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Syrmou V, Grammatikopoulou MG, Bogdanos DP, Mitsimponas KT. Temporomandibular joint disorders in seronegative spondyloarthritis: what a rheumatologist needs to know? Reumatologia 2023; 61:375-388. [PMID: 37970123 PMCID: PMC10634408 DOI: 10.5114/reum/173078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 10/02/2023] [Indexed: 11/17/2023] Open
Abstract
Temporomandibular joint (TMJ) can be affected in the context of spondyloarthritis (SpA) with detrimental impact on individuals' quality of life. Intra-articular inflammation, synovitis, enthesitis, disc displacement and cervical vertebrae malalignment are some of the pathophysiological phenomena involved. Temporomandibular joint disorders (TMD) incidence appears to be higher in patients with ankylosing spondylitis and psoriatic arthritis, especially when clinical evaluation includes not only imaging but relevant history, TMJ examination and diagnostic criteria for TMD. The Visual Analogue Scale (VAS) pain score and Health Assessment Questionnaire Disability Index (HAQ) quality of life score could be useful tools. Panoramic radiographs and ultrasound can be used for screening but in symptomatic patients magnetic resonance imaging (MRI) is preferable. Conservative management and early pharmacological treatment can prevent permanent joint impairment. For refractory cases, early referral to Legislation for Oral and Maxillofacial Surgery (OMFS) specialists is indicated. The aim of this narrative review is to address the involvement of TMJ in SpA and to encourage clinicians to incorporate TMJ assessment in their physical examination and basic screening.
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Affiliation(s)
- Vasiliki Syrmou
- Department of Rheumatology and Clinical Immunology, Medical School, Faculty of Health Sciences, University of Thessaly, Larissa, Greece
| | - Maria G. Grammatikopoulou
- Department of Rheumatology and Clinical Immunology, Medical School, Faculty of Health Sciences, University of Thessaly, Larissa, Greece
| | - Dimitrios P. Bogdanos
- Department of Rheumatology and Clinical Immunology, Medical School, Faculty of Health Sciences, University of Thessaly, Larissa, Greece
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Hypoalgesic and Motor Effects of Neural Mobilisation versus Soft-Tissue Interventions in Experimental Craniofacial Hyperalgesia: A Single-Blinded Randomised Controlled Trial. J Clin Med 2021; 10:jcm10194434. [PMID: 34640451 PMCID: PMC8509591 DOI: 10.3390/jcm10194434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/20/2021] [Accepted: 09/23/2021] [Indexed: 11/18/2022] Open
Abstract
Objective: The present trial aimed to compare the effects of the mobilisation of the nervous system (NS) to those of a soft-tissue intervention in subjects exposed to an experimentally induced hyperalgesia of the masticatory muscles. Methods: The study was a single-blinded randomised controlled trial. A total of 49 participants (mean ± SD age: 41 ± 11 years; 61% female) with latent myofascial trigger points (LMTrPs) in the craniofacial region were randomly assigned to one of three groups: neural mobilisation (NM), soft-tissues techniques and stretching (STT-S), and control group (CG). An initial assessment (baseline) was performed before the provocation chewing masticatory test. The pre-treatment measurements were registered 24 h later. Next, the randomised intervention was applied, and afterwards, post-treatment data were obtained. Outcome measures included pain-free maximum mouth opening (MMO), pressure pain thresholds (PPTs) in the trigeminal and cervical region, and trigeminal and cervical two-point discrimination (TPD). Results: ANOVA revealed significant differences for the time × group interaction for pain-free MMO and PPTs. The results showed an improvement in the MMO and the PPTs for NM and STT-S groups but not for the CG. There were no differences between the NM and STT-S groups. However, the effect sizes were large for the NM and medium for the STT-S. No differences were found for TDP between groups nor over time. Conclusions: The results show that with NM and STT-S techniques, we could influence motor and sensory variables in asymptomatic subjects with LMTrPs after a masticatory provocation test. Both techniques increased MMO and PPTs in the short term. These beneficial effects lead us to consider the importance of including these methods in clinical practice.
