Pressure Pain Threshold Research Articles

In chronic ankle instability, sensitized pressure pain threshold is associated with impaired ankle proprioception, poor static balance and more negative self-report

In chronic ankle instability, sensitized pressure pain threshold is associated with impaired ankle proprioception, poor static balance and more negative self-report

Effect of Hamstring Active Release Technique in Cervicogenic Headache

Objectives: To investigate the effect of Hamstring active release technique on pain intensity level, headache intensity, pressure pain threshold, cervical flexion rotation range of motion and Hamstring flexibility in patients with cervicogenic headache. Methods: Fifty-six patients with cervicogenic headache participated in the study, aged 25-45 years. Patients were randomized into two groups of 28 individuals each. Group A was given conventional physiotherapy only in the form of ultrasonic therapy, stretching as well as strengthening exercises. Group B was given conventional physiotherapy and active release technique for Hamstring. Each group was treated three times a week for one month. Pain intensity level, headache intensity, pressure pain threshold of Sub-occipital and Hamstring muscles trigger points, cervical flexion rotation range of motion and Hamstring flexibility were measured by visual analogue scale, the Arabic version of 6-item headache impact test, digital pressure algometry, CROM device and straight leg raising test respectively, pre and post-treatment. Results: Within group comparison showed significant difference in pain intensity level, headache intensity, pressure pain threshold of Sub-occipital and Hamstring muscles, cervical flexion rotation range of motion and Hamstring flexibility. Between groups comparison showed no significant difference in all variables, pre-study. Where a significant difference in all variables, post study, in favor of group B except right and left cervical flexion rotation range of motion. Conclusion: Hamstring active release technique improves pain intensity level, headache intensity, pressure pain threshold and Hamstring flexibility, in patients with cervicogenic headache.

Immersive visualization of movement in patients with hemophilic ankle arthropathy. Multicenter, single-blind, randomized clinical trial.

To evaluate the efficacy of immersive movement observation in adult patients with haemophilic ankle arthropathy. Multicentre, single-blind, randomized clinical trial. 48 patients with haemophilia. Patients were randomly allocated to 2 groups (180º immersive video-based visualization of movement and a control group with no intervention). Twenty-eight consecutive 15-min home sessions, 1 per day, of immersive visualization of ankle flexion-extension movement were carried out. Three evaluations were performed: pretreatment (T0), post-intervention (T1), and at 16 weeks' follow-up (T2). The primary variable was joint-pain intensity (visual analogue scale). The secondary variables were conditioned pain modulation (Conditioned Pain Modulation Index), pressure pain threshold (pressure algometer), range of motion (goniometry) and kinesiophobia (Tampa Scale of Kinesiophophia). There were intergroup differences in pain intensity (F = 37.14; p < 0.001), conditioned pain modulation (F = 5.40; p = 0.006), and dorsal (F = 19.17; p < 0.001) and plantar (F = 9.27; p<0.001) ankle flexion. More than 50% of experimental group patients exhibited changes exceeding the minimum detectable change in pain intensity (MDC = 0.43), and the pressure pain threshold in the extensor carpi radialis longus muscle (MDC = 1.34) and malleolus (MDC = 4.93). 180º immersive video-based visualization of movement can improve the intensity of pain, conditioned pain modulation, and ankle range of motion in patients with haemophilic ankle arthropathy.

Pressure Pain Hyperalgesia Expressed by Topographical Pressure Pain Sensitivity after Cardiac Surgery.

