Comparison of effects of Mulligan taping and Kinesio taping on ankle neuromuscular control in response to a sudden inversion perturbation in individuals with chronic ankle instability

OBJECTIVES

This study was aimed to compare the effects of Mulligan taping (MT) with Kinesio taping (KT) and the un-taped ankle on neuromuscular control during a sudden inversion perturbation in individuals with chronic ankle instability (CAI).

DESIGN

Randomized, single blind cross-over.

SETTING

Biomechanics lab.

PARTICIPANTS

16 individuals with chronic ankle instability.

MAIN OUTCOME MEASURES

The outcome measures were the onset time and magnitude of short (SLR) and medium latency response (MLR) for peroneus brevis (PB), peroneus longus (PL), tibialis anterior (TA), and soleus (SOL) muscles and the TA/P and SOL/TA antagonist co-activation.

RESULTS

In the groups of KT and MT, the onset time was significantly decreased at post-taping compared to pre-taping, such that for the onset time of PB MLR, the groups of KT and MT had an earlier onset time than the un-taped group. For the magnitude of TA SLR and PB MLR, groups exhibited different behaviors. In the KT group, the magnitude was significantly increased post-taping, however, in the MT group, it was decreased. Regarding the TA/P and SOL/TA co-activation, the groups of KT and MT showed significant changes post-taping.

CONCLUSION

This study suggests that KT and MT significantly affect neuromuscular control in response to a sudden perturbation in individuals with CAI, although the behavior of KT and MT appears to be somewhat different from each other.

Effects of dry needling and stretching exercise versus stretching exercise only on pain intensity, function, and sonographic characteristics of plantar fascia in the subjects with plantar fasciitis: a parallel single-blinded randomized controlled trial

OBJECTIVES

Plantar fasciitis is a common problem in the foot region which has negative considerable impact on foot function.

METHODS

In this parallel blinded randomized controlled trial, a total of thirty-seven subjects with plantar fasciitis (forty feet) were enrolled randomly to either the control group (stretching exercise) or the experimental group (stretching exercise plus dry needling). All interventions lasted six weeks and both groups were followed for two weeks. Primary outcomes were first step pain, pain, and activity daily function subscales of the FAOS questionnaire and secondary outcomes were plantar fascia thickness, and echogenicity.

RESULTS

The mixed model ANOVAs showed significant group × time interactions for all primary outcomes. In both groups, first step pain and both subscales of the FAOS questionnaire were improved compared to baseline measurements. There were considerable differences between the two groups and the experimental group experienced more improvements in primary outcomes compared to the control group. For secondary outcomes, plantar fascia thickness at insertion significantly decreased, and the echogenicity in the two regions significantly increased in the experimental group compared to the control group.

CONCLUSION

These results suggest that the combination of dry needling and stretching exercises can be an effective conservative treatment for plantar fasciitis subjects.

The effect of exergaming on cognition and brain activity in older adults: A motor- related cortical potential study

Exergames have positive effects on various cognitive domains. However, to the best of our knowledge, not only have few studies investigated the exergame-induced brain changes, but also in most of them, preparatory brain activity has not been considered. Preparatory brain activity is a particularly relevant aspect for investigating the interaction between cognitive and sensorimotor functions in the brain. Accordingly, the aim of this study was to investigate the effects of an exergame protocol versus traditional motor-cognitive dual-task training on the cognition and proactive components of movement-related cortical potential. A total of 52 older adults were randomly assigned to the intervention (exergame training) and the control group (motor-cognitive dual-task training). The outcome measurements were neurophysiological data (i.e., the amplitude of the late contingent negative variation [CNV], and alpha/beta event-related desynchronization [ERD]), and neuropsychological data (rate-correct score [RCS] in go/no go task and trail-making test [TMT]). The results revealed that both groups had a decreased late CNV, and alpha/ beta ERD in post-training compared to pre-training in Cz and C3 channels. Moreover, both groups had an increased RCS and a decreased TMT-A in post-training compared to pre-training. However, for TMT-B, the results indicated a significant interaction in favor of the exergame group. These findings indicate that in older adults, both interventions may result in increasing inhibitory control, information processing speed, and preparatory brain activity. However, for cognitive flexibility, exergame has an additional effect relative to the control group.

