Journal of Back and Musculoskeletal Rehabilitation

A validated method to assess sitting and standing posture in a clinical setting is needed to guide diagnosis, treatment and evaluation of these postures. At present, no systematic overview of assessment methods, their clinimetric properties, and usability is available.

The objective of this study was to provide such an overview and to interpret the results for clinical practice.

A systematic literature review was performed according to international guidelines. Two independent reviewers assessed risk of bias, clinimetric values of the assessment methods, and their usability. Quality of evidence and strength of recommendations were determined according to the Grading of Recommendations Assessment, Development and Evaluation working group (GRADE).

Out of 27,680 records, 41 eligible studies were included. Thirty-two assessment instruments were identified, clustered into five categories. The methodological quality of 27 (66%) of the articles was moderate to good. Reliability was most frequently studied. Little information was found about validity and none about responsiveness.

Based on a moderate level of evidence, a tentative recommendation can be made to use a direct visual observation method with global posture recorded by a trained observer applying a rating scale.

There is little evidence on the reliability of the web application-based rehabilitation systems to treat chronic low back pain (CLBP).

This protocol describes a double-blind, randomized controlled feasibility trial of an e-Health intervention developed to support the self-management of people with CLBP in primary care physiotherapy. Three Hospitals with primary care for outpatients will be the units of randomisation, in each Hospital the participants will be randomized to one of two groups, a pragmatic control group receiving either the usual home program based on electrostimulation and McKenzie Therapy and e-Health intervention. Patients are followed up at 2 and 6 months. The primary outcomes are (1) acceptability and demand of the intervention by GPs, physiotherapists and patients and (2) feasibility and optimal study design/methods for a definitive trial. Secondary outcomes will include analysis in the clinical outcomes of pain, disability, fear of movement, quality of life, isometric resistance of the trunk flexors, lumbar anteflexion and lumbar segmental range of motion.

The specific e-Health programs to home could increase adherence to treatment, prevent stages of greater pain and disability, and improve the painful symptomatology.

The e-Health programs could be an effective healthcare tool that can reach a large number of people living in rural or remote areas.

Slipping rib syndrome (SRS) consists of false or floating rib hypermobility, which can force the ribs to come into contact with each other.

We aimed to examine each case by dynamic ultrasound to determine their ultrasound characteristics and analyze the clinical features of patients with SRS in order to better manage and follow them up.

Retrospectively, we collected 14 case series presenting to SRS between June 2016 and September 2018. The diagnosis was clinical and confirmed by dynamic ultrasound maneuvers.

The mean age was 35.00 ± 10.66 years and 64.29% was male. The pain mechanism was caused by repetitive movements or a traumatic event. Dynamic ultrasound was considered a very useful tool for the diagnosis. Different conservative treatments were applied in most cases. Eco-guided infiltration was also an option.

SRS should initially be based on a clinic suspicion in order to achieve a correct diagnosis and management. It is an underdiagnosed syndrome, so these case series contribute to our knowledge regarding this syndrome.

COVID-19 has become a significant healthcare issue, particularly challenging for patients with ankylosing spondylitis (AS), because immune-related diseases and their treatments could adversely affect the susceptibility to or severity of a viral infection.

This study is conducted to present an exercise rehabilitation program that patients older than 60 years with AS can do at home during the COVID-19 pandemic.

Three Delphi surveys were conducted to reach a consensus on home-based rehabilitation programs. This study recruited ten experts and performed three Delphi rounds for a month.

The expert panel suggested that home-based rehabilitation for the patients should be carried out with a clear rehabilitation goal. Their final recommendations are to institute a program aimed to ease symptoms, such as pain and stiffness; encourage patients to consult with experts regularly to ensure that they perform exercise rehabilitation properly at home; add fast walking and stretching to the rehabilitation program; and see if indoor cycling, Pilates, or yoga could be appropriate.

This study suggests that patients with AS over 60 should repeat low-intensity exercises, such as stretching, for an hour a day, four to six times a week during the COVID-19 pandemic.

Axial spondyloarthritis (axSpA) is an inflammatory rheumatic disease primarily affecting the axial skeleton.