We aim to evaluate changes in pressure pain sensitivity before and after cardiac surgery using topographical sensitivity maps utilizing a pressure algometer. Pressure pain thresholds over 17 thoracic points and 4 distant pain-free points were assessed in 70 patients (women: 29, age: 67.5 years), before and at 1, 3, and 7 postoperative days. Thoracic topographical pressure pain sensitivity maps were calculated at all follow-ups. Postoperative pain was recorded at each follow-up on a numerical pain rate scale. Postoperative pain intensity decreased from 6.4 (SD 1.0) on the first postoperative day to 5.5 (SD 1.9) on the third and to 4.5 (SD 1.7) on the seventh day (p < 0.001). The mixed-model ANOVA revealed that the lowest pressure pain thresholds were observed one day after surgery, increased slightly during follow-up, and were lower at the xiphoid process. Significant negative correlations between postoperative pain intensity and pressure pain thresholds were observed at each time point in thoracic measures (all, p < 0.01), but not with pressure pain thresholds from distant pain-free areas. Postoperative pain after cardiac surgery can be objectively quantified using algometry. Pressure pain hyperalgesia was associated with the intensity of postoperative pain.

Immediate effects of thoracic mobilization versus soft tissue release on trunk motion, pain, and lumbar muscle activity in patients with chronic low back pain

IntroductionThoracic mobilization and tissue release are common manual techniques in clinical practice. However, the relative effects of these two treatments on chronic low back pain (CLBP) have not yet been explored. Thus, this study aimed to investigate and compare the immediate effects of thoracic mobilization with those of soft tissue release on trunk movement, pain sensation, and muscle activity in patients with CLBP. Methods28 participants were randomly assigned to two intervention groups. The mobilization group received mobilization treatment at the hypomobile joints of the trunk segment, while the soft tissue release group received thoracolumbar fascia release and massage in the lumbar region. The trunk range of motion (ROM), tissue hardness, pressure pain threshold (PPT), and erector spinae activity during light-weight lifting tasks were measured before and immediately after both interventions. FindingsAll measured outcomes in both groups improved after intervention (p < 0.05). The mobilization technique significantly improved side bending and rotation, PPT, and tissue hardness compared to soft tissue release. However, lumbar muscle activation reduced to a greater extent in the soft-tissue release group. ConclusionBoth techniques improved trunk ROM and PPT and reduced tissue hardness and muscle activation. Therefore, both these techniques are recommended for patients with CLBP. Trial registrationISRCTN75190733.

Effects of lower back foam rolling on the pressure pain threshold and the range of motion of the lumbar spine in healthy individuals.

The aim of this study was to determine the short- and long-term effects of foam rolling (FR) on the pressure pain threshold and the range of motion of the lumbar spine in healthy subjects. 43 healthy subjects without back problems were randomly assigned to an experimental group (EG) or a control group (CG). The subjects in the EG underwent a 4-week FR program (12 sessions). The subjects in the CG received no intervention. Range of motion was measured using the modified-modified Schober test for flexion and fingertip-to-floor distance for lateral flexion. The pressure pain threshold was measured with a hand-held pressure algometer. The measurements were taken before and after the first FR, after the 4-week program and at the 1-, 3- and 6-month follow-up. The significance level was set at p ≤ 0.05 and the desired power of the test was 92%. We found an improvement in flexion (p = 0.03) and lateral flexion (p < 0.001) in the EG after the first FR and recorded a significant improvement in all measured variables (flexion, lateral flexion and algometry: p < 0.001) at the end of the entire 4-week program. The effects were noticeable up to 6 months after the end of the program (p ≤ 0.03) and were statistically significantly better than in the CG (p ≤ 0.04). The calculated Cohen's d value was 1.15 for flexion, 1.06 for lateral flexion and 0.98 for algometry, which represents a large effect size. FR improves the pressure pain threshold and mobility of the lumbar spine in healthy subjects. The effects are noticeable at least 6 months after the end of an FR program.

