As its name implies, the forward head position (FHP) is when the head is further forward of the trunk than normal. This can cause neck and shoulder tension, as well as headaches. The craniovertebral angle (CVA) measured with 2D systems such as Kinovea software is often used to assess the FHP. Computer vision applications have proven to be reliable in different areas of daily life. The aim of this study is to analyze the test-retest and inter-rater reliability and the concurrent validity of a smartphone application based on computer vision for the measurement of the CVA. Methods: The CVAs of fourteen healthy volunteers, fourteen neck pain patients, and fourteen tension-type headache patients were assessed. The assessment was carried out twice, with a week of rest between sessions. Each examiner took a lateral photo in a standing position with the smartphone app based on computer vision. The test-retest reliability was calculated with the assessment of the CVA measured by the smartphone application, and the inter-rater reliability was also calculated. A third examiner assessed the CVA using 2D Kinovea software to calculate its concurrent validity. Results: The CVA in healthy volunteers was 54.65 (7.00); in patients with neck pain, 57.67 (5.72); and in patients with tension-type headaches, 54.63 (6.48). The test-retest reliability was excellent, showing an Intraclass Correlation Coefficient (ICC) of 0.92 (0.86–0.95) for the whole sample. The inter-rater reliability was excellent, with an ICC of 0.91 (0.84–0.95) for the whole sample. The standard error of the measurement with the app was stated as 1.83°, and the minimum detectable change was stated as 5.07°. The concurrent validity was high: r = 0.94, p < 0.001. Conclusion: The computer-based smartphone app showed excellent test-retest and inter-rater reliability and strong concurrent validity compared to Kinovea software for the measurement of CVA.

Myogenic temporomandibular disorders (TMDs) are commonly associated with pain sensitization (PS), manifesting decreased local and distal pressure pain thresholds (PPTs). Aerobic exercise (AE) has shown hypoalgesic effects on PS. This study aimed to analyze the effects of AE in addition to physical therapy (PT) on widespread PS in myogenic TMDs. A randomized controlled trial was carried out, involving 20 subjects allocated to PT (n = 10) or PT + AE (n = 10). Both groups performed six sessions over four weeks, consisting of education, manual therapy, and therapeutic exercise. The PT + AE group also performed high-intensity intervallic AE on a stationary bike. Primary outcome: PPT in the Achilles tendon assessed with an algometer. Secondary outcome: Central Sensitization Inventory (CSI). Outcomes were recorded at baseline (T0), post-intervention (T1), and after 12 weeks (T2). Significant between-groups differences were found favoring PT + AE at T1 and T2 for the left Achilles PPT (T1 p < 0.01; d = 1.3; T2 p < 0.001; d = 2.5) and CSI (T1 p < 0.001; d = 2.3; T2 p < 0.01; d = 1.7), and at T2 for the right Achilles PPT (p < 0.001; d = 0.9). Thus, adding AE to PT improved widespread PS more than only PT in myogenic TMD.

Background: Resistance training is commonly used to prevent the decline in muscle power associated with aging. Objective: This study aims to evaluate the effectiveness of iso-inertial (IN) training on power, physical performance, and variables associated with the risk of falls, compared to gravitational (GR) training, in physically active middle-older adults. Methods: A parallel-group, randomized controlled trial was conducted at Espai Esport Wellness Center (Granollers, Spain). In total, 44 physically active adults (age >57) were randomized 1:1 to either the IN (n=21) or GR (n=23) training groups (using R software; R Core Team). Participants completed a 6-week training program (2 sessions/week) consisting of 3 exercises (forward lunge, side lunge, and forward lunge with row). The primary outcome includes power in the eccentric phase of each exercise, evaluated using both IN and GR devices. Secondary outcomes include concentric power, physical performance, and variables associated with the risk of falls. Only outcome evaluators were blinded. We used multivariate linear regression models for the analysis. Results: In total, 27 participants completed the program (IN: n=15 IN; GR: n=12). IN training resulted in better eccentric power gains compared to GR training when assessed using the IN system, although the difference was only statistically significant for the side lunge. For forward lunge, between-group difference was 4.50 W (95% CI −2.94 to 11.94 W, P=.23); for side lunge, between-group difference was 9.24 W (95% CI 2.99-15.49 W; P<.01); and for forward lunge with row, between-group difference was 15.25 W (95% CI −0.63 to 31.13 W; P=.06). We observed no significant differences for the eccentric power using the GR system evaluation, concentric power, physical performance, and variables associated with the risk of falls. Both groups showed significant improvements from baseline across all outcomes. Conclusions: Although IN training appeared to result in greater power gains during the eccentric phase when assessed with the IN system, statistically significant differences were observed only for the side lunge exercise. Both training systems seemed equally effective in improving eccentric power as evaluated with the GR system, concentric power, physical performance, and reducing variables associated with the risk of falls.

Objective To evaluate the effectiveness of iso-inertial resistance training on eccentric power compared to gravitational training in physically active middle-older adults. Methods Parallel-group, randomised controlled trial at Espai Esport Wellness Center (Granollers, Spain). Forty-four physically active adults (>57 years of age) were randomised to iso-inertial (n=21) or gravitational (n=23) training groups (R software; 1:1 ratio). Participants had to complete a 6-week training program (2 sessions/week) consisting of three exercises (forward lunge, side lunge, forward lunge with row). Primary outcome: power in the eccentric phase of each exercise evaluated with both iso-inertial and gravitational devices. Secondary outcomes: concentric power, physical performance, risk of falls. Only outcome evaluators were blinded. We used multivariate linear regression models to analyse the effect of interventions. Results Iso-inertial training showed better eccentric power gains than gravitational training for iso-inertial system evaluation, although the difference was only statistically significant for the side lunge. Forward lunge: between-group difference 3.99 W (95% CI: -3.99 to 11.33, p: 0.28); side lunge: difference 8.50 W (95% CI: 2.13 to 14.87; p: 0.01); forward lunge with row: difference 14.07 W (95% CI: -2.07 -to 30.20, p: 0.09). We observed no differences for the gravitational system evaluation nor for concentric power, physical performance, and risk of falls. The two groups improved remarkably from baseline for all outcomes. Conclusions Iso-inertial resistance training might lead to better eccentric power gains than gravitational training. Both approaches seem equally effective in improving concentric power and physical performance, and reducing the risk of falls. Trial registration ClinicalTrials.gov (NCT06160089). WHAT IS ALREADY KNOWN ON THIS TOPIC - Physical exercise in middle-older adults is an effective strategy to promote health and improve quality of life. - Resistance training using iso-inertial devices generates an advantage in hypertrophy, electromyographic activity or balance compared to cable-resistance training in middle-older adults. - The power at which an action is performed is considered a predictor of functional capacity, as it is associated with the execution of activities of daily living such as climbing stairs, getting up from a chair or walking. WHAT THIS STUDY ADDS - The iso-inertial training system improves muscle power in the eccentric phase compared to the gravitational system, although the difference is only statistically significant for the side lunge exercise. - Iso-inertial and gravitational resistance training are equally effective in improving concentric power, and physical performance and reducing the risk of falls. - Using iso-inertial devices is recommended to evaluate power in the eccentric phase, as they may capture better the eccentric demands than gravitational devices. HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY - Using iso-inertial devices for resistance training in middle-older adults seems a promising way to improve the power in the eccentric phase of an action. - Improving eccentric power in older adults is crucial due to its transfer to daily life activities. - Regardless of the training system, clinicians should prescribe resistance training programs to middle-older adults as these programs remarkably increase power and physical performance and reduce the risk of falls.

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.

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.