Nikolaus Ballenberger

• Phd
• Professor at Osnabrück University of Applied Sciences

Spine-related neck–arm pain is heterogeneous and may present on a spectrum between nociceptive and neuropathic pain. A recently developed mechanism-based clinical framework for spine-related pain distinguishes between spinally referred pain without neurological deficits (somatic referred pain, heightened nerve mechanosensitivity, radicular pain), w...

Background and context of the study Neck pain is a prevalent and globally burdensome problem. Clinical practice guidelines have recommended conservative treatments such as education, exercise therapy (ET), manual therapy (MT), and pharmacological therapy (i.e., medication) to manage all types of neck pain based on the chronicity of the disease (acu...

Objective: The objective of this study was to investigate whether trigeminal somatosensory function and mechanosensitivity differ between groups with craniofacial neuropathic pain (CNP), non-neuropathic craniofacial pain (NNP), and healthy controls (HC). Methods: Thirty-three participants were categorized into these groups, matched for age and s...

Background Health care providers like physiotherapists should address the needs of performing artists for a specific health care derived from physical and psychosocial (performance-related) complaints. The aims of this study were (1) to compose an algorithm including subjective outcome measures in order to suggest how to evaluate the physical and p...

Background: Although awake bruxism is associated with temporomandibular disorder (TMD) as well as head and neck pain, the effects of physical therapy and bruxism education to address these factors have not been investigated. Objective: The aim of this study was to evaluate the effects of oro-facial manual therapy and bruxism neuroscience educati...

Background: Cervical manipulations are widely used by physiotherapists, chiropractors, osteopaths, and medical doctors for musculoskeletal dysfunctions like neck pain and cervicogenic headache. The use of cervical manipulation remains controversial, since it is often considered to pose a risk for not only benign adverse events (AEs), such as aggra...

This review presents a comprehensive summary and critical evaluation of Intention to Treat (ITT) analysis, with a particular focus on its application to randomized controlled trials (RCTs) within the field of rehabilitation. Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a method...

Zusammenfassung Ziel der Studie Als dysfunktionale Atemmuster (DAM) werden Abweichungen vom physiologischen Atemmuster bezeichnet. DAM scheinen mit einer geringeren Asthmakontrolle verbunden zu sein. Bisher ist unklar, welchen Einfluss eine stationäre Rehabilitation auf diese Problematik nehmen kann. Ziel dieser Arbeit ist es, den Effekt einer pneu...

Objective: A mechanism-based clinical framework for spine-related pain differentiates (i) somatic referred pain, ii) heightened nerve mechanosensitivity, iii) radicular pain, iv) radiculopathy and mixed-pain. This study aimed to determine the reliability of proposed framework. Method: Fifty-one people with unilateral spine-related neck-arm pain...

Background: Evidence concerning the development of musculoskeletal health complaints (MHCs) among music students is limited due to inappropriate study designs. We aimed to assess the occurrences of MHCs and associated risk factors in freshmen music students compared to students from other disciplines. Methods: A prospective cohort study was cond...

Background: Recently, Wolf et al. proposed a novel, marker-based method to analyze the three-dimensional upper-body kinematics of high string players for clinical application. The method provides an objective evaluation of high string players' motor strategies, especially in the shoulder complex, by distinguishing between the scapulothoracic (ST)...

A thorough knowledge of biases in intervention studies, and how they influence study results is essential for the practice of evidence-based medicine. The objective of this review is to provide a basic knowledge and understanding of the concept of biases and associated influence of these bias on treatment effects, focusing on the area of rehabilita...

Objective Music-related physical and mental health conditions are common among post-secondary music students, with many studies reporting a prevalence greater than 70%. However, there is currently no consensus on appropriate, validated assessments for this population. The aim of this pilot study was to test the feasibility of an assessment protocol...

Bias is a systematic error that can cause distorted results leading to incorrect conclusions. Intervention bias (i.e., contamination bias, cointervention bias, compliance bias, and performance bias) and detection bias are the most common biases in rehabilitation research. A better understanding of these biases is essential at all stages of research...

Background: The Craniofacial Pain and Disability Inventory (CF-PDI) is a cross-culturally adapted instrument designed from a biopsychosocial perspective to measure pain, disability, and function in orofacial head and neck pain with shown psychometric properties; however, the German cross-cultural adaption is lacking. Objectives: To carry out a t...

Currently, the treatment of musicians is an interprofessional approach. Playing-related health complaints may impact the performance of a musician. In Germany, a medical consulting hour for musicians exists, but those for athletes in sports medicine are not so common. The diagnosing and treatment procedure within the physiotherapy consultation for...