Ultrasonographic measurements of plantar fascia thickness and echogenicity in individuals with and without plantar fasciitis: Reliability and group differences

OBJECTIVE

Imaging techniques such as ultrasonography are beneficial for diagnosis of plantar fasciitis. The purpose of this study was to investigate intra-rater reliability of plantar fascia thickness and echogenicity in subjects with and without plantar fasciitis and to compare the measurements between the two groups.

DESIGN

Sonographic evaluation of the plantar fascia was performed in prone position in 20 subjects without plantar fasciitis and 20 subjects with plantar fasciitis. The outcome measures extracted from the ultrasound images included plantar fascia thickness at the insertion, 1 cm and 3 cm distal from the insertion and plantar fascia echogenicity. The reliability of outcome measures was estimated for both groups using absolute and relative reliability variables. The two groups were compared using analysis of variance (ANOVA).

RESULTS

ICCs _{(3, 3)} for intra-rater reliability of plantar fascia thickness and echogenicity were, respectively, ≥0.89 and ≥0.89 in the healthy controls and 0.87≥ and 0.90≥ in the plantar fasciitis group. The subjects with plantar fasciitis showed a thicker plantar fascia with lower echogenicity in all of measurement stations of plantar fascia compared to the healthy controls.

CONCLUSION

The results of the present study indicated that ultrasonography is a reliable method to measure plantar fascia thickness and echogenicity. Furthermore, the findings showed that plantar fascia is affected not only at its insertion but also in other points remote from the insertion in patients with plantar fasciitis. These findings support the diagnostic value of ultrasonography in therapy and research of the patients with plantar fasciitis.

Test-retest Reliability of EMG β-Band Intermuscular Coherence of Non-specific Chronic Low Back Pain During Flexion-extension Task

Introduction: This study aimed to investigate the reliability and agreement of the Beta-band Intermuscular Coherence (Bb-IMC) as a clinical assessment tool for Non-Specific Chronic Low Back Pain (NS-CLBP) patients and healthy subjects by studying four phases of the Flexion-Extension Task (F-ET): standing, flexion, relaxation, and extension phases. Materials and Methods: Twenty-four men with NS-CLBP and 20 healthy subjects voluntarily participated in this study. All subjects performed three trials of F-ET while the surface electromyography was recorded from the lumbar erector spinal, gluteus maximus,  and hamstring muscles of both sides. Beta-band intermuscular coherence analysis was used to calculate the pool coherence and the pairwise coherence for all mentioned muscles. Afterward, the Intra-class Correlation Coefficient (ICC), Standard Error of Measurement (SEM), and Minimal Detectable Change (MDC) for four phases of F-ET were used to analyze the intra- rater reliability and agreement of the measurements. Results: The investigation of ICC, SEM, and MDC showed that the reliability was moderate to a high level for pool and pairwise coherence of Bb-IMC in all mentioned muscles for   four phases of the flexion-extension task in NS-CLBP patients and healthy subjects. Yet, the agreement was low because the measurement error was relatively large. Conclusion: So far, no studies have used the Bb-IMC method to study low back pain, which is carried out in our research to check the reliability of this new method. Our findings revealed that pool and pairwise coherence obtained during F-ET have moderate to a high level of reliability for using Bb-IMC and could be considered a tool for the NS-CLBP patients’ assessment. Despite the small sample size investigated, in clinical practice the using Bb-IMC measure  can help to study the interaction of corticospinal in NS-CLBP and also in healthy subjects. This measure requires larger sample sizes in addition to studying other circumstances and functional movements such as lifting weight. Further, more research appears to be warranted by the observed effectiveness of a particular intervention in modulation mechanisms of corticospinal tract function by Bb-IMC in NS-CLBP.

Video game and motor-cognitive dual-task training could be suitable treatments to improve dual-task interference in older adults

The objective of study was to investigate the effects of video game training in comparison with traditional motor-cognitive dual-task training on dual-task interference in older adults. Sixty older adults were allocated to the video game (intervention group) or the motor-cognitive dual-task training (control group). The outcome measures were dual-task cost (DTC) of linear metrics (Standard deviation (SD) of amplitude and velocity) and DTC of nonlinear metrics (approximate entropy, Lyapunov and correlation dimension) acquired from postural sway time series from both the mediolateral (ML) and anteroposterior (AP) directions. The results revealed in both groups, dual-task cost of SD of amplitude and velocity as well as Lyapunov were significantly decreased in post-training and follow-up compared with pre-training (p < 0.017), while there was no significant difference between the groups. Video game and motor-cognitive dual-task training could be recommended as suitable treatments to improve dual-task interference.