To evaluate the short-term effects of locoregional water-filtered infrared A radiation (sl-wIRAR) in the treatment of lower back pain in patients with axSpA.

Patients with active axSpA with non-steroidal anti-inflammatory drug (NSAID) therapy undergoing a 7-day multimodal rheumatologic complex treatment in an in-patient setting were eligible. Patients were randomly assigned to the intervention group (IG) receiving sl-wIRAR treatment of the back (2 treatments/day for 30 min each for 6 days) or to the control group (CG) receiving no treatment. Primary outcome was a between-group difference in pain after sl-wIRAR therapy measured on a numeric rating scale (NRS) (0 = no pain, 10 = worst pain). Secondary outcomes included an assessment of i) the onset and development of analgesic effects and an evaluation of whether sl-wIRAR ii) improved axSpA-specific well-being and iii) influenced serum cytokine levels.

Seventy-one patients were enrolled, completed the trial and were analyzed (IG: 36 patients, CG: 35 patients). In the IG, there was a statistically significant change ( p < 0.0005) in pain level [NRS] (1.6 ± 1.9 [5; 2]) from baseline (4.1 ± 2.4 [0; 8]) to trial completion (2.6 ± 2.0 [0; 7]) and a significant difference to the CG ( p = 0.006). In the IG there was a significant improvement in axSpA-specific well-being (BAS-G) ( p = 0.006). A physiologically relevant change in serum cytokine levels could not be observed.

sl-wIRAR treatment can be useful in the treatment of patients with active axSpA as it leads to a rapid reduction of pain.

Subacromial pain (SAP) is a common complaint of young athletes, independently of the sport engaged. The prevalence of SAP in some sports is up to 50%.

The study was aimed to investigate some new factors possibly associated to subacromial pain in young athletes. The factors considered were the grade of tightness of the clavicular portion of the pectoralis major, dysfunction of the sternoclavicular joint, and serratus anterior and lower trapezius strength.

This case-control study included 82 young athletes 9–15 years, 41 with the symptoms of SAP and 41 controls. All participants self-reported whether they had subacromial pain. In addition, Hawkins–Kennedy Test was performed to all the participants to evaluate the subacromial pressure. Main outcome measures were the grade of tightness of the clavicular portion of the pectoralis major, dysfunction of the sternoclavicular joint, and serratus anterior and lower trapezius strength. The grade of tightness of the clavicular portion of the pectoralis major and the dysfunction of the sternoclavicular joint were measured with an inclinometer. Serratus anterior and lower trapezius strength were measured by a handheld dynamometer with external belt-fixation. The data were analyzed using t-test for independent samples, Mann-Whitney U test, contingency coefficients and a stepwise binary logistic regression.

Significant statistical difference was observed in the grade of tightness of the clavicular portion of the pectoralis major and in the variable representing the physiological functioning of the sternoclavicular joint, between the cases and the controls. There was no significant difference in serratus anterior and lower trapezius strength between the cases and the controls. Logistic regression analysis showed that the variable representing the physiological functioning of the sternoclavicular joint and the grade of shortening of the clavicular portion of the pectoralis major were good predictors for presence of SAP.

A strong association was determined between subacromial pain in young athletes, clavicular portion of pectoralis major tightness and the dysfunction of the sternoclavicular joint.

Fibromyalgia is accompanied by symptoms of fatigue, depression, sleep disorders, and physical and mental stress [1]. It is a difficult-to-treat disorder because its exact causes are unknown.

This study aimed to examine the effect of progressive muscle relaxation therapy (PMRT) on pain, fatigue, and stress in patients with fibromyalgia syndrome.

Thirty-seven patients with fibromyalgia syndrome (age: 20–65 years) were randomly allocated to the PMRT group ( n 1 = 18, 2 men and 16 women) or non-PMRT group ( n 2 = 19, 2 men and 17 women). The PMRT group received PMRT twice a week for 8 weeks and the non-PMRT group received conventional physical therapies such as electro-stimulation and heat therapies during this period. The outcome was evaluated before and after 8 week sofintervention using the Visual Analogue Scale, Multidimensional Assessment of Fatigue, Perceived Stress Scale, and measurement of the blood pressure and pulse rate.

