebral derotation, respectively.     

Bilateral Mechanical-Pain Sensitivity Over the Trigeminal Region in Patients With Chronic Mechanical Neck Pain

The aim of this study was to investigate bilateral pressure-pain sensitivity over the trigeminal region, the cervical spine, and the tibialis anterior muscle in patients with mechanical chronic neck pain. Twenty-three patients with neck pain (56% women), aged 20 to 37 years old, and 23 matched controls (aged 20 to 38 years) were included. Pressure pain thresholds (PPTs) were bilaterally assessed over masseter, temporalis, and upper trapezius muscles, the C5-C6 zygapophyseal joint, and the tibialis anterior muscle in a blinded design. The results showed that PPT levels were significantly decreased bilaterally over the masseter, temporalis, and upper trapezius muscles, and also the C5-C6 zygapophyseal joint (P < .001), but not over the tibialis anterior muscle (P = .4) in patients with mechanical chronic neck pain when compared to controls. The magnitude of PPT decreases was greater in the cervical region as compared to the trigeminal region (P < .01). PPTs over the masseter muscles were negatively correlated to both duration of pain symptoms and neck-pain intensity (P < .001). Our findings revealed pressure-pain hyperalgesia in the trigeminal region in patients with mechanical chronic neck pain, suggesting spreading of sensitization to the trigeminal region in this patient population.PerspectiveThis article reveals the presence of bilateral pressure-pain hypersensitivity in the trigeminal region in patients with idiopathic neck pain, suggesting a sensitization process of the trigemino-cervical nucleus caudalis in this population. This finding has implications for development of management strategies.     

Cervical Joint Position Sense in Individuals With Type 2 Diabetes and Its Correlations With Glycated Hemoglobin Levels: A Cross-Sectional Study

ObjectiveThis study aimed to compare cervical joint position sense (JPS) between individuals with type 2 diabetes (T2D) and healthy individuals and to assess the correlation between glycated hemoglobin (HbA1c) values and cervical JPS in individuals with T2D.MethodsNinety-seven individuals with T2D (mean age: 59.0 ± 6.8 years; men = 63 [67.02%], women = 34 [32.98%], and 117 healthy individuals without T2D (mean age: 57.3 ± 6.9 years; men = 70 [79.80%], women = 44 [20.20%]) were recruited into this study. Cervical JPS was evaluated using a cervical range of motion device in cervical flexion, extension, and rotation in left and right directions. Participants were required to relocate their heads actively to a predefined target position with eyes closed, and their reposition accuracy was measured in degrees as joint reposition error (JRE). The HbA1c test was performed on all participants with T2D to determine their average blood sugar level over the previous 2 to 3 months. Cervical JREs were compared and correlated with HbA1c values.ResultsThe participants with T2D showed significantly larger cervical JREs in all directions compared with the healthy group (flexion: d = 1.23, P < .001; extension: d = 1.85, P < .001; left rotation: d = 1.70, P < .001; right rotation: d = 2.60, P < .001). Pearson correlation coefficient (r) showed significant moderate positive association between HbA1c and cervical JREs in flexion (r = 0.41, P = .001), extension (r = 0.48, P < .001), left rotation (r = 0.38, P < .001), and right rotation (r = 0.37, P < .001) in participants with T2D.ConclusionThe magnitude of cervical JPS impairment was significant in individuals with T2D. In addition, HbA1c levels showed a significant negative correlation with cervical JPS.     

Effects of scapular stabilization and upper limb proprioception as an adjunct to cervical stabilization in chronic neck pain patients: A randomized controlled trial

BackgroundChronic neck pain is a prevalent health condition and a leading cause of disability worldwide. Prompt therapeutic measures are required to overcome this condition.ObjectivesTo evaluate the efficacy of incorporation of scapular stabilization and upper limb proprioceptive exercises to cervical stabilization exercises in patients with chronic neck pain (CNP).DesignA single-blinded randomized controlled design.MethodsA sample of convenience was deployed to recruit twenty-eight patients having CNP (18–45 years) and was randomized into two groups: group A (cervical stabilization exercises group) and group B (scapular stabilization and upper limb proprioceptive exercises group + cervical stabilization exercises). Pain intensity, disability, sleep quality, quality of life, scapular muscles strength and proprioception were assessed at 4 weeks follow up to determine the efficacy of the intervention.ResultsA mixed model ANOVA was used. A statistically significant (p < 0.05) group by time interaction for pain intensity (p = 0.000), scapular muscles strength of all muscles (p = 0.000) was observed. Significant group interaction for absolute error (p = 0.00), for pain (p = 0.001), disability (p = 0.04) and scapular muscle's strength (p = 0.000) was also demonstrated.ConclusionThe results indicated that scapular stabilization and upper limb proprioceptive exercises when combined with cervical stabilization exercises are more beneficial in alleviating pain and disability and improving scapular muscle strength and proprioception in patients with CNP.     

