Andoni Carrasco-Uribarren

Background and Purpose: To evaluate the effectiveness of percutaneous electrolysis (PNE), alone or combined with therapeutic exercise (TE), on pain intensity and function in patients with tendinopathy or myofascial pain syndrome. Methods: A systematic review with meta‐analysis was conducted following PRISMA guidelines and registered in PROSPERO (CRD420251238941). Searches were performed in PubMed, Web of Science, and PEDro from inception to November 2025, in accordance with the PRISMA guidelines. Randomized controlled trials comparing PNE with sham, control, or dry needling (DN) interventions were included. Pain intensity and function were analyzed using random‐effect meta‐analyses, and the certainty of evidence was assessed using GRADE. Results/Findings: Thirteen trials were included in the qualitative synthesis and twelve in the meta‐analysis. In tendinopathies, very low‐certainty evidence indicated that adding PNE to TE was not superior to sham plus TE or TE alone for pain or function at short‐, medium‐, or long‐term follow‐up. Low‐certainty evidence showed that PNE combined with TE resulted in greater short‐ and medium‐term pain reduction compared with DN plus TE without functional superiority. In myofascial pain syndrome, low to very low‐certainty evidence demonstrated no significant differences between PNE and DN for pain or function at any follow‐up. Implications for Physiotherapy Practice: Current evidence does not support the superiority of PNE over sham or control interventions when added to therapeutic exercise. PNE may provide short‐ to medium‐term pain benefits compared with DN in tendinopathy but not in myofascial pain syndrome. Further high‐quality trials are required to clarify its clinical role. Trail Registration: The protocol of this study was registered in PROSPERO (PROSPERO registration: CRD420251238941).

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Background: Patients with temporomandibular disorders (TMD) often exhibit widespread hypersensitivity and comorbidities, suggesting nociplastic pain (NP) involvement. Aerobic exercise (AE) and strength training (ST) enhance tissue oxygenation, pain inhibition, and quality of life. This study compares AE and ST, combined with physical therapy (PT), on NP and TMD clinical features. Methods: This randomized‐controlled trial with blinded assessors assigned 43 TMD and NP patients to PT ( n = 15), PT + AE ( n = 15), or PT + ST ( n = 13). A 6‐week intervention included 12 PT sessions (education, manual therapy, jaw/neck exercises), with PT + AE performing high‐intensity intervallic AE (stationary bike) and PT + ST upper/lower extremities exercises. Primary outcome: pressure pain thresholds (PPT) with algometer. Secondary outcomes: central sensitization (CS)‐related symptoms, muscle strength, pain intensity, anxiety, sleep quality, kinesiophobia. Outcomes were assessed post‐intervention (T1) and at 12‐week follow‐up (T2). Results: At T1, PT + AE demonstrated significant reductions than PT in CS (−9.5; p = 0.04), pain (−23.2; p = 0.04), kinesiophobia (−4.1; p = 0.04), sleep impairment (−3.8; p = 0.01). Pain reductions persisted at T2 (VAS −26.2; p = 0.04). PT + ST reduced kinesiophobia only at T2 (−3.8; p = 0.01). At T1, PT + AE improved proximal‐PPT against PT + ST (−0.52 kg/cm ² ; p = 0.03), while PT + ST enhanced trapezius strength (10.9 kg; p < 0.01). Conclusions: Adding AE or ST to PT improves outcomes in TMD patients and NP, with PT + AE reducing pain and CS‐related symptoms more effectively.

Background: Artificial intelligence (AI)-driven markerless motion capture (MMC) technologies are increasingly being integrated into pediatric healthcare to improve the assessment and management of movement disorders. These video-based systems enable non-invasive motion analysis without wearable sensors, facilitating more natural movement assessment in children, particularly those with neurological or developmental conditions. Objectives: We evaluated the clinical applicability of AI-based MMC tools in pediatric settings for diagnosis, monitoring of motor development, and rehabilitation. Methods: This systematic review was registered in PROSPERO (CRD42024511787) and conducted by two independent reviewers, with a third reviewer resolving disagreements. The literature published between 2018 and 2025 was systematically searched. Studies involving pediatric populations or clinically relevant pediatric applications of MMC were included. Results: Of 1521 identified studies, 52 were finally selected. The included studies evaluated populations across a wide age range. However, seven of the included articles were specifically focused on underage populations. Infant studies primarily analyzed whole-body movements, emphasizing the relevance of global motor patterns in early development. OpenPose and AlphaPose were the most frequently used frameworks in pediatric research because of their automatic full-body key point detection, whereas DeepLabCut was commonly selected for its customizable labeling capabilities. Theia3D emerged as a promising clinically applicable solution with high accuracy. Most studies evaluated kinematic parameters as objective markers of motor performance and development. However, methodological heterogeneity and limited pediatric-specific validation remain important limitations. Conclusions: AI-driven MMC technologies show considerable potential to support objective, accessible, and child-friendly movement assessment in pediatric clinical practice.