The effect of video game-based training on postural control during gait initiation in community-dwelling older adults: a randomized controlled trial

PURPOSE

The aim was to investigate the effect of video game training as compared to dual-task training on gait initiation (GI) which is a sensitive indicator of balance deficiency in older adults.

METHOD

Sixty-six older adults were allocated to the video game-based training (intervention group) or the motor-cognitive dual-task training (active control group). The outcome measures were the mediolateral (ML)/anteroposterior (AP) displacement and velocity of COP during the phases of GI (anticipatory, weight transition, and locomotor).

RESULTS

The results indicated in the anticipatory phase, the ML & AP COP displacement were significantly increased at post-training relative to pre-training across both groups (p < 0.041). In the weight transition phase, the AP COP displacement & ML COP velocity were significantly increased at post-training than pre-training (p < 0.032). However, in the locomotor phase, within the intervention group, the ML COP displacement & ML COP velocity were significantly increased at follow-up as compared to pre-training (p < 0.05), while no such differences were observed within the control group.

CONCLUSION

Both treatments were effective in improving COP trajectory during the phases of anticipatory and weight transition, while the intervention group was more effective during the phase of locomotor. So, these treatments can be recommended for clinical settings.Implications for rehabilitationThe video game and dual task training were effective in improving COP trajectory during the phases of anticipatory and weight transition.The video game-based training was more effective during the phase of locomotor.The study findings could have useful implications to further introduce cognition-based rehabilitation programs such as video games for older adults.Rehabilitation professionals could use the video game to improve the postural control of older adults.

Iliopsoas muscle thickness and pelvic alignment in pronated and normal foot postures

It is hypothesized that the subtalar hyperpronation may provoke the development of a biomechanical chain of events in lower extremity alignment. Several studies have shown that pelvic alignment may alter in the presence of immediate foot hyperpronation induced by external forces. It is unknown whether these alterations are presented in chronic foot hyperpronation or not. It is also unknown if these potential postural changes could affect iliopsoas muscle size. Therefore, it appears necessary to carry out thorough research in this study. Twenty nine females with pronated foot posture and twenty seven females with normal foot posture participated in this study. The iliopsoas muscle was measured using ultrasound imaging (USI). Pelvic angle (PA) was measured using reflective markers and digital photography. Intrarater reliability of USI for the iliopsoas muscle thickness was also measured. The results indicated that the iliopsoas muscle thickness and the PA were not different in individuals with pronated foot compared to the normal foot group. However, a good intrarater reliability of USI was found for measuring the iliopsoas muscle thickness.

Quadriceps architecture in individuals with patellofemoral pain: A systematic review

OBJECTIVES

To identify differences in architectural parameters (size, fiber/pennation angle, fiber length, and echogenicity) of the quadriceps muscle, as a whole or any individual part of it, using imaging techniques in individuals with patellofemoral pain (PFP) compared to contralateral, asymptomatic limb or separate control group.

BACKGROUND

Quadriceps muscles imbalance and weakness were proposed as risk factors for developing PFP. Although the muscle architecture (size, pennation/fiber angle and fiber length) is highly associated with skeletal muscle strength, it is not clear whether atrophy or any changes in architectural parameters of the quadriceps are presented in the PFP patients.

METHODS

Observational studies in which the total size of the quadriceps or individual parts of it were measured using imaging techniques in the PFP patients were included in this review. Electronic databases (PubMed, SCOPUS, PEDro, CINAHL, WOS, and EMBASE) were searched between January 1990 and December 2019 with no restriction of language. Study selection and data extraction and quality assessment were conducted by two independent reviewers.