Interexaminer agreement of clinical examination of the neck in manual medicine

ObjectivesTo assess interexaminer agreement in a structured, manual, clinical examination of the neck. To correlate these data with the score in a functional questionnaire (a validated, French-language version of the neck pain and disability scale).PatientsFifty-nine ambulatory patients (26 males and 33 females, mean ± SD age: 46.3 ± 12 yrs) with common neck pain but no radiation below the elbow.MethodsTwo medical practitioners (a junior and a senior consultant) assessed neck rotation (in degrees) and the presence of pain during maximum neck flexion and extension, muscle palpation trapezius, levator scapulae, splenius cervicis, semispinalis) and cervical spine palpation. Cohen's kappa coefficient was calculated for qualitative variables. Angular rotational values (as a continuous variable) were compared using the p coefficient. Pearson coefficient was used to correlate the number of tender spots to the results of the questionnaire.ResultsThere was no significant interexaminer difference (±10°) in the neck rotation measurement. Kappa was (i) 0.71 and 0.76 for pain in flexion or extension, respectively, (ii) 0.44 on average for palpation of various muscles and (iii) 0.53 on average for cervical spine palpation. The number of tender spots correlated strongly with the questionnaire score (Pearson's coefficient: 0.35; p = 0.007).ConclusionThe interexaminer agreement for our clinical examination was moderate. The number of tender spots correlated strongly with the functional impairment. Pain at the lower attachment of the levator scapulae was associated with dysfunction of the median or upper cervical spine.     

Influence of Neck Pain,Cervical Extensor Muscle Fatigue,and Manual Therapy on Wrist Proprioception

ObjectiveThe purpose of this study was to examine the effects of submaximal isometric neck muscle fatigue and manual therapy on wrist joint position sense (JPS) within healthy individuals and individuals with subclinical neck pain (SCNP).MethodsTwelve healthy participants and 12 participants with SCNP were recruited. Each group completed 2 sessions, with 48 hours between sessions. On day 1, both groups performed 2 wrist JPS tests using a robotic device. The tests were separated by a submaximal isometric fatigue protocol for the cervical extensor muscles (CEM). On day 2, both groups performed a wrist JPS test, followed by a cervical treatment consisting of manual therapy (SCNP) or neck rest (20 minutes, control group) and another wrist JPS test. Joint position sense was measured as the participant's ability to recreate a previously presented wrist angle. Each wrist JPS test included 12 targets, 6 into wrist flexion and 6 into wrist extension. Kinematic data from the robot established absolute, variability, and constant error.ResultsAbsolute error significantly decreased (P = .01) from baseline to post-fatigue in the SCNP group (baseline = 4.48 ± 1.58°; post-fatigue = 3.90 ± 1.45°) and increased in the control group (baseline = 3.12 ± 0.98°; post-fatigue = 3.81 ± 0.90°). The single session of manual cervical treatment significantly decreased absolute error in participants with SCNP (P = .004).ConclusionThis study demonstrated that neck pain or fatigue can lead to altered afferent input to the central nervous system and can affect wrist JPS. Our findings demonstrate that acute wrist proprioception may be improved in individuals with SCNP by a single cervical manual therapy session.     