Somatosensory profile in individuals with duchenne muscular dystrophy: A quantitative sensory testing (QST) study

ObjectiveThis study aimed to quantify somatosensory profiles in individuals with Duchenne muscular dystrophy (DMD). MethodsWe included 28 participants with genetically confirmed DMD (aged 8–17 years), 14 with chronic pain (DMD-CP), and 14 without pain (DMD-NP), compared to 13 healthy controls (HC) matched for age and sex. Three quantitative sensory testing (QST) modalities were examined: pressure pain threshold (PPT), temporal summation of pain (TSP) and conditioned pain modulation (CPM). Characteristics related to chronic pain, fatigue, psychological distress, and health-related quality of life were assessed using questionnaires. ResultsDecreased PPTs were found in both DMD cohorts across body areas commonly affected by pain (rectus femoris, medial gastrocnemius, paraspinal muscles, upper trapezius), as well as in a less frequently affected remote area (thenar eminence), compared to HCs (p < 0.001). The DMD-CP group exhibited greater TSP compared to HCs (p = 0.025). There were no differences in CPM effects between DMD groups and HCs. No differences were detected in all QST measures between DMD-CP and DMD-NP. SignificanceThis study is the first to explore the somatosensory profile in DMD. Preliminary evidence suggests that generalized hyperalgesia may be a common feature in DMD regardless of pain status. QST measures appear to not distinguish individuals with chronic pain from those without and thus are not recommended for assessing pain in DMD or guiding treatment.

Biological markers of brain network connectivity and pain sensitivity distinguish low coping from high coping Veterans with persistent post-traumatic headache.

Headache is the most common type of pain following mild traumatic brain injury. Roughly half of those with persistent post-traumatic headache (PPTH) also report neck pain which is associated with greater severity and functional impact of headache. This observational cohort study aimed to identify biological phenotypes to help inform mechanism-based approaches in the management of PPTH with and without concomitant neck pain. Thirty-three military Veterans (mean (SD) = 37±16 years, 29 males) with PPTH completed a clinical assessment, quantitative sensory testing, and magnetic resonance imaging of the brain and cervical spine. Multidimensional phenotyping was performed using a Random Forest analysis and Partitioning Around Medoids (PAM) clustering of input features from three biologic domains: 1) resting state functional connectivity (rsFC) of the periaqueductal gray (PAG), 2) quality and size of cervical muscles, and 3) mechanical pain sensitivity and central modulation of pain. Two subgroups were distinguished by biological features that included forehead pressure pain threshold and rsFC between the PAG and selected nodes within the default mode, salience, and sensorimotor networks. Compared to the High Pain Coping group, the Low Pain Coping group exhibited higher pain-related anxiety (p=0.009), higher pain catastrophizing (p=0.004), lower pain self-efficacy (p=0.010), and greater headache-related disability (p=0.012). Findings suggest that greater functional connectivity of pain modulation networks involving the PAG combined with impairments in craniofacial pain sensitivity, but not cervical muscle health, distinguish a clinically important subgroup of individuals with PPTH who are less able to cope with pain and more severely impacted by headache.

Pain Is Modulated Differently Between Females with and without Patellofemoral Pain: Factors Related to Sensitization.

Patellofemoral pain (PFP) has poor long-term recovery outcomes. Central sensitization describes central nervous system changes altering pain modulation, which can complicate recovery (poorer prognosis, worse function). Signs of central sensitization include amplified pain facilitation, pain hypersensitivity, and impaired pain inhibition, which can be measured with temporal summation of pain (TSP), pressure pain thresholds (PPTs) and conditioned pain modulation (CPM), respectively. Sex differences exist for these test responses, but female-only PFP investigations of sensitization are uncommon. Understanding pain modulation in females with PFP could improve treatment protocols. To determine whether females with PFP exhibit signs of central sensitization (greater TSP, lower PPTs, reduced CPM) compared to pain-free females. Cross-sectional Setting: Laboratory Patients or Other Participants: Thirty-three females [(20 PFP, 13 pain-free); Age: PFP 29.2 ± 7 years, pain-free 28 ± 7 years; Height: PFP 166.7 ± 5.9cm, pain-free 166 ± 9.5cm, Mass: PFP 66.7 ± 9.6kg, pain-free 69.3 ± 7.5kg). TSP was assessed with ten punctate stimuli applied to the knee and calculated by the difference in pain intensity between beginning and end responses. PPTs were tested at four sites [3 for local hypersensitivity (knee), 1 for widespread hypersensitivity (hand)]. CPM was conducted by comparing PPTs during two conditions (baseline, ice immersion). CPM response was defined as the percent difference between conditions. Between-group differences in TSP response were analyzed with a Welch's test. Separate Welch's tests analyzed group comparisons of PPTs and CPM responses at four sites. Females with PFP exhibited greater TSP response (P=0.019) and lower CPM response at patella center (P=0.010) and hand sites (P=0.007) than pain-free females. PPT group differences were not observed at any site (P>0.0125). Females with PFP modulate pain differently than pain-free females. Clinicians should recognize signs of central sensitization and their potential impact on treatment options.