Pain and fatigue significantly decreased in the PMRT group compared with the non-PMRT group (both P < 0.001). In addition, perceived stress ( P < 0.001), systolic blood pressure ( P < 0.001), diastolic blood pressure ( P < 0.05), and pulse rate ( P < 0.001) significantly decreased in the PMRT group compared with the non-PMRT group.

The findings indicate that progressive muscle relaxation therapy is a viable rehabilitative therapy for pain, fatigue, and stress symptoms in patients with fibromyalgia syndrome.

To compare the clinical outcomes and cement leakage rate between high-viscosity and low-viscosity cement percutaneous vertebroplasty (PVP) with manipulative reduction in the treatment of Kümmell’s disease (KD).

PVP using high-viscosity cement (Group H) or low-viscosity cement (Group L) with manipulative reduction was compared in 86 KD patients. Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), vertebral height, kyphosis angle and complications were evaluated and compared preoperative, one day postoperative, and at final follow-up.

The VAS score, ODI score, mean anterior and middle vertebral height variation significantly improved in both groups postoperatively. However, there was no significant difference between the two groups considering the above results preoperative and postoperative. Significantly less cement leakage (13.6%) and shorter operative time (35.6 ± 5.1 min) were observed in Group H when compared with Group L (45.2% and 41.1 ± 5.3 min) ( p < 0.05).

The clinical outcomes and radiologic findings of PVP with manipulative reduction was not influenced by cement viscosity. However, high cement viscosity PVP was found to be significant less cement leakage and shorter operative time.

It is important for clinicians and researchers to perform dynamic postural control evaluation for predicting musculoskeletal conditions, injury prevention, and rehabilitation.

The purpose of this study was to investigate the relationship (1) between the eccentric strength of the knee extensors and star excursion balance test (SEBT), and (2) between the knee proprioception and SEBT.

Forty healthy young adults participated in this study. The eccentric peak torque (EPT) of the knee extensors, joint position sense, and force sense were measured. The participants also performed SEBT. Pearson’s product-moment correlation and multiple linear regression analysis were used to determine the relationship between the variables and SEBT.

The posteromedial direction of the SEBT was positively and strongly correlated with EPT ( r = 0.74, P < 0.01). The anterior and posterolateral directions were positively and moderately correlated with EPT ( r = 0.46, P < 0.01, and r = 0.69, P < 0.01, respectively.). However, knee proprioception was not correlated with all the directions of SEBT ( P > 0.05). According to the results of multiple linear regression analysis, EPT of the knee extensors significantly predicted SEBT reach distances.

The eccentric strength of the knee extensors seems to be an essential factor in dynamic postural control. However, the knee proprioception did not show a significant correlation with SEBT.

Fluoroscopy-guided caudal epidural steroid injection (EDSI) is an option for conservative treatment of low back pain and sciatica; however, repeated exposure to radiation is a concern. With the blind technique, the needle misplacement rate is 30%; hence, ultrasound-guided caudal EDSI is a favored option.

To determine the efficacy of ultrasound-guided EDSI for low back pain and sciatica.

One hundred and ten patients with low back pain and sciatica who were unresponsive to conservative treatment, were prospectively recruited. Ultrasound-guided caudal EDSI was administered at 0, 3, and 6 weeks. Visual Analog Scale (VAS) score was recorded at 0, 2, 4, 12, and 24 weeks. Patients completed the Roland-Morris Disability Questionnaire (RMDQ) at pre-injection and 24 weeks post-injection.

VAS was significantly reduced at 2, 4, 12, and 24 weeks ( p < 0.01). At 2, 4, 12, and 24 weeks after injection, 20%, 26%, 74%, and 83% of patients displayed > 50% VAS reduction, respectively. The mean pre-injection RMDQ score was 15 and that post-injection at 24 weeks was 7 ( p < 0.01). The majority of patients had > 50% reduction in the RMDQ score.

