Self-Myofascial Vibro-Shearing: a Randomized Controlled Trial of Biomechanical and Related Changes in Male Breakdancers

Background

This randomized controlled trial explored the practicality and effectiveness of a novel tool-assisted self-help device, one that combines vibrational oscillation, leverage, and the shearing effect from the edges, for promoting meaningful changes in key biomechanical tissue indices and related parameters.

Methods

One hundred and thirteen male breakdancers were randomized to an intervention or control group. Individuals assigned to the intervention group performed the self-help treatment on the quadriceps and the iliotibial band of their right thighs for 8 min, while individuals assigned to the control condition merely sat quietly during this period. Various primary outcome measures (e.g., elasticity, stiffness, range of motion, pain pressure threshold sensitization, and blood flow) were assessed before and after the intervention for each participant, with position and posture being standardized throughout. Subjective sensations and a measure selected to assess for potential experimental demand effects, serving as secondary measures, were also administered pre- to post-treatment.

Results

Stiffness was significantly reduced for both structures (p < 0.001), elasticity and flexibility of the quadriceps were increased significantly (p < 0.001 for each), sensitization was significantly lessened (p < 0.001), and local temperatures increased to a significant degree as well (p < 0.001) when comparing change scores following application of the self-help tool on the treated thighs to those on the untreated thighs. Participants using the self-help tool reported their treated leg as being more relaxed, light, and stable.

Conclusions

The vibro-shearing manipulation with a muscle-fascia tool resulted in significant improvements in various objective mechanical tissue properties, range of motion, and pain desensitization in healthy, well-conditioned dancers. These promising effects for a new tool-assisted self-treatment indicate further basic investigations are warranted, as are pilot investigations with patient populations.

Electronic supplementary material

The online version of this article (10.1186/s40798-018-0128-1) contains supplementary material, which is available to authorized users.

Mindfulness and pharmacological prophylaxis after withdrawal from medication overuse in patients with Chronic Migraine: an effectiveness trial with a one-year follow-up

BACKGROUND

Chronic Migraine (CM) is a disabling condition, worsened when associated with Medication Overuse (MO). Mindfulness is an emerging technique, effective in different pain conditions, but it has yet to be explored for CM-MO. We report the results of a study assessing a one-year course of patients' status, with the hypothesis that the effectiveness of a mindfulness-based approach would be similar to that of conventional prophylactic treatments.

METHODS

Patients with CM-MO (code 1.3 and 8.2 of the International Classification of Headache Disorders-3Beta) completed a withdrawal program in a day hospital setting. After withdrawal, patients were either treated with Prophylactic Medications (Med-Group), or participated in a Mindfulness-based Training (MT-Group). MT consisted of 6 weekly sessions of guided mindfulness, with patients invited to practice 7-10 min per day. Headache diaries, the headache impact test (HIT-6), the migraine disability assessment (MIDAS), state and trait anxiety (STAI Y1-Y2), and the Beck Depression Inventory (BDI) were administered before withdrawal and at each follow-up (3, 6, 12 after withdrawal) to patients from both groups. Outcome variables were analyzed in separate two-way mixed ANOVAs (Group: Mindfulness vs. Pharmacology x Time: Baseline, 3-, 6-, vs. 12-month follow-up).

RESULTS

A total of 44 patients participated in the study, with the average age being 44.5, average headache frequency/month was 20.5, and average monthly medication intake was 18.4 pills. Data revealed a similar improvement over time in both groups for Headache Frequency (approximately 6-8 days reduction), use of Medication (approximately 7 intakes reduction), MIDAS, HIT-6 (but only for the MED-Group), and BDI; no changes on state and trait anxiety were found. Both groups revealed significant and equivalent improvement with respect to what has become a classical endpoint in this area of research, i.e. 50% or more reduction of headaches compared to baseline, and the majority of patients in each condition no longer satisfied current criteria for CM.

CONCLUSIONS

Taken as a whole, our results suggest that the longitudinal course of patients in the MT-Group, that were not prescribed medical prophylaxis, was substantially similar to that of patients who were administered medical prophylaxis.