The Stiffness Comparison Test: A pilot study to determine inter-individual differences in palpatory skill related to gender,age, and occupation-related experience

BackgroundManual palpation is a core skill in physical examination. Assessing elastic properties such as tissue stiffness has the potential for being an important diagnostics tool in the detection of cancer and other diseases.ObjectiveThe study describes the newly developed Stiffness Comparison Test (SCT). The aim of our study was to test the SCT as a tool to detect interindividual differences in palpation skill related to gender, age and occupational experience.MethodsWe used eight pairs of polyuterhane gel pads with the stiffness difference decreasing from the first to the last pair. Test subjects were asked to palpate each pair and determine stiffness differences.ParticipantsWe recruited 25 osteopaths, 48 other manual therapists and 50 participants from other non-manual professions.ResultsAs hypothesized there was no significant difference in SCT performance between the sexes (t(121) = 0.288, p = .774). To investigate if an age-related decline would have an effect on palpation skill, we carried out a linear regression. As hypothesized, the model did not predict any significant associations (F(1, 121) = 2.733, b = −0.149, p = .101, R² = 0.022). To compare the effect of occupational groups on SCT performance a one-way ANOVA was conducted. There were no statistically significant differences between group means (F(2, 120) = 0.598, p = .552).ConclusionsThe SCT can be used as simple and affordable tool for assessment, teaching and training in all disciplines of manual medicine. Further refinements of the tool are suggested to advance its discrimination power.     

Craniocervical Posture Assessed With Photogrammetry and the Accuracy of Palpation Methods for Locating the Seventh Cervical Spinous Process: A Cross-sectional Study

ObjectiveThe purpose of this study was to compare craniocervical posture assessed by photogrammetry using 2 distinct palpation methods for locating the spinous process of the seventh cervical vertebra (C7SP).MethodsThis cross-sectional study was conducted in 2 phases. In phase I (n = 42), the assessor's accuracy in locating the C7SP using the flexion-extension and the modified thorax-rib static methods was compared to radiography. In phase II (n = 68), the craniocervical posture was analyzed with photogrammetry after palpation using the 2 methods. Neck pain intensity and disability were also determined.ResultsThe accuracy in locating the C7SP was higher using the modified thorax-rib static method (67%, 95% confidence interval [CI], 55-79) compared to the flexion-extension method (38%, 95% CI, 26-50, P = .016). Lower values of the craniocervical angle were obtained with the flexion-extension method than the modified thorax-rib static method (mean difference = ?1.1°, 95% CI, ?1.6 to ?0.6, P < .001). However, both palpation methods resulted in similar classifications of participants as with or without forward head posture (P = .096). Weak correlations were observed between the craniocervical angle and neck pain intensity (ρ = ?0.088 and ?0.099, respectively) and disability (ρ = ?0.231 and ?0.249, respectively).ConclusionCraniocervical angles obtained using palpation methods with different accuracies were different, although the magnitude of the difference was insufficient to lead to different classifications of a forward head posture in adults with mild neck pain and disability. Craniocervical posture was weakly correlated with neck-pain intensity and disability.     

Anatomical landmark position – Can we trust what we see? Results from an online reliability and validity study of osteopaths

BackgroundPractitioners traditionally use observation to classify the position of patients' anatomical landmarks. This information may contribute to diagnosis and patient management.ObjectivesTo calculate a) Inter-rater reliability of categorising the sagittal plane position of four anatomical landmarks (lateral femoral epicondyle, greater trochanter, mastoid process and acromion) on side-view photographs (with landmarks highlighted and not-highlighted) of anonymised subjects; b) Intra-rater reliability; c) Individual landmark inter-rater reliability; d) Validity against a ‘gold standard’ photograph. Design: Online inter- and intra-rater reliability study.SubjectsPhotographed subjects: convenience sample of asymptomatic students; raters: randomly selected UK registered osteopaths.Methods40 photographs of 30 subjects were used, a priori clinically acceptable reliability was ≥0.4. Inter-rater arm: 20 photographs without landmark highlights plus 10 with highlights; Intra-rater arm: 10 duplicate photographs (non-highlighted landmarks). Validity arm: highlighted landmark scores versus ‘gold standard’ photographs with vertical line. Research ethics approval obtained.RatersOsteopaths (n = 48) categorised landmark position relative to imagined vertical-line; Gwet's Agreement Coefficient 1 (AC1) calculated and chance-corrected coefficient benchmarked against Landis and Koch's scale; Validity calculation used Kendall's tau-B.ResultsInter-rater reliability was 'fair' (AC1 = 0.342; 95% confidence interval (CI) = 0.279–0.404) for non-highlighted landmarks and 'moderate' (AC1 = 0.700; 95% CI = 0.596–0.805) for highlighted landmarks. Intra-rater reliability was 'fair' (AC1 = 0.522); range was ‘poor’ (AC1 = 0.160) to ‘substantial’ (AC1 = 0.896). No differences were found between individual landmarks. Validity was ‘low’ (T_B = 0.327; p = 0.104).ConclusionBoth inter- and intra-rater reliability was ‘fair’ but below clinically acceptable levels, validity was ‘low’. Together these results challenge the clinical practice of using observation to categorise anterio-posterior landmark position.     