RESULTS

Five cross-sectional studies were eligible to include in this review. Three out of five included studies that assessed the total size of the quadriceps and reported no significant differences between the PFP and healthy control group. Two out of five of the studies assessed the total size of the quadriceps between the symptomatic and asymptomatic limb of the PFP patients and reported the statistical difference between limbs. Only one study measured the fiber angle of the VMO muscle at the patella. Controversial results were found between studies that assessed the size of individual parts of the quadriceps.

CONCLUSION

Due to the controversial results of the included studies, this systematic review failed to draw a conclusion on the role of quadriceps atrophy in PFP pathology. The limitation in PFP literature considering pennation/fiber angle, echogenicity and fiber length of individual parts of the quadriceps muscle, rises the need for research that focuses on the biomechanical properties of the quadriceps in PFP patients.

Effects of Muscle Energy Technique on Daily Activities and Lumbar Stiffness in Women With Sacroiliac Joint Dysfunction: A Randomized Controlled Clinical Trial Study

Introduction: Lumbar stiffness is a common complaint of patients with low back pain. The Muscle Energy Technique (MET) is a common intervention to treat the spine and sacroiliac joint dysfunctions and their resulting disability in daily activities. This research aimed to evaluate the effects of MET on pain, functional disability, and lumbar stiffness of patients with sacroiliac joint dysfunctions by considering the type of dysfunction and the orientation of the correcting maneuver. Materials and Methods: Fifty women with ant innominate or post innominate dysfunctions were recruited for the research and randomly divided into two groups (n=25). One group received one session of MET, and the other group received the sham position. Visual Analogue Scale (VAS), lumbar Stiffness Disability Index (SDI) and Oswestry Disability Index (ODI) were used for the evaluation of the participants before, 24 hours after and one week after the intervention. Results: According to the results, MET significantly decreased the mean range of VAS and ODI, 24 hours, and a week after the intervention (P<0.01). We did not see any significant difference in SDI values before, 24 hours, and one week after MET in the patients (P>0.01). Conclusion: Applying MET regarding the kind of dysfunction may reduce the patient’s pain and disability.

Effectiveness of Dry Needling for the Management of Plantar Fasciitis: A Review Study

Introduction: Plantar Fasciitis (PF) is an overuse syndrome as it develops over time. It is most frequently seen in both the non-athletic and athletic populations. PF is a multifactorial and self-limiting disorder that several factors are involved in its onset. Many well-established treatments are available for plantar heel pain. The purpose of this review is to determine the effectiveness of dry needling for the management of PF. Materials and Methods: This article is a review study,  in which  we present  the  studies that compare dry needling with other treatments for the management of plantar  heel pain.  We included all of the studies on patients with plantar heel pain and plantar fasciitis that investigated the effects of dry needling. Finally, seven articles were included in this review. The  study  designs  were  randomized  controlled,  quasi-experimental,  and  case-control. The Physiotherapy Evidence-based Database (PED) scale was used to measure the methodological quality of the studies. Results: The PEDro scoring of the articles ranged between 2.10-7.10. The results of this review show that dry needling may be useful in improving the pain of individuals with plantar heel pain and plantar fasciitis. Conclusion: Further high-quality research studies are needed to determine the effectiveness of dry needling in the management of plantar heel pain. Because a variety of protocol treatments of dry needling were used in the studies, we cannot recommend dry needling schedule prescriptions for the management of individuals with plantar heel pain and plantar fasciitis.

Comparative effect of driving side on low back pain due to Repetitive Ipsilateral Rotation

Objective:

To determine the effects of repetitive ipsilateral rotation on low back pain among the taxi drivers of right and left hand drive.

Methods:

A total of 1200 (600 Iran+600 Pakistan) male taxi drivers, aged between 20-60 years with work experience of more than one year were randomly selected and interviewed in Tehran (Iran) & Lahore (Pakistan) to fill self-administered questionnaires in Persian and Urdu languages which contained socio-demographic, work related and LBP characteristics. Chi-square test and multiple logistic regression models were employed for statistical analyses.

Results:

Point, one week, one year and lifetime prevalence of LBP among right hand drive taxi drivers was 26.7%, 35.5%, 49.8% and 77.7% respectively. Point, one week, one year and lifetime prevalence of LBP among left hand drive taxi drivers was 37%, 42.7%, 53.5% and 72.3% respectively. Mean Numeric Pain rating scale (NPRS) score was 4.15 (SD=1.42) in Pakistan, while in Iran it was 4(SD=1.57). There was no significant difference regarding pain intensity (p=0.123) between drivers from both countries. Mean Roland-Morris Questionnaire (RMQ) score among drivers in Pakistan with LBP was 7.76(SD= 2.50), while in Iranian drivers who had LBP, mean RMQ score was 7.71(SD=2.99).

