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The objective of this investigation was to evaluate the activity of the suprahyoid musculature during swallowing and to correlate the findings with the degree of megaesophagus, oral and pharyngeal videofluoroscopy and esophageal manometry in patients with achalasia caused by Chagas' disease. Twenty-nine patients with positive serology for Trypanosoma cruzi and dysphagia (Chagas' disease group) and 29 individuals matched by sex and age (control group) participated in the study. Surface electromyography of the suprahyoid musculature and videofluoroscopy during swallowing of paste and liquid consistencies were performed. Canonical correlation analysis of the MANOVA test results showed that the Chagas' disease group had lower electromyographic activity when compared with controls. Overlapping circles of radiological findings were found for megaesophagus. The Spearman test showed a positive correlation between the electromyographic activity in the maximum voluntary isometric contraction and the time of pharyngeal transit for both liquid (p = 0.014) and paste (p = 0.047). The logistic regression test showed no association between electromyographic activity of the suprahyoid muscles and esophageal manometry results (p > 0.05). In conclusion, individuals with chagasic megaesophagus have reduced electromyographic activity of the suprahyoid muscles during swallowing, in addition to a greater recruitment of the suprahyoid musculature with increased pharyngeal transit time.

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PURPOSE: Neck pain is considered a common characteristic of migraine attacks. The relationship between neck pain and migraine can be explained by central sensitization of the trigeminocervical complex, where superior cervical afferents and the trigeminal nerve converge. However, few studies have evaluated motor control of cervical muscles in individuals with migraine. Thus, the purpose of the present study was to determine the extensor/flexor ratio of neck muscle strength and electromyographic activity during a test of maximal voluntary isometric contraction and craniocervical flexion in individuals with migraine and individuals without history of migraine or other headaches. METHODS: Fifty-two women with the disease and 52 women with neither a history of migraine nor neck pain, between 18 and 55 years old, were included in the study. The electromyographic activities of the sternocleidomastoid, anterior scalene, splenius capitis, and upper trapezius muscles were evaluated during a test of maximal voluntary isometric contraction and craniocervical flexion. RESULTS: The migraine group presented lower flexor muscle strength and a higher extensor/flexor muscle strength ratio than the control group. In addition, the migraine group showed a reduced electromyographic extensor/flexor muscle ratio during maximal voluntary isometric contraction in flexion. The results demonstrated worse performance in the craniocervical flexion test of the migraine group and a lower electromyographic ratio of extensor/flexor neck muscles in the last stage of the test. CONCLUSION: Altogether, the migraine group presented an imbalance in cervical muscles verified not only during force production, but also during muscle activity. These slides can be retrieved under Electronic Supplementary Material.

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OBJECTIVE: To investigate the association between the presence of self-reported neck pain in patients with migraine and clinical features, upper cervical mobility, and neck muscle performance. METHODS: A total of 142 patients with migraine were recruited and stratified by the presence (n = 99) or absence of self-reported neck pain (n = 43). The clinical examination included the Migraine Disability Assessment, the 12-item Allodynia Symptom Checklist, a flexion rotation test, and the Craniocervical Flexion Test. RESULTS: Migraine-related disability was reported by more than 80% in both groups (p = 0.82). However, there was a greater prevalence and severity of cutaneous allodynia observed in the group with neck pain (p < 0.001). Reduced upper cervical mobility was verified in 67% of the patients with neck pain and in 41% of those without neck pain (p = 0.005). In addition, 67% of the patients with neck pain and 40% without neck pain were not able to maintain the third stage of the Craniocervical Flexion Test without compensation (p = 0.003). CONCLUSIONS: The presence of self-reported neck pain in patients with migraine was associated with a poor clinical presentation regarding cutaneous allodynia, neck mobility, and muscle function. However, there were no differences in migraine-related disability.