Effects of myofascial release on flexibility and electromyographic activity of the lumbar erector spinae muscles in healthy individuals

ObjectiveTo investigate the effects of myofascial release on the flexibility and electromyographic activity of the lumbar erector spinae muscle in healthy individuals.MethodsTen healthy subjects were recruited to an intervention protocol of myofascial release techniques: (1) superficial myofascial release; (2) deep myofascial release apply along 10 sessions, twice a week, with 40 min per sessions. The outcomes evaluated were flexibility (Toe-Touch Test) and electromyography activity (EMG) of the lumbar erector spinae muscle (Iliocostalis and Longissimus bilaterally) during the movement of extension-flexion of the trunk. Paired t-test was used to compare the electromyographic outcomes, while the Wilcoxon test was used to compare the flexibility outcomes.ResultsThe myofascial release techniques increased the flexibility (p = 0.005; r = 0.88) and have no influence over the electromyographic activity of the right iliocostalis (p = 0.179; r = 0.43), right longissimus (p = 0.877; r = 0.05), left iliocostalis (p = 0.386; r = 0.29) and left longissimus (p = 0.418; r = 0.27).ConclusionsThe application of myofascial release techniques increase flexibility and did not influence over the electromyographic activity of the lumbar erector spinae muscles in healthy individuals. Further studies should include a larger sample with a sham group and/or compare EMG activity of the lumbar erector spinae muscles with patients with low back pain during the movement of extension-flexion of the trunk.     

Transverse oscillatory pressure in management of cervical radiculopathy: A randomised controlled study

BackgroundCervical radiculopathy is an important subgroup of neck disorders causing severe pain and disability.ObjectivesThe study assessed the effect of transverse oscillatory pressure (TOP) on pain intensity and functional disability of patients with cervical radiculopathy.MethodsTwenty-six individuals with unilateral radiating neck pain were randomly allocated into Group A (8 males and 5 females) and Group B (6 males and 7 females). Participants in the two groups received kneading massage, cryotherapy, and active isometric exercises to the posterior paraspinal muscles, trapezuis, and sternomastoid muscles. TOP was administered to Group A, whereas Group B served as control. Treatment was applied three times per week for 4 weeks, making 12 treatment sessions for each participant. Visual analogue scale and Neck Disability Index were used to assess pain intensity and neck disability, respectively, at baseline, 2 weeks, and 4 weeks. Data were analysed using repeated-measures analysis of variance.ResultsThere was a significant improvement in pain intensity and neck functional disability of patients between baseline, 2^nd week, and 4^th week of treatment sessions in Groups A and B (p < 0.05). There was a significant reduction in pain intensity in Group A (f = 7.08, p < 0.05) at the 2^nd week and 4^th week compared with Group B.ConclusionIt can be concluded that TOP reduces pain faster in patients with cervical radiculopathy.     

Reliability of visual inspection and palpation to assess relative flexibility of the shoulder

IntroductionMovement compensations during internal rotation of the shoulder can provoke pain. Reliably observing and measuring compensations in the shoulder using visual and palpatory methods can result in more efficacious treatments of shoulder pathology. Despite this, the reliability of these measures and the relationship between them is unknown.MethodsBilateral shoulders of 33 Doctor of Physical Therapy (DPT) students were measured. Two third-year DPT student examiners used visual inspection and physical palpation to identify the first signs of internal rotation (IR) passive stiffness. Measurements were taken and recorded by a third examiner using the GetMyROM (Version 1.1) iPhone application.ResultsGood intra-rater reliability for both examiners was identified for physical palpation (ICC = 0.896, 95% CI = 0.830, 0.936, ICC = 0.901, 95% CI = 0.839, 0.939) and visual inspection (ICC = 0.813, 95% CI = 0.699, 0.884, ICC = 0.782, 95% CI = 0.667, 0.880). Moderate interrater reliability was found between the examiners for physical palpation (ICC = 0.681, 95% CI = 0.479, 0.797) while poor interrater reliability was found between examiners for visual inspection (ICC = 0.481, 95% CI = 0.234, 0.648). The correlation between physical palpation and visual inspection indicated moderate reliability for both examiners (r = 0.815, p = 0.01, r = 0.832, p = 0.01).ConclusionThe findings of this research study indicate that both physical palpation and visual inspection are reliable methods for measuring relative flexibility of shoulder IR when performed by the same examiner. However, the reliability for both methods decreases when performed by different examiners. Additionally, a strong correlation was found between both measures.     

