Comparison of two different techniques of mobilization in mechanical neck pain with decrease temporomandibular joint mobility

Pain in the anatomic region of neck is known as mechanical neck pain which is primarily caused by overuse of a normal anatomical structure, secondary to injury and deformity of anatomical structure. Also, mechanical neck pain can be defined as generalized neck pain provoked by sustained neck postures, neck movement, and pain on palpation of cervical musculature without pathologies. Restrictions of the neck movement occur and forced movement on the neck may worsen the pain. Mechanical neck pain is also known as nonspecific neck pain. It is a common complaint which affects 45-54% of the general population. The incidence of neck pain is higher in women (15%) than men (9%). High prevalence of neck pain was reported in desk job workers. 1-year prevalence of neck pain and work-related neck pain was reported as 43.3% and 28.3%. To compare the effect of Maitland and Mulligan mobilization with myofascial release on mechanical neck pain with decreased temporomandibular joint mobility. Total 45 subjects were selected and divided into three groups by random sampling method. This study concludes that Maitland mobilization and Mulligan mobilization are effective in mechanical neck pain with TMJ disability.

Management of Anterocapitis and Anterocollis: A Novel Ultrasound Guided Approach Combined with Electromyography for Botulinum Toxin Injection of Longus Colli and Longus Capitis

Chemodenervation of cervical musculature using botulinum neurotoxin (BoNT) is established as the gold standard or treatment of choice for management of Cervical Dystonia (CD). The success of BoNT procedures is measured by improved symptomology while minimizing side effects and is dependent upon many factors including: clinical pattern recognition, identifying contributory muscles, BoNT dosage, and locating and safely injecting target muscles. In patients with CD, treatment of anterocollis (forward flexion of the neck) and anterocaput (anterocapitis) (forward flexion of the head) are inarguably challenging. The longus Colli (LoCol) and longus capitis (LoCap) muscles, two deep cervical spine and head flexor muscles, frequently contribute to these patterns. Localizing and safely injecting these muscles is particularly challenging owing to their deep location and the complex regional anatomy which includes critical neurovascular and other structures. Ultrasound (US) guidance provides direct visualization of the LoCol, LoCap, other cervical muscles and adjacent structures reducing the risks and side effects while improving the clinical outcome of BoNT for these conditions. The addition of electromyography (EMG) provides confirmation of muscle activity within the target muscle. Within this manuscript, we present a technical description of a novel US guided approach (combined with EMG) for BoNT injection into the LoCol and LoCap muscles for the management of anterocollis and anterocaput in patients with CD.

Surface electromyography in orofacial and cervical musculature in mouth breathing children: an integrative literature review

ABSTRACT Purpose: to review, in an integrative manner, studies using surface electromyography in the orofacial and cervical musculature in mouth breathing children aged from three to 11 years and 11 months old. Methods: the survey was conducted in national and international databases, from 1998 to 2018, in Portuguese, English and Spanish. Review articles, dissertations, book chapters, case studies and editorials were excluded. Results: 86 articles were found, 14 of which met the inclusion criteria. Most of these studies used surface electromyography to assess and describe the muscle condition of the mouth breathing population. Only one study addressed the influence of myofunctional speech therapy and two studies included physical therapy treatment, using electromyographic evaluation before and after the intervention. Given the main categories of analysis, the discussion was based on the year, state of publication and journal, sample size, scientific methodology, muscles assessed, assessment protocols used and the results of the publications. Conclusions: surface electromyography has been used mainly in the initial assessment of orofacial and postural myofunctional changes caused by mouth breathing and not as a therapeutic biofeedback, thus, it is important to conduct longitudinal studies using this instrument in mouth breathers.