Zusammenfassung Die Lumbale Spinalkanalstenose (LSS) bezeichnet eine symptomatische Verengung des Spinalkanals aufgrund einer kongenitalen Erkrankung (primäre LSS) oder eines degenerativen Prozesses (sekundäre LSS). Laut Schätzungen unterziehen sich 40 % aller von LSS betroffenen Patienten innerhalb der ersten 10 Jahre einem chirurgischen Eingriff....

Background The clinical presentation of neck-arm pain is heterogeneous with varying underlying pain types (nociceptive/neuropathic/mixed) and pain mechanisms (peripheral/central sensitization). A mechanism-based clinical framework for spinally referred pain has been proposed, which classifies into (1) somatic pain, (2) neural mechanosensitivity, (3...

Background: Attrition, missing data, compliance, and related biases are three interrelated concepts. Previous research has found that these biases can affect the treatment estimates of randomized trials (RCTs). The extent to which the effects of attrition, missing data, compliance, and related biases influence effect size estimates in rehabilitati...

Background: Attrition, missing data, compliance, and related biases can influence the magnitude of treatment effects in randomized controlled trials (RCTs). It is unclear which items should be considered when reporting and evaluating the influence of these biases in trial reports in the rehabilitation field. Objectives: To describe which individ...

Despite normal neurological integrity tests, some patients with non-specific neck-arm pain (NSNAP) have heightened nerve mechanosensitivity upon neurodynamic testing. The aim of this study was to determine whether or not a nerve dysfunction is present in patients with positive neurodynamic tests compared to those with negative neurodynamic tests or...

This study examined the feasibility of employing an assessment battery developed in Germany, investigating mental and physical health of university music students, in Canada. Using a cross sectional design, first-semester music and control students were recruited at two university campuses. Eligibility criteria were: 1) first-semester, full-time un...

Objective: To identify assessment tools used to evaluate patients with temporomandibular disorders (TMD) considered to be clinically most useful by a panel of international experts in TMD physical therapy (PT). Methods: A Delphi survey method administered to a panel of international experts in TMD PT was conducted over three rounds from October...

AIMS: High string players (violin and viola) often suffer from musculoskeletal disorders. Although 3D motion analysis has proved helpful in diagnosing different musculoskeletal syndromes and identifying injurious movement patterns in violin and viola performance, more detailed analyses of upper body movement strategies and especially of the shoulde...

Objectives To develop a time-efficient motor control (MC) test battery while maximising diagnostic accuracy of both a two-level and three-level classification system for patients with non-specific low back pain (LBP). Design Case–control study. Setting Four private physiotherapy practices in northern Germany. Participants Consecutive males and f...

Purpose: Bruxism is highly prevalent and defined as abnormal habitual mouth activity including clenching of the teeth and increased jaw muscle activity. The association between bruxism and temporomandibular dysfunction (TMD) is debated, in particular the association between cervical spine impairments, bruxism, and TMD. Hence the purpose of this stu...

Background Assessment of low back pain (LBP) includes segmental motion tests. Although often used in clinical practice, the validity, inter- and intra-rater reliability of such tests in individuals with LBP are not universally accepted, making it difficult to interpret findings in clinical practice. Objective The purposes of this study were to det...

Zusammenfassung Hintergrund In der Forschung werden seit längerem die wechselseitigen Beziehungen einer veränderten dentalen Okklusion im Zusammenhang mit der Umorganisation der Körperhaltung kontrovers diskutiert. Insbesondere im Profisport wird der Einsatz von Aufbiss-Schienen immer häufiger untersucht. Weniger wurden dabei die Effekte von Aufbis...

Viele Musiker leiden an spielbedingten muskuloskelettalen Beschwerden (playing-related disorder, PRMD). Eine Vielzahlepidemiologischer Untersuchungen hinsichtlich spielbedingter Beschwerden bei Musikern setzen keine Selbstbeurteilungsinstrumente ein,insbesondere zur Beurteilung muskuloskelettaler Schmerzintensität und -beeinträchtigung im Kontext v...

Introduction: Tests to evaluate the integrity of the alar ligaments are important clinical tools for manual therapists, but there is limited research regarding their validity. Method: A single blinded examiner assessed alar ligament integrity using the lateral shear test (LST), rotation stress test (RST) and side-bending stress test (SBST) on a sam...

Background: Muscle fatigue seems to be a risk factor in the development of performance-related musculoskeletal disorders (PRMDs) in musicians, but it is unclear how muscle activity characteristics change between musicians with and without PRMDs over a prolonged playing period. Purpose: To investigate muscle activity patterns in muscles of the ar...