Conclusion:

Static or less dynamic muscles are more prone to LBP due to lower endurance. Lack of exercising habit, work as a driver for more number of years, driving within city, more driving hours in a day, forward bending, lifting, no seat comfort, lack of awareness regarding ergonomics and lower satisfaction level of job were the main reasons of LBP.

Quadriceps architecture in individuals with patellofemoral pain: a systematic review protocol

OBJECTIVE

The objective of this review is to identify differences in quadriceps architectural parameters between healthy individuals and those with patellofemoral pain (PFP).

INTRODUCTION

Patellofemoral pain is one of the most common causes of knee pain among physically active populations. Muscular imbalance may play an important role in patellar malalignment or patellar maltracking. A systematic review will clarify the possible architectural changes of quadriceps muscles in persons with PFP.

INCLUSION CRITERIA

Eligible observational studies will include individuals younger than 50 years who have been diagnosed with unilateral or bilateral PFP. The comparator will be the contralateral, asymptomatic limb of the individual with PFP or a healthy matched subject. Studies that include measurement of quadriceps muscle size as the primary outcome will be considered. Studies in which participants had coexisting pathology, a history of lower limb surgery or injury, or pain originating from other joints will be excluded.

METHODS

PubMed/MEDLINE (NLM), Scopus, Embase, Physiotherapy Evidence Database, Web of Science and CINAHL databases and multiple gray literature sources will be searched. Studies published since 1 January 1990 will be considered; there will be no language restriction. Retrieval of full-text studies, assessment of methodological quality and data extraction will be performed independently by two reviewers. If possible, meta-analyses will be performed, and a Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Summary of Findings presented.

Pattern of changes in latissimus dorsi, gluteus maximus, internal oblique and transverse abdominus muscle thickness among individuals with sacroiliac joint dysfunction

Background and Objective:

Altered Pattern of the Global Muscle system is presented in literature among individuals with sacroiliac Joint Dysfunctions. However, the pattern of changes in the Latissimus dorsi (LD) and gluteal maximus (GM) among sacroiliac joint dysfunctions (SIJD) is not reported. This study aimed to investigate the changes in the resting muscle thickness of the Latissimusdorsi and gluteal maximus in SIJD.

Method:

A total of 88 subjects (44 individuals with SIJD and 44 healthy individuals as matched control) was included in this study. The resting thickness of the Latissimusdorsi and gluteal maximus was measured using real time musculoskeletal ultrasonography and data was compared between the ipsilateral side and contra lateral side among subjects with SIJD as well as healthy subjects. Independent sample t test was used to analyze the data by using SPSS version-25.

Results:

The results showed that contralateral LD were reduced significantly among subjects with SIJD when compared with the other side and with control. It also showed that ipsilateral IO, TrA and GM were reduced significantly among subjects with SIJD when compared with the controls and with contralateral side.

Conclusion:

The reduced resting muscle thickness showed an altered motor pattern of Deep Muscles of local system and Gross muscles of global system among patients with sacroiliac joint dysfunction.

Ultrasound evaluation of the quadriceps muscles in pronated foot posture

OBJECTIVE

The main goal of this study was to investigate the size of all portions of the quadriceps muscles in individuals with pronated foot posture compared to normal foot posture using ultrasound imaging.

DESIGN

Twenty nine females with pronated foot posture and 29 age-, body weight-, body height-matched females with normal foot posture were recruited from university communities. The muscle thicknesses of the rectus femoris (RF), vastus medialis (VM), vastus medialis oblique (VMO), vastus lateralis (VL) and vastus intermedius (VI) were measured using ultrasound imaging.

RESULTS

The thicknesses of the RF and VMO were significantly smaller in individuals with pronated foot posture compared to normal foot posture (p<0.05). No significant differences were observed in the VM, VL, and VI muscle thicknesses in both groups.