Central Mechanisms of Controlled-Release Metoprolol in Migraine: A Double-Blind, Placebo-Controlled Study

β-Blockers are widely used in the prophylaxis of migraine and have been described as very effective drugs in many studies. Some investigators have demonstrated that the clinical improvement of migraine corresponds to the normalization of the contingent negative variation (CNV), a slow cortical potential measuring cortical information processing. However, most of these studies have contained a variety of methodological pitfalls, which we attempted to address in the current study. Twenty patients suffering from migraine without aura were randomly divided into two groups. The groups were treated either with controlled-release metoprolol or placebo for 3 months, using a double-blind design. Twice before and once after each month of the treatment the CNV was recorded. After 3 months, a significant reduction of migraine frequency, duration and intensity was demonstrated for the metoprolol compared with the placebo group. The CNV was characterized by a marked reduction of the amplitude of the total CNV and postimperative negative variation and normalization of the eartly CNV habituation following treatment. Therefore, metoprolol may exert its prophylactic effect in migraine through the influence on cortical information processing and excitability represented by the CNV.

Mindfulness and headache: A "new" old treatment, with new findings

Background Mindfulness refers to a host of procedures that have been practiced for centuries, but only recently have begun to be applied to varied pain conditions, with the most recent being headache. Methods We reviewed research that incorporated components of mindfulness for treating pain, with a more in depth focus on headache disorders. We also examined literature that has closely studied potential physiological processes in the brain that might mediate the effects of mindfulness. We report as well preliminary findings of our ongoing trial comparing mindfulness alone to pharmacological treatment alone for treating chronic migraine accompanied by medication overuse. Results Although research remains in its infancy, the initial findings support the utility of varied mindfulness approaches for enhancing usual care for headache management. Our preliminary findings suggest mindfulness by itself may produce effects comparable to that of medication alone for patients with chronic migraine and medication overuse. Conclusions Much work remains to more fully document the role and long term value of mindfulness for specific headache types. Areas in need of further investigation are discussed.

Myofascial triggerpoint release (MTR) for treating chronic shoulder pain: A novel approach

BACKGROUND

This study comprehensively evaluated a myofascial triggerpoint release (MTR) technique for shoulder pain.

METHODS

Twenty-three (from an initial sample of 25) patients experiencing shoulder pain received MTR, in four 10-min sessions over a period of 2 weeks, applied exclusively on the more painful shoulder, with assessments being recorded both before and after treatment (and for pain at 1 and 13 months). Measures of stiffness and elasticity were collected to monitor the process of therapy, while subjective measures of pain and objective measures of pressure pain thresholds tracked primary outcomes. Secondary outcomes focused on suffering, stress, and quality of life.

RESULTS

A statistically significant decrease in stiffness and increase in elasticity was observed post intervention for the treated side only, while pressure pain thresholds improved on the untreated side as well. Reports of pain significantly decreased after treatment, with gains being maintained at 1 and 13 months following treatment. Levels of suffering, stress, and quality of life revealed statistically significant improvement as well.

CONCLUSIONS

MTR resulted in clinically significant improvements in the primary measures of pain, objective mechanical tissue properties, and secondary measures in patients with chronic shoulder pain.

Optimizing Staff Performance in an Institutional Behavior Change System

Program equipment changes (two levels), information feedback (three levels), and administrative policy changes (two levels) were serially introduced to reduce errors made by nonprofessional staff in a forensic psychiatry institution. Errors were reduced from an initial level of 62.2% to 6.2%. Due to the uncontrolled nature of the design, it was not possible to determine the independent contributions of the three variables. However, introduction of the program equipment changes resulted in the smallest error reductions. The introduction of information feedback produced the next largest error reductions. Errors were optimally reduced when the information feedback was presented to the line staff and first level supervisors but attenuated when presented to second level supervisors. The largest and most consistent error reductions occurred following the introduction of administrative policy changes.