Effect of a honey-sweetened beverage on muscle soreness and recovery of performance after exercise-induced muscle damage in strength-trained females.

This study explores a novel approach to mitigating delayed-onset muscle soreness (DOMS), a common issue among strength-trained females. By investigating the potential of a honey-sweetened beverage, which contains anti-inflammatory properties, we aim to enhance muscle recovery after exercise-induced muscle damage (EIMD). A randomized, cross-over, placebo-controlled, and double-blinded study was conducted with sixteen female strength athletes. Firstly, the baseline measurements were recorded, and participants were randomly divided into two conditions: honey-sweetened beverage (HSB; 70g of honey in 250mL water with a concentration of 28%) and placebo (PLA; 250mL of water with 70g of artificial sweetener). The HSB and PLA were consumed 90min before the EIMD started (200 vertical jumps with 10% body-weighted vests). Recovery monitoring of performance indicators and DOMS was performed after EIMD. The results of wall-sit, V-Sit and reach flexibility test (VSFT), vertical jump height (VJH), pressure pain threshold (PPT), and one repetition maximum (IRM) tests were recorded 48h after EIMD. Also, DOMS was recorded using the visual analog scale (VAS) before the start of the test and immediately, 12, 24, and 48h after EIMD. A one-week interval was considered a washout period for each condition. The collected data were analyzed by repeated measures of ANOVA and Bonferroni post hoc test and dependent t-test at P ≤ 0.05 level. Compared to PLA, HSB ingestion improves wall-sit performance (p = 0.003), 1RM (p = 0.019), and RPE (p = 0.003) after EIMD. However, no significant differences were observed between BL, PLA, and HSB in VJH (p = 0.384), VSFT (p = 0.840), and PPT (p = 0.151) after EIMD. Furthermore, HSB, compared to PLA, considerably decreased the values of DOMS immediately, 12, 24, and 48h after EIMD (p < 0.05). Our findings illustrated that ingesting HSB in strength-trained females can be a helpful strategy for improving recovery indicators such as muscle strength, endurance, and muscle soreness after EIMD.

Active versus passive foam rolling on range of motion, tissue property, and neural adaptation in healthy young adults: A randomised controlled trial

IntroductionSelf-massage using a foam roller (foam rolling) is effective for increasing range of motion (ROM). However, the independent effects of pressure stimulation and voluntary movement during foam rolling remain unclear. This study investigated the effects of pressure stimulation and voluntary movement during the foam rolling intervention on ROM and its related parameters from the aspects of tissue mechanical properties and the central nervous system. MethodsThis study set a randomised open-label controlled parallel group design involving active foam rolling with pressure stimulation and voluntary movement (A-FR), passive foam rolling with only pressure stimulation (P-FR), and sham rolling with only voluntary movement (SHAM) of the calf muscle. Twenty-seven healthy active adults (males: 16, females: 11) were analysed. Parameters of tissue mechanical properties (as measured by tissue stiffness and thickness) and systemic nervous adaptation (as measured by PPT, stretch tolerance, HRV, and mood states), as well as maximal ankle active/passive dorsiflexion ROM, were measured. ResultsA-FR significantly improved pressure pain threshold, stretch tolerance, and negative mood and increased active and passive ROM. P-FR significantly improved parasympathetic nervous activity and negative mood and increased passive ROM. However, SHAM did not affect any ROM or parameters of tissue mechanical properties and systemic neural adaptation except for some negative mood improvement. ConclusionVoluntary movement does not independently affect ROM, whereas pressure simulation independently enhances ROM during the foam rolling intervention. Combining pressure stimulation and voluntary movement can enhance the ROM effect and influence parameters of tissue mechanical properties and the central nervous system.