CONCLUSION

Based on the results of the present study, it seems that besides the foot and lower leg muscles, an integrated assessment of proximal knee muscles, especially quadriceps, is required in individuals with pronated foot posture.

Test-retest reliability of nerve and muscle morphometric characteristics utilizing ultrasound imaging in individuals with unilateral sciatica and controls

Background

Ultrasound imaging has been suggested for studying the structure and function of nerves and muscles; however, reliability studies are limited to support the usage. The main aim of this study was to explore the intrarater within-session reliability of evaluating the sciatic nerve and some related muscles morphology by ultrasound imaging.

Methods

Three B-mode images from two scans (transverse and longitudinal) were acquired from the multifidus, biceps femoris, soleus and medial gastrocnemius muscles bilaterally from 15 participants with sciatica and 15 controls in one session, 1-h apart. The data were collected from March to July 2017. Contraction ratio was measured only by longitudinal scan, while the echo intensity was measured using maximum rectangular region of interest in two scans (transverse and longitudinal) for all muscles. Cross-sectional area, direct (tracing) and indirect (ellipsoid formula) methods were used to measure the sciatic nerve. Intraclass correlation coefficient (ICC 3,1), standard error of measurement and minimal detectable change were calculated.

Results

Good to high ICCs (0.80–0.96) were found for muscle contraction ratio in the longitudinal scans in all the muscles in both sciatica and control groups. For echo intensity measurements ICCs ranged from moderate to high, with higher ICCs seen with the maximum region of interest in the transverse scans. The minimal detectable change values ranged between 0.11 and 0.53 cm for contraction ratio.

Conclusions

Ultrasound imaging has high intrarater within-session reliability for assessing the sciatic nerve Cross-sectional area and muscle contraction ratios. Transverse scans with the maximum region of interest result in higher reliability. The sciatic Cross-sectional area is most accurately measured utilizing the direct tracing method rather than the indirect ellipsoid method.

The effect of dry needling on spasticity, gait and muscle architecture in patients with chronic stroke: A case series study

Objectives The objective of this study was to assess the short-term effects of dry needling on spasticity, gait, and muscle architecture of patients with chronic stroke. Methods A case series study was designed; and six chronic stroke patients with ankle spasticity and gait impairment received a single session of dry needling for gastrocnemius medialis, lateralis, and soleus muscles. The main outcome measures were the Modified Modified Ashworth Scale (MMAS), and Timed Up and Go test (TUG). In addition, ultrasonography measurements (e.g. thickness, pennation angle, and fascicle length) were performed for gastrocnemius medialis at baseline (T0), immediately after intervention (T1) and 30 min after intervention (T2), while the MMAS and TUG Test were only measured at T0 and T2. Results Based on the TUG test, there was a significant improvement in gait function (p = 0.023). Furthermore, the MMAS results (p = 0.014) showed a decrease in resistance to passive movements from plantar flexor muscles. Furthermore, a significant decrease in pennation angle (p = 0.014) and muscle thickness (p = 0.001), and also a significant increase in fascicle length of gastrocnemius medialis (p = 0.001) were observed after dry needling. Discussion & conclusions Based on the outcomes of this study, dry needling application seems to have short term effects in terms of reducing spasticity, improving gait, and muscle architecture of gastrocnemius medialis in patients with chronic stroke. The changes of muscle architecture may be interpreted as the positive effects of dry needling on the physical properties of hypertonic muscles.

Reliability of digital photography for assessing lower extremity alignment in individuals with flatfeet and normal feet types

AIM

The aim of this study was to investigate the intratester reliability of digital photographic method for quantifying static lower extremity alignment in individuals with flatfeet and normal feet types.

METHODS

Thirteen females with flexible flatfeet and nine females with normal feet types were recruited from university communities. Reflective markers were attached over the participant's body landmarks. Frontal and sagittal plane photographs were taken while the participants were in a standardized standing position. The markers were removed and after 30 min the same procedure was repeated. Pelvic angle, quadriceps angle, tibiofemoral angle, genu recurvatum, femur length and tibia length were measured from photographs using the Image j software.

RESULTS

All measured variables demonstrated good to excellent intratester reliability using digital photography in both flatfeet (ICC: 0.79-0.93) and normal feet type (ICC: 0.84-0.97) groups.