Forward head posture (FHP) is one of the most frequently reported postural deviations in contemporary populations. Therapeutic exercise has been associated with improvements in FHP, rounded shoulders, and thoracic kyphosis. However, it remains unclear whether exercise programs targeting the neck region differ in their effects from those that also include the thoracic spine compared with control conditions. A systematic review with meta-analysis was conducted following a comprehensive search of the Cochrane Library, PubMed, PEDro, and Web of Science databases from inception to 9 February 2026. Eligible studies were randomized controlled trials investigating therapeutic exercise interventions in patients with FHP. The intervention had to be based on therapeutic exercise. Studies were required to compare the intervention with a control group. Methodological quality was assessed using the PEDro scale, and the certainty of the evidence was evaluated according to the GRADE guidelines. Thirteen randomized controlled trials involving 819 participants were included in qualitative synthesis and meta-analysis. Both neck-focused exercise and combined neck - thoracic exercise programs showed statistically significant short-term improvements in craniovertebral angle and neck disability compared with control conditions. Combined neck - thoracic exercise programs demonstrated significant reductions in pain intensity post-intervention. The certainty of the evidence ranged from low to very low. Therapeutic exercise programs targeting the neck region, alone or combined with thoracic exercises, may improve craniovertebral angle and neck-related outcomes in individuals with FHP. However, the certainty of the evidence ranged from low to very low and the findings should be interpreted with caution. PROSPERO registration ID CRD420261304664.

Physical therapy programs are tasked with delivering an increasing volume of content to prepare graduates as healthcare professionals [1]. In order for students to be able to provide safe care for ...

The aim of the present study was to compare longus capitis and longus colli (LC/C) and sternocleidomastoid (SCM) activity during a craniocervical flexion (CCF) exercise task performed using the Spinertial device versus the pressure biofeedback unit (PBU). A prospective, observational, cross-sectional study was conducted with 40 volunteers. Participants were eligible if they were at least 18 years old, had no history of neck pain, and were able to correctly perform the CCF test up to the fourth or fifth stages (28-30 mmHg). Each participant performed a standardized CCF exercise task using both devices. The linear depth (thickness) of the LC/C was measured with ultrasound imaging, and the electrical activity of the SCM via surface electromyography. Range of motion and friction forces were standardized across conditions. Forty participants (20 women and 20 men) were included in the study, with a mean age of 24.9 ± 3.4 years. The increase in LC/C thickness with the standardized CCF exercise task was significantly greater with Spinertial device than with the PBU (p = 0.015, d = 0.6). The SCM activity during the CCF exercise was significantly lower with the Spinertial device compared to the PBU (p < 0.001, d = 0.8). Performing CCF with the Spinertial device facilities greater activation (thickness) of the LC/C with reduced SCM activity compared with the PBU. These findings support its potential clinical utility in targeted motor control training of the CCF.

Background/Objective: Emerging evidence indicates that temporomandibular disorders (TMD) patients may present features of nociplastic pain (NP), characterized by central sensitization (CS)-related symptoms. This study aims to identify factors associated with CS-related symptoms and pain sensitivity in patients with TMD and NP-related features. Methods: In this cross-sectional study, 43 TMD patients were assessed for CS-related symptoms (CSI), proximal, distal, global pressure pain threshold (PPTs, algometer), orofacial pain intensity (VAS), jaw impairment (FAI), maximal isometric strength of four muscle groups (dynamometer), resting heart rate (RHR, chest band), kinesiophobia (TKS-11), physical activity level (IPAQ), anxiety (HADS), and sleep quality (PSQI). Associations were analyzed using linear regression models adjusted for gender, age, and symptoms duration. Results: Multivariate analysis showed that higher CSI was significantly associated with greater jaw impairment (Estimate 0.09, 95% CI 0.01 to 0.18) and higher pain intensity (Estimate 0.26, 95% CI 0.14 to 0.38). Lower PPT was significantly associated with lower grip strength (Proximal: Estimate 0.03, 95% CI 0.01 to 0.05; Distal: Estimate 0.07, 95% CI 0.01 to 0.14; Global: Estimate 2.44, 95% CI 0.57 to 4.31), and proximal PPT with higher RHR (Estimate −0.02, 95% CI −0.03 to 0). Conclusions: Association was found between CS-related symptoms and pain intensity and jaw impairment, while lower PPTs were related to decreased maximal isometric grip strength and elevated RHR, thus highlighting the need for multimodal treatment in TMD patients.

Objectives: The aim of this systematic review was to evaluate the effectiveness of thoracic manual therapy with or without exercise for improving clinical outcomes (pain, disability, range of motion (ROM), quality of life (QoL) and satisfaction) in patients with subacromial pain syndrome (SPS). Methods: A systematic review was conducted following PRISMA guidelines. Randomized controlled trials (RCTs) involving thoracic manual therapy with or without thoracic exercise for patients with SPS were included. Databases searched included PubMed, PEDro, Cochrane Library, and Web of Science up to April 2025. The methodological quality was evaluated with the PEDro scale. Results: Seven RCTs involving 393 patients were included. Interventions ranged from thoracic manipulation alone to combinations with exercises. Better outcomes were reported for every clinical outcome evaluated: pain, disability, ROM, QoL and satisfaction. However, methodological heterogeneity and variability in follow-up durations limited result generalizability. Conclusions: Thoracic manual therapy applied in isolation or with exercise was reported to have positive effects in reducing pain and disability in patients with SPS, especially in the short term. These findings support the inclusion of thoracic interventions as complementary strategies in shoulder rehabilitation programs. Future high-quality trials with long-term follow-up are needed to confirm and standardize these approaches.