Effect of Transcutaneous Auricular Vagus Nerve Stimulation on Conditioned Pain Modulation in Trigeminal Neuralgia Patients.

Conditioned pain modulation (CPM) is a quantitative estimation of the capacity for endogenous pain modulation. Reduced CPM enables chronic painful event development or exacerbates pre-existing pain symptoms. Emerging reports indicate that patients with trigeminal neuralgia (TN) have dysregulated endogenous pain modulation. Transauricular vagus nerve stimulation (taVNS) is known to alleviate both acute and chronic pain symptoms. Its role in modulation or management of TN remains unknown. Here, we evaluated the taVNS efficacy in modulating CPM among TN patients. Conclusions from this investigation may facilitate establishment of novel non-invasive adjunctive approaches to treating TN patients. All research work was conducted at the First Affiliated Hospital of the University of Science and Technology of China (Anhui Provincial Hospital). In all, we recruited 62 study participants, 31 TN patients and 31 healthy volunteers, for a 2-day experimental test. At the beginning of the experiment (Day 1), all subjects received 30min of active taVNS. On Day 2, they received sham taVNS with the same duration and intensity. Meanwhile, technicians documented participant pressure pain thresholds (PPT) and CPM values at baseline, and at 15 and 30min post-active or sham taVNS. A 30-min active taVNS exposure substantially elevated the PPT and CPM effect (P<0.05) among TN patients, and we also observed a notable rise in the PPT and CPM effect (P<0.05) among healthy controls. Additionally, there were no serious adverse events from the administered treatment. Exposure to 30min of active taVNS strongly augmented the CPM effect and elevated the PPT among TN patients and healthy controls. These effects were not observed with sham stimulation. Despite the limitations inherent to survey studies, such as duration and compliance biases, we consider that taVNS is a promising, safe, and cost-effective therapy. In future investigations, we recommend assessment of long-term taVNS application and its effects on CPM and clinical pain. ChiCTR2300078673 ( www.Chictr.org.cn ).

Efficacy of mulligan technique on sub-acromial space in patients with shoulder impingement syndrome

IntroductionTo estimate the effectiveness of the Mulligan technique for the shoulder complex on the subacromial space, shoulder ROM, pressure pain threshold, and function of the shoulder in the impingement syndrome patient.MethodsThirty patients who suffered from shoulder impingement syndrome were at random allocated into two groups; the experimental group received shoulder complex mobilization with movement plus conventional therapy, and the control group received conventional treatment. All patients were examined by ultrasonography for subacromial space, shoulder range of motion using a digital goniometer, electronic algometry for pressure pain threshold, and the Quick DASH for a difficulty level involved in carrying out several physical activities.ResultsIn comparison to group B post-treatment, there were statistically significant improvements in the subacromial space (&lt;i&gt;p&lt;/i&gt; &gt; 0.004), flexion and abduction ROM, PPT of the biceps and supraspinatus (&lt;i&gt;p&lt;/i&gt; &gt; 0.001), and a significant reduction in the quick DASH (&lt;i&gt;p&lt;/i&gt; &gt; 0.001).ConclusionsShoulder complex mobilization with movement plus conventional therapy improved subacromial space, shoulder ROM, pressure pain thresholds, and function more than conventional therapy alone in shoulder impingement syndrome patients.

Can assessment of human assumed central sensitisation improve the predictive accuracy of the STarT Back screening tool in acute low back pain?