Ultrasound-guided EDSI was safe and efficacious for low back pain and sciatica treatment at the intermediate follow-up.

Patients with lumbar disc herniation (LDH) may experience low back pain (LBP) and radiating pain (RP). Currently, there is no substantial clinical benefit (SCB) of assessing both LBP and RP due to LDH.

To determine enhanced SCB values by simultaneously assessing LBP and RP.

We retrospectively evaluated hospitalized LDH patients with concomitant LBP and RP between June 1, 2012, and May 31, 2013, and determined the numeric rating scale (NRS) and Oswestry Disability Index (ODI) scores at admission and discharge. Furthermore, the area under the receiver operating characteristic curve (AUC) was computed to assess diagnostic accuracy.

SCB as per NRS for both LBP and RP was - 2.50 in the 186 enrolled patients (AUC: 0.699 and 0.704, respectively). SCB as per ODI was - 18.78 (AUC: 0.771). SCB for the mean of the two NRS scores for LBP and RP was - 2.75 (AUC: 0.757). SCB for NRS score with a larger change in LBP and RP was - 3.50 (AUC: 0.767).

SCB may be determined by comprehensively considering LBP and RP and choosing the mean NRS or NRS score with a large change.

Prone hip extension (PHE) has been investigated to strengthen the hip joint and back extensor muscles. However, it has not been compared with various PHE exercises in individuals with iliopsoas shortness.

This study compared pelvic compensation and hip and back extensor muscle activities in individuals with iliopsoas shortness during prone hip extension (PHE) using the abdominal drawing-in maneuver alone (PHEA) and after iliopsoas stretching (PHEAS).

Twenty-five individuals with iliopsoas shortness were included in the study. Electromyography was used to investigate bilateral erector spinae (ES) and ipsilateral gluteus maximus (GM), biceps femoris (BF), and semitendinosus (ST) muscles during PHE, PHEA, and PHEAS. Pelvic anterior tilting and rotation angles were measured during each PHE exercise via electromagnetic motion tracking. A modified Thomas test was used to examine the hip extension angle before and after iliopsoas stretching. One-way repeated-measures analysis of variance was used to investigate differences in pelvic anterior tilting and rotation angle and in hip and back extensor muscle activities among PHE, PHEA, and PHEAS. The level of statistical significance was set at α = 0.01.

GM muscle activity was significantly greater with PHEAS, compared to PHE and PHEA ( p < 0.01). Bilateral ES and ipsilateral BF and ST muscle activities were significantly reduced with PHEAS, compared to PHE and PHEA ( p < 0.01). Anterior pelvic tilting and rotation angles were significantly reduced with PHEAS, compared to PHE and PHEA ( p < 0.01).

PHEAS is recommended to selectively strengthen GM muscles with minimal BF and ST muscle activities and pelvic compensation in individuals with iliopsoas shortness. The abdominal drawing-in maneuver (ADIM) after iliopsoas stretching is more efficient than ADIM alone during PHE, especially in individuals with iliopsoas shortness.

Physical therapy and exercise programs are frequently used in the treatment of knee osteoarthritis (OA). However, it is not known at what stage of knee OA it is more effective.

The purpose of this work was to determine the relationship between the effectiveness of the physical therapy and exercise programs and the radiological findings presence/grade of knee OA.

Overall, 92 patients (65F, 27M) with knee OA were enrolled in the retrospective study. Standard knee radiographs were graded according to Kellgren-Lawrence. Pain and functional status were evaluated using a visual analog scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at baseline, at the end of the physical therapy program (first month), and at third-month control visits. The demographic characteristics and VAS/WOMAC scores of the subjects were obtained from patient files.

We analyzed 131 knees of 92 patients with knee OA (65F, 27M, mean age 53.02 ± 11.13 years). The mean total VAS and WOMAC scores on the first and third months were significantly lower than the initial values (all p < 0.001). The mean VAS scores on the first and third months were significantly lower than the initial values in the group without radiological damage, but WOMAC scores were similar between the evaluations ( p = 0.009, p 50 = 0.003, respectively). The mean VAS and WOMAC scores on the first and third months were significantly lower than the initial values in the grade 1 according to the Kellgren-Lawrence radiological grades (all p < 0.001).