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OBJECTIVE: The purpose of this study was to assess the correlations between neck muscle strength and pain features, such as neck-related disability, neck pain frequency and intensity, and headache frequency in women with headache. METHODS: Seventy women with migraine between 18 and 55 years of age diagnosed according to International Headache Society criteria were assessed. Participants provided clinical information regarding neck pain and headache. The Neck Disability Index was used to assess neck-related disability, and neck muscle strength was assessed via maximum voluntary contraction during flexion, extension, and lateral flexion with a handheld dynamometer. The correlation was verified with Spearman's correlation coefficient (ρ). Multiple linear regression was performed to verify whether the clinical variables could predict the strength of neck muscles. All calculations were performed adopting a level of significance of 0.05. RESULTS: Neck extensor strength was negatively correlated with all clinical variables (ρrange = -.24 to -.32, p < .05); lateral flexor strength was negatively correlated with headache frequency, neck pain intensity, and neck-related disability (ρrange = -.27 to -.39, p < .05); and flexor strength also correlated negatively with neck pain intensity and related disability (ρr = -.26 to -.29, p < .05). Headache frequency and neck pain intensity were identified as significant predictors of the strength variability in extension (R2 = 0.16, p < .05) and in lateral flexion (R2 = 0.18, p < .05). CONCLUSIONS: For the women with migraine in this study, correlations of headache and neck pain with neck muscle strength features were weakly to moderately negative. Headache frequency and neck pain intensity may influence a small proportion of the strength variability in extension and lateral flexion.

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BACKGROUND: Surface electromyography (EMG) has been used as a reliable tool for the evaluation of electrical muscle activity. OBJECTIVE: The purpose of this study was to evaluate the EMG indices of the masticatory muscles (masseter, anterior temporalis and suprahyoid) in women with temporomandibular disorder (TMD) and asymptomatic controls in the time domain, by the integrated EMG signal (IEMG) and in the frequency domain, using the median power frequency (MPF). METHODS: An observational, cross-sectional study was conducted involving 30 asymptomatic women as the control (mean age: 25.85 ± 2.57 years) and 74 women with myogenous TMD (mean age: 26.54 ± 2.45 years) diagnosed using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Three EMG readings were taken during maximum voluntary clenching (MVC) of the molars on parafilm for five seconds with a three-minute rest interval between readings. The mixed-model analysis of variance test followed by the Bonferroni correction or the Student-t test was used for the analyses, with the level of significance set to 5% (p < 0.05). RESULTS: IEMG values were significantly higher in the masseter muscles than the anterior temporalis muscles in the control group (p < 0.01). IEMG values were significantly higher in the masseter muscles of the control group than the group with myogenous TMD (p < 0.05). MPF values of the suprahyoid muscles were significantly higher in the myogenous TMD group than the control group. CONCLUSIONS: These significant findings show that women with myogenous TMD have reduction of electrical activity of their masseter muscles and increased firing rate of the motor units of the suprahyoid muscles. These findings may help the treatment of myogenous TMD in women.

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OBJECTIVE: The objective of this retrospective study was to evaluate the impact of myofascial trigger points (MTrPs) in patients with articular disc displacement with reduction (DDWR) and to identify which clinical variables are associated with the concomitant presence of DDWR and MTrPs. MATERIAL AND METHODS: 130 patients were selected that sought treatment due to joint pain, with ages ≥18 years, of both genders, with DDWR confirmed by magnetic resonance imaging. The sample was divided into two groups: Group 1, patients with DDWR and MTrPs (N=101); and Group 2, patients with DDWR and no MTrPs (N=29). Information on gender, age, pain duration, pain scores, and maximal interincisal distance (MID) were collected. The logistic regression model was used and the odds ratios (OR) was calculated (p<0.05). RESULTS: Group 1 presented statistically significant higher mean pain scores (p=0.007), and smaller MID (p=0.0268) than Group 2. OR were significant for the pain scores (1.429), MID (0.937) and gender (women) (2.810). CONCLUSIONS: Patients with DDWR and MTrPs had increased pain scores and a MID decrease compared to patients with DDWR and no MTrPs. The variables pain scores, MID, and gender (women) showed a significant association with the concomitant presence of DDWR and MTrPs.