BackgroundThe STarT Back Screening Tool (SBT) is recommended to provide risk-stratified care in low back pain (LBP), yet its predictive value is moderate for disability and low for pain severity. Assessment of human assumed central sensitisation (HACS) in conjunction with the SBT may improve its predictive accuracy. ObjectivesTo examine whether assessment of HACS in acute LBP improves the predictive accuracy of the SBT for LBP recovery at six months in people with acute non-specific LBP. DesignA prospective longitudinal study. MethodData were drawn from the UPWaRD study. One hundred and twenty people with acute non-specific LBP were recruited from the community. Baseline measures included SBT risk status, nociceptive flexor withdrawal reflex, pressure and heat pain thresholds and conditioned pain modulation. Primary outcome was the presence of LBP (pain numeric rating scale ≥1 and Roland Morris Disability Questionnaire score ≥3) at six-month follow-up. Regression coefficients were penalised using the least absolute shrinkage and selection operator technique to select predictor variables. Internal validation was performed using ten-fold cross-validation. Results/findingsSBT risk status alone did not predict the presence of LBP at six months (area under receiver operating characteristic curve [AUC] = 0.58). Adding measures of HACS to the SBT did not improve discrimination for whether LBP was present at six months (AUC = 0.59). ConclusionsThis study confirmed the suboptimal predictive accuracy of the SBT, administered during acute LBP, for LBP recovery at six months. Assessment of HACS in acute LBP does not improve the predictive accuracy of the SBT.

Nociceptive Pain in Patients with Neuromuscular Disorders: A Cross-Sectional Clinical Study.

Muscle pain is a common symptom in patients with neuromuscular disorders (NMD) and accounts for severely reduced quality of life. OBJECTIVE: This clinical study aimed to observe possible differences in pain prevalence among distinct NMDs and to determine whether the patients' nociceptive pain is influenced by gender, muscle strength and psychological factors and to examine potential pain-associated alterations in muscle properties. The cross-sectional study on nociceptive pain in various NMDs involved patient-reported outcomes, muscle strength evaluations (dynamometry and quick motor function test (QMFT)), nociceptive pain evaluations (muscular pressure pain threshold (PPT)), and non-invasive measurement of muscle stiffness, frequency, decrement, relaxation, and creep (myotonometry). Involving 81 NMD patients and a control group, the study found high variability in pain prevalence among the subgroups. Patients with DM2 and FSHD had significantly higher levels of pain prevalence compared to other examined NMD subgroups and the control group. Female gender, high fatigue levels (representing factors such as depression, anxiety, stress, and impairment of quality of life), and low QMFT scores (representing reduced muscle strength) showed an association with increased sensitivity to pressure pain in the arm and leg region. As assessed by myotonometry, less pain is experienced in neck muscles with a high muscle tone, high stiffness, and a short relaxation time highlighting the importance of intrinsic muscular tone for their pressure pain sensitivity. Individualized therapeutic concepts including psychological and physical approaches in the pain management of patients with NMDs, especially in women, should be considered. Further research in this field is necessary to gain a more detailed insight into the perception of muscle pain.

Linking Intra-Articular Inflammatory Biomarkers with Peripheral and Central Sensitization in Late-Stage Knee Osteoarthritis Pain: A Pilot Study.