CONCLUSION

The findings of the current study indicate that digital photography is a highly reliable method of measurement for assessing lower extremity alignment in both flatfeet and normal feet type groups.

Therapeutic effects of dry needling in patients with upper trapezius myofascial trigger points

BACKGROUND

Active myofascial trigger points (MTrPs) are major pain generators in myofascial pain syndrome. Dry needling (DN) is an effective method for the treatment of MTrPs.

OBJECTIVE

To assess the immediate neurophysiological and clinical effects of DN in patients with upper trapezius MTrPs.

METHODS

This was a prospective, clinical trial study of 20 patients with upper trapezius MTrPs and 20 healthy volunteers (matched for height, weight, body mass index and age), all of whom received one session of DN. Primary outcome measures were neuromuscular junction response (NMJR) and sympathetic skin response (SSR). Secondary outcomes were pain intensity (PI) and pressure pain threshold (PPT). Data were collected at baseline and immediately post-intervention.

RESULTS

At baseline, SSR amplitude was higher in patients versus healthy volunteers (p<0.003). With respect to NMJR, a clinically abnormal increment and normal reduction was observed in patients and healthy volunteers, respectively. Moreover, PPT of patients was less than healthy volunteers (p<0.0001). After DN, SSR amplitude decreased significantly in patients (p<0.01), but did not change in healthy volunteers. A clinically important reduction in the NMJR of patients and increment in healthy volunteers was demonstrated after DN. PPT increased after DN in patients, but decreased in healthy volunteers (p<0.0001). PI improved after DN in patients (p<0.001).

CONCLUSIONS

The results of this study showed that one session of DN targeting active MTrPs appears to reduce hyperactivity of the sympathetic nervous system and irritability of the motor endplate. DN seems effective at improving symptoms and deactivating active MTrPs, although further research is needed.

TRIAL REGISTRATION NUMBER

IRCT20130316128.

Effects of one session radial extracorporeal shockwave therapy on post-stroke plantarflexor spasticity: a single-blind clinical trial

Purpose To examine the effects of radial extracorporeal shockwave therapy (rESWT) on plantarflexor spasticity after stroke. Method Twelve patients with stroke were randomly included for this prospective, single-blind clinical trial. Patients received one rESWT session (0.340 mJ/mm², 2000 shots) on plantarflexor muscle. The Modified Modified Ashworth Scale (MMAS), H-reflex tests, ankle range of motion (ROM), passive plantarflexor torque (PPFT) and timed up and go test (TUG) were measured at baseline (T₀), immediately after treatment (T₁) and one hour after the end of the treatment (T₂). Results Patients had improved the MMAS scores for both the gastrocnemius and the soleus muscles, active and passive ROM, PPFT and TUG over time after rESWT. For the PPFT, it was greater at high velocity than at low velocity, and there was a significant three-way interaction between time, knee position (extended/flexed) and velocity (low/high). The H-reflex latency had decreased at T₁, but there was no significant effect on H_max/M_max ratio. Conclusions The rESWT improved plantarflexor spasticity, and the effects sustained for one hour, whereas it was not effective in improving spinal excitability. Implications for Rehabilitation One session radial extracorporeal shock wave therapy (rESWT) is safe and effective in improving post stroke plantarflexor spasticity, ankle active and passive range of motion, passive torque, and walking capability. The spasticity scores improved for both the gastrocnemius and the soleus muscles and persisted one hour after rESWT. The magnitude of resistive plantarflexor passive torque in the knee extended position and high velocity was larger over time suggesting greater gastrocnemius spasticity than soleus. The rESWT had no significant effects on alpha motorneuron excitability.

Effect of cognitive task on postural control of the patients with chronic ankle instability during single and double leg standing

OBJECTIVE

The aim of this study was to investigate the effect of a cognitive task on standing postural control of the injured and non-injured leg of athletes with chronic ankle instability.

METHODS

Postural stability was measured by center of pressure parameters while chronic ankle instability patients (n = 8) randomly performed single and double leg standing in isolation or concurrently with a digit-backward cognitive task.

RESULTS

After performing a concurrent cognitive task, anteroposterior sway significantly decreased in injured leg (P < 0.05) and area significantly decreased in both injured and non-injured legs (P < 0.05). There was no significant difference in all center of pressure parameters between injured and non-injured legs.