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Parravicini G, Ghiringhelli M. Osteopathic Cranial Manipulation for a Patient With Whiplash-Associated Disorder: A Case Report. J Chiropr Med 2021; 20:163-169. [DOI: 10.1016/j.jcm.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 11/12/2021] [Accepted: 12/03/2021] [Indexed: 10/18/2022] Open
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Electromyographic Patterns of Masticatory Muscles in Relation to Active Myofascial Trigger Points of the Upper Trapezius and Temporomandibular Disorders. Diagnostics (Basel) 2021; 11:diagnostics11040580. [PMID: 33805008 PMCID: PMC8063936 DOI: 10.3390/diagnostics11040580] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/08/2021] [Accepted: 03/20/2021] [Indexed: 01/04/2023] Open
Abstract
The presented study aimed to analyze and compare the electromyographic patterns of masticatory muscles in subjects with active myofascial trigger points (MTrPs) within upper trapezius, patients with temporomandibular disorders (TMDs) and healthy adults. Based on the diagnostic criteria of MTrPs according to Travell & Simons and the Research Diagnostic Criteria for Temporomandibular Disorders, 167 people were qualified for the study. Subjects were divided into 3 groups: with active MTrPs in the upper trapezius, with diagnosed temporomandibular disorders (TMDs) and healthy adults. Measurements of the bioelectric activity of the temporalis anterior (TA) and masseter muscle (MM) were carried out using the BioEMG III ™. Based on statistical analysis, significantly lower values of TA resting activity were observed among controls in comparison to MTrPs (1.49 μV vs. 2.81 μV, p = 0.00) and TMDs (1.49 μV vs. 2.97 μV, p = 0.01). The POC index values at rest differed significantly between MTrPs and TMDs (86.61% vs. 105%, p = 0.04). Controls presented different electromyographic patterns within AcI in comparison to both MTrPs (4.90 vs. −15.51, p = 0.00) and TMDs (4.90 vs. −16.49, p = 0.00). During clenching, the difference between MTrPs and TMDs was observed within MVC TA (91.82% vs. 116.98%, p = 0.02). TMDs showed differences within AcI in comparison to both MTrPs group (−42.52 vs. 20.42, p = 0.01) and controls (−42.52 vs. 3.07, p = 0.00). During maximum mouth opening, differences between MTrPs and TMDs were observed within the bioelectric activity of masseter muscle (16.45 μV vs. 10.73 μV, p = 0.01), AsI MM (0.67 vs. 11.12, p = 0.04) and AcI (13.04 vs. −3.89, p = 0.01). Both the presence of MTrPs in the upper trapezius and TMDs are related to changes in electromyographic patterns of masticatory muscles.
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Acute Effect of the Compression Technique on the Electromyographic Activity of the Masticatory Muscles and Mouth Opening in Subjects with Active Myofascial Trigger Points. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10217750] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Active myofascial trigger points (MTrPs) in masticatory muscles are associated with a reduced range of motion and muscle weakness within the stomatognathic system. However, it is hard to identify the most effective treatment technique for disorders associated with MTrPs. The objective of this study was to analyze the acute effect of the compression technique (CT) on active maximal mouth opening (MMO) and electromyographic activity of the masseter (MM) and temporalis anterior (TA) muscles in subjects with active myofascial trigger points in the MM muscles. The study group comprised 26 women (mean age 22 ± 2) with bilateral active myofascial trigger points (MTrPs) in the MM. The control group comprised 26 healthy women (mean age 22 ± 1) without the presence of MTrPs in the MM. Masticatory muscle activity was recorded in two conditions (during resting mandibular position and maximum voluntary clenching) before and after the application of the CT to the MTrPs in MM. After the CT application, a significant decrease in resting activity (3.09 μV vs. 2.37 μV, p = 0.006) and a significant increase in clenching activity (110.20 μV vs. 139.06 μV, p = 0.014) within the MM muscles were observed in the study group, which was not observed within TA muscles. Controls showed significantly higher active MMO values compared to the study group before CT (50.42 mm vs. 46.31 mm, p = 0.024). The differences between the study group after CT and controls, as well as among the study group before and after CT did not reach the assumed level of significance in terms of active MMO. The compression technique appears to be effective in the improvement of the active maximal mouth opening and gives significant acute effects on bioelectric masticatory muscle activity. Therefore, CT seems to be effective in MTrPs rehabilitation within the stomatognathic system.