Background/Objectives: To investigate if intra-articular biomarkers relate to peripheral and central sensitization in patients with late-stage knee osteoarthritis (KOA). Methods: A total of 17 (6M, 11F) patients (aged 69 ± 10 years) were assessed for peripheral (pressure pain thresholds (PPT)) and central (temporal summation (TS) and conditioned pain modulation (CPM)) sensitization the day before total knee arthroplasty. Synovial fluid was collected during surgery and assayed for IL-6, IL-8, IL-10, TNF-α, CXCL-10, BDNF, NGF, CCL2, CCL5, VEGF, IL-1RI, MMP-1, MMP-7, IL-1β, and CXCL-9. Associations of biomarkers and their combinations reflecting chronic (CXCL-9) and acute ((CCL2×CXCL-10)/IL-10)) inflammation, cartilage degeneration (MMP-1×MMP-7), and neurotrophy (NGF×BDNF) with PPT, TS, and CPM were analyzed by bivariate correlations and by multiple linear regression analyses corrected for BMI, sex, and age. Results: The medial joint line and the superior medial joint region showed the lowest PPT. Higher acute inflammation related significantly to worse pressure tenderness at the superior medial joint region (R2 = 0.642; p = 0.010). Cartilage degeneration and chronic inflammation were associated with both absolute (R2 = 0.827; p = 0.001) and relative CPM (R2 = 0.882; p < 0.001). Acute inflammation and neurotrophy were related to relative TS at the m. tibialis anterior (R2 = 0.728; p = 0.02). Conclusions: This study demonstrates that increased levels of intra-articular biomarkers of acute inflammation are related to peripheral sensitization and that biomarkers of cartilage degeneration and chronic inflammation are associated with central sensitization. These results may be a stepping-stone toward a better understanding of the working mechanism of peripheral and central sensitization in KOA pain and the development of more targeted therapeutic interventions.

Analysis and relationship between the volume of upper limb lymphoedema and pressure pain threshold, neural range of motion, pain intensity, kinesiophobia, pain hypervigilance and catastrophizing in breast cancer survivors.

Lymphedema of the upper limbs and persistent pain are frequent sequelae after surgical treatment of breast cancer. The aim of this paper was to analyze the upper limb volume, pressure pain threshold, neural range of motion, pain intensity, kinesiophobia, pain hypervigilance and catastrophizing in patients with and without lymphoedema after breast cancer surgery. Secondly, we aimed to investigated the association between upper limb volume and these variables. Descriptive observational study. Faculty of Health Sciences of the University of Granada. Fifty-eight post-surgical breast cancer survivors, 29 with upper limb lymphoedema and 29 without lymphoedema. We measured upper limb volume (perimetric method). Also, pressure pain thresholds were assessed with a digital algometer, neural range of motion (neurodynamic test for radial, ulnar and median nerves), pain intensity (visual analogue scale), kinesiophobia, pain hypervigilance and catastrophizing (validated tests). To detect differences between the groups for the measurement variables we performed a t-test for independent samples analysis. A simple linear regression analysis adjusting for age and body mass index was performed to check the association among upper limb volume and pain variables in the group with lymphoedema. The analysis showed that lymphoedema group had lower pressure pain threshold bilaterally in the masseter (origin P≤0.036; insertion P≤0.046), temporalis (insertion P≤0.021), suboccipitalis (P≤0.036); second (P≤0.014), third (P≤0.001) and tenth rib (P≤0.001); affected side of the temporalis (origin P=0.025); temporomandibular joint (P=0.024); neural range of motion in the median nerve (P=0.047), ulnar (P=0.042) on the affected side and radial (P=0.039) on the unaffected side; and greater kinesiophobia (P=0.042). Linear regression analysis only showed a significant association between upper limb volume and neural range of motion in the radial nerve (P=0.020) in the lymphedema group. No significant associations were obtained for the rest of variables. These findings suggest that the presence of lymphoedema may contribute to an increased level of generalized mechanosensitivity and fear to movement in this population. Upper limb lymphedema can lead to heightened mechanosensitivity and movement-related fear in breast cancer survivors. Therefore, fast track rehabilitation approach should be focus in screening and rehabilitation methods for detection and control this sequalae.

Comparing The Effects of Compression Contrast Therapy and Dry Needling on Muscle Functionality, Pressure Pain Threshold, and Perfusion after Isometric Fatigue in Forearm Muscles of Combat Sports Athletes: A Single-Blind Randomized Controlled Trial.