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INTRODUCTION: Neck pain is the leading cause of years lived with disability worldwide and it accounts for high economic and societal burden. Altered activation of the neck muscles is a common musculoskeletal impairment presented by patients with neck pain. The craniocervical flexion test with pressure biofeedback unit has been widely used in clinical practice to assess function of deep neck flexor muscles. This systematic review will assess the measurement properties of the craniocervical flexion test for assessing deep cervical flexor muscles. METHODS AND ANALYSIS: This is a protocol for a systematic review that will follow the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. MEDLINE (via PubMed), EMBASE, PEDro, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus and Science Direct will be systematically searched from inception. Studies of any design that have investigated and reported at least one measurement property of the craniocervical flexion test for assessing the deep cervical flexor muscles will be included. All measurement properties will be considered as outcomes. Two reviewers will independently rate the risk of bias of individual studies using the updated COnsensus-based Standards for the selection of health Measurement Instruments risk of bias checklist. A structured narrative synthesis will be used for data analysis. Quantitative findings for each measurement property will be summarised. The overall rating for a measurement property will be classified as 'positive', 'indeterminate' or 'negative'. The overall rating will be accompanied with a level of evidence. ETHICS AND DISSEMINATION: Ethical approval and patient consent are not required since this is a systematic review based on published studies. Findings will be submitted to a peer-reviewed journal for publication. PROSPERO REGISTRATION NUMBER: CRD42017062175.

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OBJECTIVE: The purpose of this study was to investigate the correlation between head and neck posture and superficial neck flexor and extensor activity during performance of the craniocervical flexion test (CCFT) in women with migraine and healthy controls. METHODS: Fifty-two women with episodic migraine, 16 with chronic migraine, and 23 healthy controls participated. Head and neck posture were determined by assessing the craniovertebral (CV) angle and cervical lordosis angle. Surface electromyography signals were recorded bilaterally from sternocleidomastoid, anterior scalene, splenius capitis, and upper trapezius muscles as participants performed the CCFT. Differences in electromyogram activity and posture among groups were compared with analyses of variance. Correlations between posture and electromyogram activity were analyzed with the Pearson correlation coefficient. RESULTS: Both migraine groups had a significant increase in splenius capitis muscle activity, when acting as an antagonist, at the last stage of CCFT (F = 4.687; P = .012) compared with controls. No differences among groups were observed for head and neck posture. No significant correlation was found in the episodic migraine group. Moderate correlations between the CV angle and upper trapezius activity at the majority stages of the CCFT (-0.61 < r < -0.65, all P < .05) were observed within the chronic migraine group: the more extended the head posture, the higher the activity of the upper trapezius muscle. The CV angle also was correlated with upper trapezius muscle activity at the first stage of the CCFT and with splenius capitis muscle activity at the last stages (-0.42 < r < -0.52; P < .05). CONCLUSION: An extended (forward) head posture was moderately correlated with an increased in electrical activity of superficial neck extensor muscles, particularly the upper trapezius, when acting as an antagonist, during the performance of the CCFT in women with chronic but not episodic migraine.

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Abstract Objective The objective of this retrospective study was to evaluate the impact of myofascial trigger points (MTrPs) in patients with articular disc displacement with reduction (DDWR) and to identify which clinical variables are associated with the concomitant presence of DDWR and MTrPs. Material and Methods 130 patients were selected that sought treatment due to joint pain, with ages ≥18 years, of both genders, with DDWR confirmed by magnetic resonance imaging. The sample was divided into two groups: Group 1, patients with DDWR and MTrPs (N=101); and Group 2, patients with DDWR and no MTrPs (N=29). Information on gender, age, pain duration, pain scores, and maximal interincisal distance (MID) were collected. The logistic regression model was used and the odds ratios (OR) was calculated (p<0.05). Results Group 1 presented statistically significant higher mean pain scores (p=0.007), and smaller MID (p=0.0268) than Group 2. OR were significant for the pain scores (1.429), MID (0.937) and gender (women) (2.810). Conclusions Patients with DDWR and MTrPs had increased pain scores and a MID decrease compared to patients with DDWR and no MTrPs. The variables pain scores, MID, and gender (women) showed a significant association with the concomitant presence of DDWR and MTrPs.

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