Smoking and Smoking Increase in Caregivers of Alzheimer's Patients

PURPOSE OF THE STUDY

The relationship between stress and smoking has been established, but there is little research on the effects of stress and coping on smoking in caregivers of Alzheimer's disease patients. This study examines how caregiver stressors and coping resources explain smoking status and recent smoking increase.

DESIGN AND METHODS

Data were obtained from the Resources for Enhancing Alzheimer's Caregivers Health (REACH II) study. Analyses identified differences between caregiver smokers and nonsmokers and between caregiver smokers who reported a recent smoking increase and those who did not. Variables that were significantly different between the groups were examined in two logistic regression analyses to explain smoking status and smoking increase.

RESULTS

Of 642 caregivers, nearly 40% reported smoking and 25% of smokers reported recent increase in smoking. Younger caregivers were more likely to report smoking. Explanatory variables for smoking increase were being Caucasian or African-American, higher depression scores, and less caregiving skills.

IMPLICATIONS

This study demonstrates that smoking among caregivers is a valid public health concern. Further investigation of ways that explanatory variables affect smoking status and increase in caregivers, and incorporation of smoking cessation strategies that address depression and low caregiving skills, seem warranted in future caregiver interventions.

Using visual evoked potentials for the early detection of amnestic mild cognitive impairment: a pilot investigation

OBJECTIVE

Amnesic mild cognitive impairment (MCIa) is often characterized as an early stage of Alzheimer's dementia (AD). The latency of the P2, an electroencephalographic component of the flash visual evoked potential (FVEP), is significantly longer in those with AD or MCIa when compared with controls. The present investigation examined the diagnostic accuracy of several FVEP-P2 procedures in distinguishing people with MCIa and controls.

METHODS

The latency of the FVEP-P2 was measured in participants exposed to a single flash condition and five double flash conditions. The double flash conditions had different inter-stimulus intervals between the pair of strobe flashes.

RESULTS

Significant group differences were observed in the single flash and two of the double flash conditions. One of the double flash conditions (100 ms) displayed a higher predictive accuracy than the single flash condition, suggesting that this novel procedure may have more diagnostic potential. Participants with MCIa displayed similar P2 latencies across conditions, while controls exhibited a consistent pattern of P2 latency differences. These differences demonstrate that the double stimulation procedure resulted in a measurable refractory effect for controls but not for those with MCIa.

CONCLUSIONS

The pattern of P2 group differences suggests that those with MCIa have compromised cholinergic functioning that results in impaired visual processing. Results from the present investigation lend support to the theory that holds MCIa as an intermediate stage between normal healthy aging and the neuropathology present in AD. Measuring the FVEP-P2 during several double stimulation conditions could provide diagnostically useful information about the health of the cholinergic system.

Behavioral treatment of migraine: current status and future directions

The empirical support for three behavioral treatments (relaxation, biofeedback and cognitive therapy) for managing migraine headaches in children and adults is reviewed. Meta-analyses and evidence-based reports show that these approaches are of considerable value, they appear to work equally well when applied individually, in groups or in limited contact formats. Meta-analyses comparing behavioral and prophylactic medication show equivalent results. However, outcomes are optimized when these treatments are combined. Researchers are currently seeking to identify factors predictive of response to behavioral approaches. Patients experiencing medication-overuse, refractory, cluster or post-traumatic forms of headache or comorbid conditions present special challenges that can require intensive, comprehensive and multidisciplinary approaches to treatment. Behavioral treatments have met with mixed success for menstrual migraine in the few studies that have been conducted. This review concludes by highlighting directions for future research efforts such as importing treatments to settings where headache patients most often seek care and developing algorithms for optimizing combinations of behavioral and pharmacological treatments to enhance effectiveness, reduce costs, minimize dosing requirements and improve adherence to needed medications. Other research efforts include developing treatments that target the underlying pathophysiology more directly, gaining a greater understanding of mediators and moderators of behavioral treatments, exploiting e-technology for assessment and treatment, and assessing outcome in multiple ways--such as quality of life.