Immediate effects of rhythmic joint mobilization of the temporomandibular joint on pain,mouth opening and electromyographic activity in patients with temporomandibular disorders

BackgroundRhythmic joint mobilizations (RJM) of the temporomandibular joint (TMJ) are employed to relieve pain and improve function in patients with temporomandibular disorders (TMD). However, the evidence on the immediate effects of RJM in patients with TMD is scarce. The aim of this study was to assess the immediate clinical and functional effects of RJM in patients with TMD.Materials and methodsThis was a one-group quasi-experimental before and after study. Thirty-eight patients with TMD were assessed by means of pain intensity (visual analogue score, VAS), pressure pain threshold (PPT, measured through pressure algometry on the masseter and temporal muscles), mouth opening (MO, measured with a ruler), and surface electromyographic activity of the masseter and temporal muscles (asymmetry index, AI). Measurements were performed before and after a single, 1-min session of RJM of each TMJ. All statistical analyses were performed using the SPSS version 20.0 statistical package.ResultsA statistical significant difference was found in pain intensity, PPT and MO after the intervention (p < 0.05). No difference was found in the AI. A large effect size was observed for pain intensity, PPT of the left and right masseter muscles and MO (d = 0.85–1.13), whereas for the left and right temporal muscles the effect size was moderate (d = 0.62) and small, respectively (d = 0.49).ConclusionIn this sample of patients with TMD, a single session of RJM of the TMJ seemed to be effective in reducing pain intensity, increasing PPT and improving MO immediately after the intervention, without differences in the AI.     

Comparison of the prevalence of myofascial trigger points of muscles acting on knee between patients with moderate degree of knee osteoarthritis and healthy matched people

IntroductionTrigger points have been implicated in the development of several musculoskeletal disorders. Trigger points harbored in lower limb muscles might represent a ubiquitous source of pain in patients with knee osteoarthritis (OA). This study was carried out to evaluate the prevalence of Myofascial Trigger Points (MTrPs) in muscles acting on the knee in patients with OA.MethodsThirty-seven patients aged at least 55 years old with a moderate degree of OA (grade III of Kellgren and Lawrence scale) were recruited. Thirty asymptomatic people, matched on age and body mass index, were considered as the control group. Ten muscles acting on the knee joint were selected. Taut bands were also identified using a skin rolling method. A pressure of 3 kg/cm² was used to identify myofascial trigger points in all muscles except the popliteus (8 kg/cm²).ResultsChi-square was performed to compare the prevalence of trigger points between the groups. The McNemar test was administered to compare the prevalence of trigger points in the right and left sides of participants. Prevalence of the trigger points was significantly higher in patients with knee OA compared with asymptomatic people in all muscles except for right (p = 0.17) and left (p = 0.41) rectus femoris, right (p = 0.61) and left (p = 0.22) sartorius and left biceps femoris (p = 0.08). Comparison of the prevalence of MTrPs bilaterally revealed that only the right and left sartorius differed significantly (p = 0.008).ConclusionsThe prevalence of MTrPs in the muscles acting on the knee joint is higher in patients with a moderate degree of knee OA compared with asymptomatic subjects.     