Aim: In this prospective longitudinal study, the physical and psychological health status of music students is assessed at the beginning of their university music study and tracked over time. Analysis strategies and interim results from the first-year cohort, including 1-year incidences, monthly prevalences, and predictors of developing musculoske...

Many musicians suffer from playing-related musculoskeletal disorders (PRMDs) however many of the epidemiological surveys on PRMD do not utilize evaluated self-report instruments, especially as a tool to assess musculoskeletal pain intensity and pain interference in terms of function and psychosocial constructs. The aim of this study was to translat...

Background: The primary objective of this study was to determine the structural and known-group validity as well as the inter-rater reliability of a test battery to evaluate the motor control of the craniofacial region. Methods: 70 volunteers without TMD and 25 subjects with TMD (Axes I) per the DC/TMD were asked to execute a test battery consis...

Objectives: To identify clinical patterns of impairment affecting the cervical spine and masticatory systems in different subcategories of temporomandibular disorder (TMD) by an explorative data-driven approach. Methods: For this observational study, 144 subjects were subdivided according to Research Diagnostic Criteria for TMDs into: Healthy contr...

Background: There is preliminary evidence of cervical musculoskeletal impairment in some temporomandibular disorder (TMD) pain states. Objectives: To determine whether people with TMD, classified as either mild or moderate/severe TMD, have more cervical signs of dysfunction than healthy subjects. Design: Cross-sectional survey. Method: Based...

Streszczenie Wstęp Astma wieku dziecięcego dzieli się na astmę alergiczną (AA) i astmę niealergiczną (NA), jednak leczenie w obu przypadkach jest identyczne i tylko częściowo skuteczne. Cel Identyfikacja nowych immunofenotypów w przypadku AA i NA u dzieci. Metody Badaniem Stowarzyszenia Badań Klinicznych nad Astmą objęto 275 niemieckich dzieci w...

Background and objective There is currently no evidence of changes in pressure sensitivity of myofascial trigger points (MTrPs) in extra-trigeminal regions in patients with craniomandibular dysfunction (CMD). The purpose of this study was to evaluate whether pressure sensitivity of MTrPs in patients with CMD increases in trigeminal and extra-trigem...

Background: Childhood asthma is classified into allergic asthma (AA) and nonallergic asthma (NA), yet both are treated identically, with only partial success. Objective: We sought to identify novel immune phenotypes for childhood AA and NA. Methods: The Clinical Asthma Research Association cohort study includes 275 steroid-naive 4- to 15-year-...

Background: Increased serum IgE levels are characteristic but not specific for allergic diseases. Particularly, severe atopic dermatitis (AD) overlaps with hyper-IgE syndromes (HIES) regarding eczema, eosinophilia, and increased serum IgE levels. HIES are primary immunodeficiencies due to monogenetic defects such as in the genes DOCK8 and STAT3. A...

Previous studies suggested that maternal farm exposure during pregnancy modulates early immune development toward an allergy-protective status potentially mediated by TH1 or regulatory T (Treg) cells. However, the underlying mechanisms might involve immune modulation of additional T-cell populations, such as TH17 cells, influenced by genetic predis...

The transcription factor STAT6 is crucial for activation of the interleukin (IL)-4/IL-13 pathway and has been linked to regulatory T cells (Tregs). Associations of STAT6 polymorphisms with IgE levels were described; however, their impact on neonatal immune responses and early disease development is unknown. STAT6 polymorphisms were genotyped in cor...

For several immune-mediated diseases, immunological analysis will become more complex in the future with datasets in which cytokine and gene expression data play a major role. These data have certain characteristics that require sophisticated statistical analysis such as strategies for non-normal distribution and censoring. Additionally, complex an...

Typical distribution of left censored cytokine (real data). (TIF)

(DOCX)

Variable after quadratic transformation from normality into a heavily skewed variable. The distribution has two local maxima and resembles distribution from Fig. S1. (TIF)

Survival function according to the Kaplan-Meier method applied to example with right censoring at multiple detection levels for unexposed children. (DOCX)

The aim of this study was to determine the activity of the masseter and anterior temporalis muscles in relation to different positions of the upper cervical spine during maximal voluntary isometric clenching by surface electromyography (EMG). This was a cross-sectional study with a repeated-measures design performed using 25 asymptomatic subjects (...

TBX21 (T cell specific T-box transcription factor) and HLX1 (H.20-like homeobox 1) are crucial transcription factors of T(H)1-cells, inducing their differentiation and suppressing T(H)2 commitment, particularly important for early life immune development. This study investigated the influence of TBX21 and HLX1 single nucleotide polymorphisms (SNPs)...

Distribution of TLR2 polymorphisms within HLX1 genotypes. Results are presented as % and below absolute numbers shown in brackets. (DOC)