Behavioral treatment of headaches: extending the reach

Behavioral treatments (predominantly biofeedback, relaxation, and cognitive-behavioral) have been utilized in headache management for many decades. Although effective, they have not been as widely implemented as desired, chiefly due to their time-intensive nature, special therapist qualifications, and patient costs. This paper focuses on ways to make these treatments more affordable and more readily accessible to patients. Various alternative delivery models have been explored. This paper reviews progress to date on three such approaches for treating recurrent headaches in adults--prudent limited office contact, Internet delivery, and mass media approaches. Clinical outcomes, advantages, and disadvantages of these approaches are reviewed in brief.

The reliability and validity of the Visual Analog Mood Scales in non-English-speaking pain patients

OBJECTIVES

This study assessed the validity and reliability of the Visual Analog Mood Scales (VAMS) when administered to a non-English-speaking, headache population.

METHODS

The VAMS and another frequently administered measure of mood, the Profile of Mood States (POMS), were administered to sixty patients at a headache clinic in Milan, Italy. The VAMS and POMS were both administered before and after a regularly scheduled appointment at the clinic. Multitrait-multimethod analyses were conducted to assess the validity of each subscale comprising the VAMS.

RESULTS

All subscales comprising the VAMS possessed high test-retest reliability, and the "confused,""sad,""angry,""energetic," and "tired" subscales of the VAMS were shown to be valid when administered to a non-English-speaking pain population. Further, compared to age-matched controls (from available normative data), pain patients reported being significantly more confused, sad, and tense on the VAMS and significantly more tired, confused, depressed, and tense on the POMS.

DISCUSSION

Given the evidence of strong reliability and validity, the VAMS may be useful as a clinical diagnostic tool when administered to non-English-speaking pain populations.

Neuropsychological deficits in scuba divers: an exploratory investigation

OBJECTIVE

To investigate whether divers with varying levels of experience and without a history of reported decompression sickness (DCS) show neuropsychometric alterations possibly as a result of so-called repetitive "silent" paradoxical gas embolisms.

METHODS

Using reaction time as a psychometric measure, 17 experienced military divers (ED, logging between 150 and 1,200 diving hours) and eight very experienced military divers (VED, logging between 2,800 and 9,800 diving hours) with no decompression sickness (DCS) in their medical histories were compared to 23 healthy controls without any diving history, matched as closely as possible with respect to age for the two diving groups. Motor reaction time, decision reaction time and error rates were measured during completion of both simple and complex reaction time tasks.

RESULTS

Compared to their control group, VED showed significantly higher motor reaction times on both tasks and significantly higher decision reaction times in the complex task. ED were not found to be different from their respective controls. No changes in performance quality in terms of increased errors were observed in any of the tasks for either diving group.

CONCLUSIONS

The findings support the proposed possibility that minimal cerebral lesions occur after diving even without DCS. Further studies with this highly selective population of very experienced divers using more elaborate neurocognitive and neuromotor tasks seem warranted.

Chronic migraine with medication overuse pre-post withdrawal of symptomatic medication: clinical results and FMRI correlations

BACKGROUND

Chronic migraine with symptomatic medication overuse (CMwMO) is a common and often debilitating clinical condition. Withdrawal of the offending drug(s) is considered the first step in management. Functional magnetic resonance imaging (fMRI) may be a useful technique for obtaining information on particular neuronal changes in the pain network involved in this condition.

OBJECTIVE

To identify specific fMRI patterns in patients suffering from CMwMO before and after withdrawal intervention.

METHODS

We collected fMRI data from a group of patients suffering from CMwMO, evaluating those patients prior to and 6 months following withdrawal. We applied stimuli at sites far removed from where the headaches were experienced. Moreover, pre-intervention fMRI data from the headache patients were compared with those obtained from headache-free and otherwise healthy controls.

RESULTS

Before withdrawal, the right supramarginal gyrus, the right inferior and superior parietal cortex were hypoactive. Activity recovered to almost normal 6 months after withdrawal of the offending medications.

CONCLUSIONS

The hypoactivation we detected in the lateral pain system indicate that there exists a modification of the pain network in CMwMO and that these changes are reversible with therapy.