Is forward head posture relevant to cervical muscles performance and neck pain? A case–control study

BackgroundForward head posture (FHP) and muscular dysfunction are likely contributing factors to chronic neck pain (CNP) but there are inconsistent findings on the relevance of these factors to clinical CNP characteristics.ObjectiveTo compare FHP, cervical muscles size and endurance between CNP and asymptomatic participants and to investigate their association with pain and disability and relative involvement of deep/superficial and flexor/extensor muscles.MethodsThirty-two patients with CNP and 35 asymptomatic participants were included in this case–control study. FHP in standing, extensor and flexor muscles endurance and dimensions were assessed using digital photography, clinical tests and ultrasonographic imaging, respectively. The visual analog scale and neck disability index were also used to evaluate CNP patients’ clinical characteristics.ResultsDeep flexor (mean difference = 0.06, 95% CI = 0.02–0.11) and extensor muscles size (mean difference = 0.07, 95% CI = 0.01–0.12) were found to be significantly smaller in CNP patients. CNP patients also demonstrated lower levels of flexor (mean difference = 14.68, 95% CI = 3.65–25.72) and global extensor endurance capacity. FHP was neither different between the groups nor correlated with any of the dependent variables. Neither FHP nor endurance was correlated with pain/disability. Extensor endurance in both groups and flexor endurance in the asymptomatic group showed significant correlations with muscles size.ConclusionsFHP was found neither different between groups nor correlated with muscle performance or CNP clinical characteristics. While cervical endurance was found lower in CNP patients, it did not show any association with pain/disability. The muscular size–endurance relationship seems to become more complex in the presence of NP. While deep muscles seem to be differentially affected in the presence of CNP, the alterations do not seem to be uniform in the flexor and extensor groups.     

Influence of Body Posture and Apnea Severity on the Tone and Elasticity of Upper Airway Muscles in Awake Patients With Obstructive Sleep Apnea: A Cross-Sectional Study

ObjectiveThe purpose of this study was to compare the effect of body posture and apnea severity on the tone, stiffness, and elasticity of upper airway muscles in awake patients with obstructive sleep apnea syndrome (OSAS).MethodsEighty adult patients with OSAS from the Sleep Laboratory of the Bitlis State Hospital between April and December 2021 were included in the study. The tone, stiffness, and elasticity of the genioglossus and accessory muscles (sternocleidomastoid, masseter) were measured while the patients were awake, sitting upright, and in supine posture. According to polysomnography results and the Apnea-Hypopnea Index, patients were classified as mild, moderate, or severe OSAS.ResultsThere were 56 male (70%) and 24 female (30%) patients (age 45.0 ± 11.0 years). Tone of genioglossus, masseter, and sternocleidomastoid muscles were higher in supine than in sitting posture (all P < .05). There was no difference in elasticity scores of the bilateral genioglossus muscle in sitting and supine posture (P > .05). The elasticity scores of the sternocleidomastoid and masseter muscles were higher in sitting (all P < .05). An interaction effect of postural change and apnea severity was observed on stiffness scores of the genioglossus muscle (P < .05).ConclusionResults showed that the genioglossus muscle and accessory muscles take on the inspiratory load that develops with postural strain, regardless of the severity of apnea, in awake patients with OSAS. For participants measured in this study, accessory muscles supported respiration by increasing their elasticity.     

Chinese women's motivation to receive future screening: The role of social-demographic factors,knowledge and risk perception of cervical cancer

Purpose of the researchThis paper adopted Protection Motivation Theory (PMT) to examine Chinese women's knowledge and perceptions of cervical cancer risk and factors influencing their motivation to receive future screening.Methods and sampleA cross-sectional survey was conducted with 167 Chinese women (142 women were willing to receive a screening in the future and 25 women were not) in 2007 to collect women's socio-demographic information and sexual history, perceptions related to body health and knowledge about cervical cancer and screening, and Protection Motivation Theory measures.Key resultsThe majority of women stated they intended to receive future screening and response efficacy was significantly associated with their intention. However, no significant association was observed between sexual history and protection motivation. Using multivariate analysis, cancer in relatives (odds ratio, OR = 9.97, 95% CI [1.44–436.3], p = 0.010), a perception that visiting a doctor regularly is important to health (OR = 9.85, 95% CI [1.61–999.9], p = 0.009)), and ever attending for cervical screening during the previous three years (OR = 3.49, 95% CI [1.23–11.02], p = 0.016) were significantly associated with women' motivation to receive future screening.ConclusionThe findings of this study highlight the important role of women's beliefs in the value of cervical screening and previous screening experience in motivating them to receive a screening. Education intervention is needed to provide information and raise public awareness about the importance of cervical screening to women's health. Culture-related beliefs and social motivational processes in addition to those specified by PMT need to be addressed.