Myofascial Pain: Diagnosis and Behavior in Patients with Orofacial Pain and TMD

The high prevalence, significant demand for treatment of patients with Chronic Pain, and the general difficulty of establishing an accurate diagnosis, together with psychosocial and behavioral conditions, lead many therapeutic approaches to failure or unexpected outcomes. The objective of the present report was to show the evolution of a clinical case of long-term and highintensity Myofascial Pain, in which the patient had been undergoing treatment with Tricyclic Antidepressants (Nortriptyline Hydrochloride) for two years, using minimally invasive conduct. In order to reach the Diagnostic Hypothesis of Myalgia, the DC/TMD (Diagnosis Criteria for Temporomandibular Disorders) protocol was employed, in which the subdivision of this form of TMD was attained. We found substantial myofascial impairment of chewing and cervical muscles, with referred pain and secondary cephalea. The temporomandibular joints (TMJ) did not exhibit any clinical changes in movement, noise or arthralgia. After locating the myofascial trigger points (TrPs), Dry Needling was incorporated, with manipulation of the oral and cervical musculature (with and without resistance), in addition to electrotherapy with TENS (Transcutaneous Electrical Nerve Stimulation) coupled with heat application. The patient was instructed to perform cervical and masseter stretching exercises twice daily and to carry out sleep and medication prophylaxis. The result was rewarding. After seven visits in six months, with an interval from the sixth to the seventh visit of sixty days (follow-up), the patient was discharged and scheduled to return after a six-month period. Pain episodes continue to occur occasionally, but with low intensity, score 3 on the visual analog scale (VAS), and short duration. The course of treatment was well administered by the patient, without the use of antidepressants and cephalea and myofascial pain, and without the use of interocclusal devices, as shown in this report.

The biomechanics of foraging determines face length among kangaroos and their relatives

Increasing body size is accompanied by facial elongation across a number of mammalian taxa. This trend forms the basis of a proposed evolutionary rule, cranial evolutionary allometry (CREA). However, facial length has also been widely associated with the varying mechanical resistance of foods. Here, we combine geometric morphometrics and computational biomechanical analyses to determine whether evolutionary allometry or feeding ecology have been dominant influences on facial elongation across 16 species of kangaroos and relatives (Macropodiformes). We found no support for an allometric trend. Nor was craniofacial morphology strictly defined by dietary categories, but rather associated with a combination of the mechanical properties of vegetation types and cropping behaviours used to access them. Among species examined here, shorter muzzles coincided with known diets of tough, resistant plant tissues, accessed via active slicing by the anterior dentition. This morphology consistently resulted in increased mechanical efficiency and decreased bone deformation during incisor biting. Longer muzzles, by contrast, aligned with softer foods or feeding behaviours invoking cervical musculature that circumvent the need for hard biting. These findings point to a potential for craniofacial morphology to predict feeding ecology in macropodiforms, which may be useful for species management planning and for inferring palaeoecology.

The Effectiveness of Cervical Strengthening in Decreasing Neck-Injury Risk in Wrestling

Clinical Scenario:In wrestling, athletes often support a large amount of weight on their heads or are forced into extreme ranges of motion. These suboptimal movement conditions lead to a high prevalence of neck injuries in wrestlers. A large portion of the work done by the cervical musculature in wrestling is theorized to be eccentric or isometric types of contractions. Strengthening of these cervical muscles is clinically considered to play a vital role in being competitive on the wrestling mat. The cervical stability provided by strengthening these muscles may also play a part in injury prevention among wrestlers.Focused Clinical Question:Does increased cervical strength lead to a decreased risk of injury in wrestling?Summary of Search, “Best Evidence” Appraised, and Key Findings:The literature was searched for studies of level 4 evidence or higher using the Oxford Centre for Evidence-Based Medicine level of evidence system that investigated the relationship between cervical strength and injury risk in wrestling. No studies were found comparing cervical strength to injury risk in wrestling, but 2 related studies were found and have been included in this critically appraised topic.Clinical Bottom Line:There is poor evidence to support a relationship between cervical strength and injury risk in wrestling.Strength of Recommendation:There is grade C evidence to indicate that increased cervical strength decreases the risk of injury in wrestling.

Evolution of the head-trunk interface in tetrapod vertebrates

Vertebrate neck musculature spans the transition zone between head and trunk. The extent to which the cucullaris muscle is a cranial muscle allied with the gill levators of anamniotes or is instead a trunk muscle is an ongoing debate. Novel computed tomography datasets reveal broad conservation of the cucullaris in gnathostomes, including coelacanth and caecilian, two sarcopterygians previously thought to lack it. In chicken, lateral plate mesoderm (LPM) adjacent to occipital somites is a recently identified embryonic source of cervical musculature. We fate-map this mesoderm in the axolotl (Ambystoma mexicanum), which retains external gills, and demonstrate its contribution to posterior gill-levator muscles and the cucullaris. Accordingly, LPM adjacent to the occipital somites should be regarded as posterior cranial mesoderm. The axial position of the head-trunk border in axolotl is congruent between LPM and somitic mesoderm, unlike in chicken and possibly other amniotes.