The aim of this study was to compare the acute effects of compression contrast therapy (CT) and dry needling therapy (DN) on muscle tension (MT), muscle strength (Fmax), pressure pain threshold (PPT), and perfusion (PU) following fatigue of forearm muscles (e.g., flexor carpi radialis) in combat sports athletes. A single-blind randomized controlled trial was employed. Participants first underwent muscle fatigue induction, which involved sustaining an isometric handgrip at 60% of their maximum voluntary contraction in 5-second cycles. This was followed by exposure to one of the regenerative therapies. Forty-five participants were randomly assigned to one of three groups: CT/DN (n = 15), CT/ShDN (n = 15), and ShCT/DN (n = 15). The sham condition (Sh) involved a simulated version of the technique. Measurements were taken at four time points: (i) at rest; (ii) immediately after exercise that led to a state of fatigue; (iii) 5 minutes after therapy (PostTh5min); and (iv) 24 hours after therapy (PostTh24h). Each participant was exposed to one experimental condition and one control condition, thereby undergoing evaluation in two sessions. Significant differences between groups were found in MT during the PostTh5min (p = 0.005), as well as in PU during the PostTh5min (p < 0.001) and PU during the PostTh24h (p < 0.001). All groups showed significant improvements at 5 minutes post-therapy compared to immediately post-muscle fatigue. As conclusions, CT/DN seems to be significantly better for enhancing MT and PU after 5 minutes of muscle fatigue induction. Using either CT, DN, or both combined is recommended to enhance the recovery of muscle functionality and properties, favoring recovery and potentially speeding up performance enhancement.

Topical glyceryl trinitrate (GTN) and eccentric exercises in the treatment of mid-portion achilles tendinopathy (the NEAT trial): a randomised double-blind placebo-controlled trial

ObjectivesTo investigate if daily treatment with glyceryl trinitrate (GTN) ointment, over 24 weeks combined with a 12-week eccentric exercise programme is more effective for chronic mid-portion Achilles tendinopathy than placebo...

Effects of a Manual Treatment on Lumbar Microcirculation and Tissue Stiffness Following Submaximal Eccentric Trunk Extensor Exercise: A Randomized Controlled Trial.

Recent studies have shown that the extramuscular connective tissue (ECT) is thickened and stiffened in delayed onset muscle soreness (DOMS). However, contrarily to the normal population, severe DOMS is rare in athletes or highly trained individuals. The present randomized, controlled trial therefore aimed to investigate pain as well as microcirculation and stiffness of the ECT and the erector spinae muscle following submaximal eccentric trunk extension exercise not causing DOMS. The effect of manual treatment by a therapist (myofascial release; MFR) on these parameters was to be studied. Trained healthy participants (n = 21; 31.3 ± 9.6 years; > 4 h exercise per week) performed submaximal eccentric exercise of the trunk extensors. One group was manually treated (n = 11), while the other group (n = 10) received placebo treatment with sham laser therapy. Stiffness of the ECT and the erector spinae muscle (shear wave elastography), microcirculation (white light and laser Doppler spectroscopy), palpation pain (100 mm visual analogue scale, VAS) and pressure pain threshold (indentometry, PPT) were assessed before (t0), 24 h (t24) and 48 h (t48) after conditions. Erector spinae muscle stiffness increased after eccentric exercise from t0 to t24 (0.875 m/s) and from t0 to t48 (0.869 m/s). After MFR, erector spinae muscle stiffness decreased in contrast to placebo treatment at t24 (-0.66 m/s), while ECT stiffness remained unchanged. Oxygen saturation increased (17-20.93%) and relative haemoglobin decreased (-9.1 - -12.76 AU) after eccentric exercise and MFR differed from placebo treatment at t48 (-3.71 AU). PPT differed after MFR from placebo treatment at t48 (20.69 N/mm), while VAS remained unchanged. Multiple linear regression showed that ECT stiffness and group membership predicted erector spinae muscle stiffness. MFR could have a positive effect on pain, microcirculation and muscle stiffness after submaximal eccentric exercise, suggesting better recovery, which needs to be confirmed by future work.