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Dueñas L, Zamora T, Lluch E, Artacho-Ramírez MA, Mayoral O, Balasch S, Balasch-Bernat M. The effect of vibration therapy on neck myofascial trigger points: A randomized controlled pilot study. Clin Biomech (Bristol, Avon) 2020; 78:105071. [PMID: 32521284 DOI: 10.1016/j.clinbiomech.2020.105071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 05/26/2020] [Accepted: 06/01/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the effect of low-frequency self-administered vibration therapy into myofascial trigger points in the upper trapezius and levator scapulae on patients with chronic non-specific neck pain. METHODS Twenty-eight patients with chronic non-specific neck pain were randomly assigned into a vibration group, receiving 10 self-applied sessions of vibration therapy in the upper trapezius and levator scapulae trigger points; or a control group, receiving no intervention. Self-reported neck pain and disability (Neck Disability Index) and pressure pain threshold were assessed at baseline and after the first, fifth and 10th treatment sessions. FINDINGS Significant differences were found in the vibration group when compared to the control group after the treatment period: the vibration group reached lower Neck Disability Index scores (F = 4.74, P = .033, η2 = 0.07) and greater pressure pain threshold values (F = 7.56, P = .01, η2 = 0.10) than the control group. The vibration group reported a significant reduction in Neck Disability Index scores (χ2 = 19,35, P = .00, Kendall's W = 0.28) and an increase in pressure pain threshold (χ2 = 87,10, P = .00, Kendall's W = 0.73) between the assessment times over the course of the treatment. The mean increase in pressure pain threshold in the vibration group after the 10 sessions was 8.54 N/cm2, while the mean reduction in Neck Disability Index scores was 4.53 points. INTERPRETATION Vibration therapy may be an effective intervention for reducing self-reported neck pain and disability and pressure pain sensitivity in patients with chronic non-specific neck pain. This tool could be recommended for people with non-specific neck pain.
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Affiliation(s)
- L Dueñas
- Department of Physical Therapy, University of Valencia, Gascó Oliag 5, 46010, Valencia, Spain.
| | - T Zamora
- European Sleep Care Institute, San Vicente 16, 46023, Valencia, Spain.
| | - E Lluch
- Department of Physical Therapy, University of Valencia, Gascó Oliag 5, 46010, Valencia, Spain; "Pain in Motion" international research group, Belgium.
| | - M A Artacho-Ramírez
- Department of Engineering Projects, Universitat Politècnica de València, Camí de Vera s/n, 46022 València, Spain.
| | - O Mayoral
- Physical Therapy Unit, Hospital Provincial de Toledo, Toledo, Spain.
| | - S Balasch
- Departamento de Estadística e Investigación Operativa Aplicadas y Calidad, Universitat Politècnica de València, Camí de Vera s/n, 46022 València, Spain.
| | - M Balasch-Bernat
- Department of Physical Therapy, University of Valencia, Gascó Oliag 5, 46010, Valencia, Spain.
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Byatnal A, Ramesh DNSV, Nair D, Kempwade P, Thriveni R, Rukhsar I. Comparative evaluation of the effect of therapeutic ultrasound and transcutaneous electric nerve stimulation in temporalis and masseter myofascial pain. J Nat Sci Biol Med 2020. [DOI: 10.4103/jnsbm.jnsbm_125_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Spinal high-velocity low-amplitude manipulation with exercise in women with chronic temporomandibular disorders. MANUELLE MEDIZIN 2018. [DOI: 10.1007/s00337-018-0406-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Sedighi A, Nakhostin Ansari N, Naghdi S. Comparison of acute effects of superficial and deep dry needling into trigger points of suboccipital and upper trapezius muscles in patients with cervicogenic headache. J Bodyw Mov Ther 2017; 21:810-814. [PMID: 29037632 DOI: 10.1016/j.jbmt.2017.01.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 12/06/2016] [Accepted: 12/23/2016] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The purpose of this study was to compare the acute effects of superficial and deep dry needling into trigger points of suboccipital and upper trapezius muscles in patients with cervicogenic headache. METHODS Thirty participants (8 men, 22 women) aged 19-60 years (mean age ± SD, 39 ± 10 y) with a clinical diagnosis of cervicogenic headache were randomly divided into superficial and deep groups. Headache index, trigger points tenderness, cervical range of motion (CROM), functional rating index was assessed at baseline, immediate and 1 week after the treatment. RESULTS Two approaches of dry needling showed reduction in headache index and trigger points tenderness. Deep dry needling showed greater improvement of cervical range of motion (p < 0.001) and functional rating index (p < 0.01). CONCLUSION The application of dry needling into trigger points of suboccipital and upper trapezius muscles induces significant improvement of headache index, trigger points tenderness, functional rating index and range of motion in patients with cervicogenic headache. Deep dry needling had greater effects on CROM and function.