According to the results of our study, physical therapy and exercise was effective on pain in all patients with knee OA, but only effective on knee functional capacity in the group with radiological findings, and especially more effective in patients with Kellgren-Lawrence grade 1.

The Movement System Impairment (MSI) model is useful for identifying spine-hip mobility and motor control deficits that may contribute to low back pain (LBP). While previous studies have found differences in global spine-hip movement impairments between lumbar MSI subgroups, no studies have compared segmental spine movement impairments between these subgroups. Therefore, the purpose of this study is to analyze segmental lumbar mobility in participants with LBP and a lumbar flexion- or extension-based MSI.

Forty participants with subacute-chronic LBP were placed into one of three age groups ( < 35, 35–54, or > 54 years-old) and then classified into a flexion- or extension-based MSI sub-group. Segmental lumbar range of motion (ROM) was measured in degrees using a skin-surface device. Total lumbar and segmental flexion and extension ROM of L1-L2 to L5-S1 was compared between MSI sub-groups for each age group using separate two-way ANOVAs.

Significant main effects were found for the independent variables of MSI subgroup and age. Participants in all three age groups with a flexion-based MSI displayed significantly less lumbar extension ( - 0.6 ∘ ) at L4-5 as compared to participants with an extension-based MSI ( - 2.1 ∘ ), p = 0.03. In addition, lumbar total and segmental ROM was significantly less for older individuals in both subgroups.

Individuals with LBP may demonstrate a pattern of lumbar segmental hypomobility in the opposite direction of their MSI. Future studies may investigate the added value of direction-specific spinal mobilization to a program of MSI-based exercise.

The transversus abdominis (TrA) is an important muscle for spinal stabilization. The abdominal draw-in maneuver (ADIM) is a method that selectively activates the TrA without overactivation of the external oblique (EO) and internal oblique (IO). Individuals with low back pain may have trouble in understanding proper contraction of the TrA.

The aim of this study was to investigate the differences between two feedback techniques to re-educate the TrA.

One hundred eighty healthy volunteers (123 female, 57 male) were randomized into two groups. The ADIM was performed with different feedback methods: conventional (verbal and tactile) feedback and visual feedback from real-time ultrasound images.

A within-group comparison revealed a significant increase in the thickness of the TrA, IO, and EO during the ADIM ( p < 0.001) in both groups. The mean change (SD) in the thickness of the TrA and IO between rest and the ADIM was an increase of 2.541.25 and 1.882.14 in group 1 and 1.821.27 and 1.241.87 in group 2, respectively ( p < 0.001). No significant differences were observed in EO thickness between the two groups.

Although visual biofeedback shows a greater effect on ADIM training, both approaches are applicable, and clinicians may decide on which to use based on their clinical environment and experience.

Electrotherapy is part of a physician’s toolbox for treating various musculoskeletal conditions, including radicular pain, but the preferred modality is yet unclear.

To compare the short-term efficacy of three electrotherapeutic modalities in relieving lumbar disc herniation (LDH)-induced radicular pain.

Fourteen patients with LDH-induced radicular pain attended a single session of electrotherapy, which included four 10-min consecutive treatments: transcutaneous electrical nerve stimulation (TENS), interferential (IF) stimulation, a combined treatment with pulsed ultrasound and IF current (CTPI), and a sham control. Treatments were randomized and the straight leg raise (SLR) degree was measured immediately before and after each treatment.

Each of the three active modalities significantly improved the SLR score. The most prominent improvement was observed in the CTPI condition, followed by IF and, finally, TENS. The sham stimulation did not affect the SLR scores.

A single session with either TENS, IF current or CTPI is sufficient to improve the range of motion and degree of radicular pain associated with LDH. CTPI appears to be the most effective modality of the three, possibly due to greater penetration efficiency of the induced current. The effects of a long-term treatment schedule are yet to be identified.

New motor adaptation to pain theory suggests that patients with low back pain (LBP) use the lumbopelvic stiffening strategy by redistribution of within and between muscle activities to protect painful structure. This could result in an altered postural control of the lumbopelvic region during active prone hip rotation (PHR).

To investigate coordination and timing of lumbopelvic and hip movements, and smoothness of the lumbopelvic control during PHR between participants with and without LBP.

Eight participants with LBP and eight participants without LBP were recruited. The electromagnetic tracking system was used to record kinematic data during PHR. Cross-correlation between hip rotation and lumbopelvic movement in the transverse plane was calculated. Correlation at zero time-lag, time-lag, correlation at time-lag, and maximal lumbopelvic motion were derived. Frequency of movement disruption was identified. An independent t -test was used in conjunction with the effect size and 95% minimal detectable difference (MDD 95 ) to determine the difference in kinematic parameters.

Participants with LBP demonstrated a significant delay (exceeding MDD 95 ) in lumbopelvic motion while nonsignificant frequency of disrupted motion on the painful side PHR demonstrated a trend with a large effect size that exceeded MDD 95 . There were trends with moderate to large effect sizes and differences exceeding MDD 95 in delay of lumbopelvic motion with greater movement disruption on the nonpainful side in participants with LBP.

Participants with LBP used a lumbopelvic stiffening strategy for postural control to protect painful structures; however, the stiffening might complicate efforts to smoothly control lumbopelvic movement.

Due to the extended use of smartphones, people spend a lot of time on these devices while lying down.

The purpose of the present study was to compare the differences in neck muscle activity of participants while they watched videos on a smartphone in four different lying positions (supine (SUP), prone on elbows (PE), side lying (SIDE), and 45 ∘ head turn while side lying (45-SIDE)).

Twenty-three healthy volunteers (22.4 ± 1.7 years) were enrolled in this study. We assessed the activities of their right and left sternocleidomastoid (SCM), anterior scalene, cervical erector spinae (CES), and upper trapezius (UT) muscles while they watched videos on a smartphone in four different lying positions.

The right and left SCM and CES had significantly different muscle activities depending on the lying positions. The SCM activity had a significantly greater asymmetry in the 45-SIDE position, while the CES activity had a significantly greater asymmetry in the SIDE and 45-SIDE positions. Moreover, the UT activity had a significantly greater asymmetry in the SUP, PE, and SIDE positions.

Neck muscle activity and asymmetry were the lowest in the SUP position relative to the other positions. Therefore, lying down in the SUP position may minimize neck muscle activation while using a smartphone.

Myofascial trigger points (MTrPs) in neck muscles seem to be related to the main symptoms of patients with chronic neck pain.

The objective was to investigate the effects of dry needling (DN) on pain, disability, kinesiophobia, pain catastrophizing and psychological distress in patients with chronic neck pain.

A double blind randomized controlled pilot trial was designed. Twenty-one patients with chronic neck pain were randomly allocated to the DN group ( n = 7), Sham-DN group ( n = 7) or Control group ( n = 7). All groups received a Transcutaneous Electrical Nerve Stimulation and Therapeutic Ultrasound (TENS/US) protocol with patient education. The DN and Sham-DN groups received two sessions of DN and sham DN, respectively. The primary outcome was pain intensity. Secondary outcomes were disability, kinesiophobia, pain catastrophizing, psychological distress, self-reported improvement and success of blinding.

The DN group showed a greater decrease in pain intensity, disability and pain catastrophizing compared to the Sham-DN group ( p < 0.05) and the Control group ( p < 0.05). The DN group showed the highest self-reported improvement.

Adding two sessions of DN in active MTrPs in upper trapezius, levator scapulae and sternocleidomastoid muscles to a TENS/US protocol with patient education decreased pain intensity, disability and pain catastrophizing in patients with chronic neck pain.

Fibromyalgia (FM) is a chronic condition characterized by widespread muscular or musculoskeletal pain of at least 3 months’ duration, occurring above and below the waist, on both sides of the body.

The aim of this study was to evaluate the effectiveness of a rehabilitation program based on motor imagery versus a conventional exercise program in FM in terms of pain, functional and psychological outcomes.