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Affiliation(s)
- Asefeh Sedighi
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
| | - Noureddin Nakhostin Ansari
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Soofia Naghdi
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
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Evaluation of 2-stage Treatment for Cervical Dorsal Rami Entrapment Syndrome: A Randomized, Controlled Trial. Neurologist 2017; 22:157-165. [PMID: 28859020 DOI: 10.1097/nrl.0000000000000148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate the effectiveness of a 2-stage nonoperative treatment for patients with cervical dorsal rami entrapment syndrome. MATERIALS AND METHODS The study included 66 patients diagnosed with cervical dorsal rami entrapment syndrome randomized to an experimental group (n=33) and control group (n=33). The experimental group was treated with additional diagnostic block if regular 2 weeks medication was not effective. The control group only received nonsteroidal anti-inflammatory drugs for 2 weeks. A visual analog scale (VAS) and pain treatment satisfaction scale (PTSS) were used to assess pain. Muscle power in the upper limbs was also assessed. The registration number of this study is ChiCTR-IIR-15007565. RESULTS The VAS scores of the experimental group were significantly lower at 2, 4, and 6 months after treatment compared with baseline and the VAS scores of the control group (all P<0.001). The PTSS scores of the experimental group were significantly higher at 2, 4, and 6 months after treatment compared with baseline and the PTSS scores of the control group (all P<0.001). Maximal muscle power after treatment was significantly greater in the experimental group compared with the control group for shoulder abduction (P<0.001), thumb pinch force (P=0.001), and grasp (P<0.001). CONCLUSIONS The results suggest that the 2-stage treatment is effective for patients with cervical dorsal rami entrapment syndrome.
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Grondin F, Hall T, von Piekartz H. Does altered mandibular position and dental occlusion influence upper cervical movement: A cross-sectional study in asymptomatic people. Musculoskelet Sci Pract 2017; 27:85-90. [PMID: 27847242 DOI: 10.1016/j.math.2016.06.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 05/25/2016] [Accepted: 06/07/2016] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Gross mandibular position and masticatory muscle activity have been shown to influence cervical muscles electromyographic activity. The purpose of this study was to investigate the influence of three different mandible positions including conscious occlusion, tongue tip against the anterior hard palate (Palate tongue position) and natural resting position (Rest), on sagittal plane cervical spine range of motion (ROM) as well as the flexion-rotation test (FRT) in asymptomatic subjects. MATERIALS AND METHODS An experienced single blinded examiner evaluated ROM using an Iphone in 22 subjects (7 females; mean age of 29.91years, SD 5.44). RESULTS Intra-rater reliability for range recorded was good for the FRT with ICC (intraclass correlation) 0.95 (95% CI: 0.88-0.98) and good for sagittal plane cervical ROM with ICC 0.90 (95% CI: 0.77-0.96). A repeated measures ANOVA determined that mean ROM recorded during the FRT differed significantly between assessment points (F(1.99, 41.83) = 19.88, P < 0.001). Bonferroni Post hoc tests revealed that both conscious Occlusion and Palate tongue position elicited a significant large reduction in ROM recorded during the FRT from baseline (p < 0.01). Despite this, one activation strategy did not influence ROM more than the other. An additional repeated measures ANOVA determined that mean sagittal cervical ROM did not significantly vary between assessment points (F(2, 42) = 8.18, P = 0.08). CONCLUSION This current study provided further evidence for the influence of the temporomandibular region on upper cervical ROM. Results suggest that clinicians should focus on the natural mandible rest position when evaluating upper cervical mobility.
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Affiliation(s)
- Francis Grondin
- Laboratory of Anatomy, Bordeaux University Hospital, Hôpital Pellegrin, Place Amélie-Raba-Léon, 33076, Bordeaux, France.
| | - Toby Hall
- School of Physiotherapy and Exercise Science, Curtin University, P.O. Box U1987, Perth, WA, 6845, Australia.
| | - Harry von Piekartz
- University of Applied Science, Department of Rehabilitation, Osnabrück, Germany.