Twenty-nine female subjects were randomly assigned to a group receiving motor imagery-based rehabilitation (MIG) or to a control group (CG) performing conventional rehabilitation. Outcome assessments were performed before (T0) and after 10 sessions of treatment (T1) and at a 12-week follow-up (T2). Pain, function and psychological measurements were conducted by means of different questionnaires.

Both treatments improved all outcomes at post-treatment (T1) and follow-up (T2). The MIG showed a significant improvement in anxiety disorder associated with FM with respect to the CG, as well as improvements in coping strategies.

Rehabilitation treatment based on motor imagery showed a stronger effect on anxiety and coping behavior than traditional physiotherapy in patients with FM. Integrated psychological support would be desirable in this setting. Further research is needed to explore the aspects investigated in more depth.

The medial hamstring (MH) and lateral hamstring (LH) can be selectively trained through tibial internal and external rotation during prone knee flexion. However, no study has identified how a combined tibial rotation and lumbo-pelvic stability strategy influences MH and LH muscle activities.

To investigate the combined effects of tibial rotation and the abdominal drawing-in maneuver (ADIM) on MH and LH muscle activities as well as pelvic rotation during prone knee flexion.

Fifteen female volunteers performed prone knee flexion with tibial internal and external rotation, with and without the ADIM. Under each condition, MH and LH muscle activities were measured by surface electromyography (EMG), and the pelvic rotation angle by a smartphone inclinometer application.

The results showed increased MH (without the ADIM: p < 0.001, effect size ( d ) = 2.05; with the ADIM: p < 0.001, d = 1.71) and LH (without the ADIM: p < 0.001, d = 1.64; with the ADIM: p = 0.001, d = 1.58) muscle activities under internal and external tibial rotation, respectively. However, addition of the ADIM led to increased MH (internal tibial rotation: p = 0.001, d = 0.67; external tibial rotation: p = 0.019, d = 0.45) and LH (internal tibial rotation: p = 0.003, d = 0.79; external tibial rotation: p < 0.001, d = 1.05) muscle activities combined with reduced pelvic rotation (internal tibial rotation: p < 0.001, d = 3.45; external tibial rotation: p < 0.001, d = 3.01) during prone knee flexion.

These findings suggest that the ADIM could be useful for reducing compensatory pelvic rotation and enhancing selective muscle activation in the MH and LH, according to the direction of tibial rotation, during prone knee flexion.

Lumbar radiculopathy is characterized by a significant amount of backache causing loss of workforce and is a significant health problem frequently seen in the general population.

The purpose of this study was to compare the effects of conventional physiotherapy (CT) and proprioception exercises (PE) on ankle proprioception and lumbar pain between patients with lumbar radiculopathy and a healthy control group.

In this randomized clinical trial, 89 patients referred to the Physical Medicine and Rehabilitation outpatient clinic were selected through convenience sampling. They were randomly assigned to three groups: CT ( n = 27), PE ( n = 31), CT&PE ( n = 31). Thirty healthy volunteers were included in the study as the control group. Proprioception measurements were made with an isokinetic dynamometer at 10 ∘ dorsiflexion (DF), 11 ∘ , and 25 ∘ plantarflexion (PF) angles. Lumbar pain was assessed by using the Numerical Pain Rating Scale (NPRS). The data were analyzed by IBM SPSS Statistics version 22.0 via the Kruskal-Wallis and Mann-Whitney U tests.

There was a statistically significant difference between the groups in terms of ankle proprioception and NPRS measurements in post-treatment evaluations ( p < 0.05). Statistically significant differences were found between CT and PE groups and CT&PE and control groups. There was no statistically significant difference in comparing CT and PE groups and CT&PE and control groups within themselves ( p > 0.05).

The combined use of CT and PE is an effective method that can be used in the clinic to reduce angular differences in ankle proprioception which is one of the primary factors of balance and coordination and lumbar pain.