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Pasinato F, Bordin J, Santos-Couto-Paz CC, Souza JA, Corrêa ECR. Cervical-scapular muscles strength and severity of temporomandibular disorder in women with mechanical neck pain. FISIOTERAPIA EM MOVIMENTO 2016. [DOI: 10.1590/0103-5150.029.002.ao05] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction: Changes in cervical muscle function have been observed in patients with neck pain (NP) and TMD. However, the relationship between TMD severity and neck muscle strength in the presence/absence of NP is unknown. Objective: To determine the prevalence of TMD in women with and without mechanical NP and assess the cervical-scapular muscle strength and its association with TMD severity. Methods: Fifteen volunteers without neck pain (CG) and 14 women with mechanical neck pain (NPG) took part and were selected by the Neck Disability Index. The diagnosis and severity of TMD were determined by the Research Diagnostic Criteria for TMD and Temporomandibular Index (TI), respectively. The strength of the upper trapezius muscle, and cervical flexor and extensor muscles was measured by digital hand dynamometer. Results: 64.5% of women with NP and 33.3% without NP were diagnosed with TMD (p = 0.095). The NPG showed lower strength of the cervical flexor (p = 0.044) and extensor (p=0.006) muscles, and higher TI (p = 0.038) than in the CG. It was also verified moderate negative correlation between TI and the strength of dominant (p = 0.046, r = -0.547) and non-dominant (p = 0.007, r = -0.695) upper trapezius, and cervical flexors (p = 0.023, r = -0.606) in the NPG. Conclusion: There was no difference in the prevalence of TMD in women with and without NP. However, women with NP have lower cervical muscle strength - compared to those without NP - which was associated with greater severity of TMD. Thus, in women with NP associated with TMD, it is advisable to assess and address the severity of this dysfunction and identify the cervical-scapular muscles compromise.
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Chiarotto A, Clijsen R, Fernandez-de-las-Penas C, Barbero M. Prevalence of Myofascial Trigger Points in Spinal Disorders: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil 2016; 97:316-37. [DOI: 10.1016/j.apmr.2015.09.021] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 09/22/2015] [Indexed: 10/22/2022]
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Stuhr SH, Earnshaw DH, Duncombe AM. Use of orthopedic manual physical therapy to manage chronic orofacial pain and tension-type headache in an adolescent. J Man Manip Ther 2014; 22:51-8. [PMID: 24976748 DOI: 10.1179/2042618613y.0000000054] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Temporomandibular dysfunction (TMD) is frequently associated with multiple headache types. While the efficacy of orthopedic manual physical therapy (OMPT) intervention for TMD with/without headache symptoms has been investigated, it has received less attention than other musculoskeletal conditions. This case describes the OMPT treatment and outcome of a 14 year-old female with a 2-year history of facial pain surrounding the right temporomandibular joint (TMJ), and bilateral occipital and temporal tension-type headaches (TTHs). Intervention included manual mobilization of the TMJ and surrounding cervical/facial soft tissue structures, postural re-education, and patient/family education on prevention, self-treatment, and postural adaptations. Outcomes included pain free and maximal mouth opening (MMO), pressure pain threshold (PPT) over the masseter muscle belly, fear avoidance beliefs questionnaire-physical activity subscale (FABQ-PA), jaw pain and function questionnaire (JPFQ), visual analog pain scale (VAS) for facial pain, and headache frequency, duration, and intensity on a VAS. Results included increased pain free and MMO by 22 mm, improved PPT bilaterally by 403.05 kPa on the affected, and 360.88 kPa on the unaffected side, and decreased reported headache frequency, duration, and intensity. Score decreases of 5 points on VAS with MMO, 8 points on FABQ-PA, and 5 points on JPFQ were also noted. Further research is warranted to investigate the effects of OMPT on pain processing and functional outcomes in patients with TMD and headache.
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Affiliation(s)
- Sarah H Stuhr
- University of Illinois Hospital and Health System, Chicago, IL, USA
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Effects of Deep Cervical Flexor Training on Pressure Pain Thresholds Over Myofascial Trigger Points in Patients With Chronic Neck Pain. J Manipulative Physiol Ther 2013; 36:604-11. [DOI: 10.1016/j.jmpt.2013.08.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 08/06/2013] [Accepted: 08/08/2013] [Indexed: 01/06/2023]
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Manual Treatment for Cervicogenic Headache and Active Trigger Point in the Sternocleidomastoid Muscle: A Pilot Randomized Clinical Trial. J Manipulative Physiol Ther 2013; 36:403-11. [DOI: 10.1016/j.jmpt.2013.05.022] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Revised: 02/12/2013] [Accepted: 02/19/2013] [Indexed: 11/23/2022]
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