The cranio-cervical flexion exercise and sub-occipital muscle inhibition technique have been used to improve a forward head posture among neck pain patients with straight leg raise (SLR) limitation. However, little is known about the cranio-vertebral angle (CVA) and cervical spine range of motion (CROM) after applying stretching methods to the hamstring muscle.

To compare the immediate effects of static stretching and proprioceptive neuromuscular facilitation stretching on SLR, CVA, and CROM in neck pain patients with hamstring tightness.

64 subjects were randomly allocated to the static stretching ( n 1 = 32) or proprioceptive neuromuscular facilitation ( n 2 = 32) stretching group. The SLR test was performed to measure the hamstring muscle’s flexibility and tightness between the two groups, with CROM and CVA also being measured. The paired t-test was used to compare all the variables within each group before and after the intervention. The independent t-test was used to compare the two groups before and after the stretching exercise.

There were no between-group effects for any outcome variables ( P > 0.05). However, all SLR, CVA, and CROM outcome variables were significantly improved within-group ( P < 0.05).

There were no between-group effects for any outcome variable; however, SLR, CVA, and CROM significantly improved within-group after the one-session intervention in neck pain patients with hamstring tightness.

Carpal tunnel syndrome (CTS) is one of the most common forms of peripheral neuropathies due to median nerve compression. Occupational factors, such as repetitive hand motions are believed to be associated with this condition.

This clinical trial assessed the effect of Kinesio taping (KT) of hand flexor muscles on the management of mild to moderate CTS in Iranian manual laborers.

Thirty manual laborers with mild to moderate CTS participated in this clinical trial. They were assigned to an intervention or a control group. The treatment consisted of a 2-week KT followed by a 4-week follow-up. The control group received sham KT without tension applied. Boston Carpal Tunnel Questionnaire scores, pinch and grip force tests, and electrophysiological examination of the median nerve were performed for each participant at baseline, 24 to 48 hours, and two to four weeks of follow-up. The statistical analysis of variance was performed (2 groups × 5 times) for all participants, comparing differences in the data within and between the two groups.

The baseline assessment revealed no inter-group differences in the clinical outcomes ( P > 0.05). Comparisons of the changes in the electro-physiological and functional variables indicated significantly greater improvement in the KT group than in the sham counterpart ( P < 0.05). No statically significant improvement was evident by the electrodiagnostic criteria in the sham-KT group ( P > 0.05).

KT is an effective, safe, reliable, and conservative therapeutic choice for the management of patients with CTS. The treatment does not restrict the daily activities of patients nor has it any side effects.

Rheumatoid arthritis (RA) mainly affects the joints of the upper and lower limbs, so evaluating functional exercise capacity in individuals with RA via dynamic tests of the locomotor system is essential.

To compare functional exercise capacity using the Glittre-activities of daily living (ADL) test (G-AT) in women with and without RA in the absence of RA pulmonary disease (RA-PD) and to correlate the findings with hand functioning, physical functioning, handgrip strength (HGS), and quadriceps strength (QS).

This cross-sectional pilot study evaluated 35 women with RA and 25 healthy controls by assessing hand functioning using the Cochin Hand Functional Scale (CHFS), physical functioning with the Health Assessment Questionnaire Disability Index (HAQ-DI), muscle functioning using HGS and QS, and G-AT results.

Compared to the women in the control group, the women with RA presented higher scores for the CHFS ( p < 0.0001) and HAQ-DI ( p < 0.0001) and lower HGS ( p < 0.0001) and QS ( p = 0.013) values. The median G-AT time was higher in the RA patients than in the healthy controls [300 (295–420) vs. 180 (155–203) s], p < 0.0001), and the greatest difficulty reported by patients after the G-AT was squatting to perform the shelving tasks. G-AT time was positively correlated with the HAQ-DI ( r s = 0.668, p < 0.0001) and CHFS ( r s = 0.586, p = 0.0007) and negatively correlated with QS ( r s = - 0.429, p = 0.037). There was no significant correlation between the G-AT time and HGS.

Women with RA take longer to perform G-AT tasks. Moreover, G-AT time was associated with hand functioning, physical functioning and QS, but not with HGS.