CONCLUSION

The findings confirm the effect of a concurrent digit-backwards memory task on single leg standing balance in chronic ankle instability patients but the response to cognitive loading was not significantly different between the injured and non-injured legs.

Neurophysiological and clinical effects of dry needling in patients with upper trapezius myofascial trigger points

INTRODUCTION

Dry needling (DN) is a widely used in treatment of myofascial trigger points (MTrPs). The purpose of this pretest-posttest clinical trial was to investigate the neurophysiological and clinical effects of DN in patients with MTrPs.

METHODS

A sample of 20 patients (3 man, 17 women; mean age 31.7 ± 10.8) with upper trapezius MTrPs received one session of deep DN. The outcomes of neuromuscular junction response (NMJR), sympathetic skin response (SSR), pain intensity (PI) and pressure pain threshold (PPT) were measured at baseline and immediately after DN.

RESULTS

There were significant improvements in SSR latency and amplitude, pain, and PPT after DN. The NMJR decreased and returned to normal after DN.

CONCLUSIONS

A single session of DN to the active upper trapezius MTrP was effective in improving pain, PPT, NMJR, and SSR in patients with myofascial trigger points. Further studies are needed.

Effects of repetitive transcranial magnetic stimulation on lower extremity spasticity and motor function in stroke patients

PURPOSE

To investigate the effect of low-frequency repetitive transcranial magnetic stimulation (rTMS) on lower extremity (LE) spasticity, motor function and motor neurone excitability in chronic stroke patients.

METHOD

This study was a randomised sham-controlled cross-over trial with 1-week follow-up. A total of 20 post-stroke patients were randomised to receive active (n = 10) or sham (n = 10) rTMS. Fourteen of them (7 in each group) crossed over to the sham or active rTMS after a washout period of 1 month. Interventions consist of five consecutive daily sessions of active or sham rTMS to the unaffected lower extremity motor area (1000 pulses; 1 Hz; 90% of the tibialis anterior motor threshold). Outcome measures were modified modified ashworth scale (MMAS), the H-reflex, lower extremity section of Fugl-Mayer assessment (LE-FMA) and timed UP and GO (TUG) test. All outcomes were measured at three levels in each intervention period: pre- and post-intervention and 1-week follow-up.

RESULTS

Friedman's test revealed significant improvement in MMAS score only after active rTMS. This improvement lasted for one week after the active rTMS. Repeated measure analysis of variance (ANOVA) showed significant time*intervention interaction for LE-FMA. There are no differences between groups for the MMAS and LE-FMA. No significant change in Hmax/Mmax ratio and TUG test was noted.

CONCLUSION

Low-frequency rTMS over the LE motor area can improve clinical measures of muscle spasticity and motor function. More studies are needed to clarify the changes underlying this improvement in spasticity. Implications for Rehabilitation Spasticity is a common disorder and one of the causes of long-term disability after stroke. Physical therapy modalities, oral medications, focal intervention and surgical procedures have been used for spasticity reduction. Beneficial effect of the repetitive transcranial magnetic stimulation (rTMS) for post-stroke upper extremity spasticity reduction and motor function improvement was demonstrated in previous studies. This study shows amelioration of lower extremity spasticity and motor function improvement after five daily sessions of inhibitory rTMS to the unaffected brain hemisphere which lasted for at least 1 week following the intervention.

Effect of Countermovement and Arm Swing on Vertical Stiffness and Jump Performance

Objectives To determine the effect of using arm swing and countermovement on vertical stiffness and maximum vertical jump performance. Participants A total of 25 young healthy females were participated in the study. They stood on the force plate and performed two models of squat jump with (SJA) and without arm swing (SJ) and two models of countermovement jump with (CMJA) and without arm swing (CMJ).Main outcome measures Vertical leg stiffness, jump height, flight time, contact time and power were compared in SJ, SJA, CMJ and CMJA.Results In the CMJs, the stiffness and jump height were significantly higher than SJA and SJ. Contact time in jumps with countermovement and/or arm swing was three times lower than SJA and SJ.Conclusion Vertical stiffness and performance parameters can be improved by using countermovement and arm swing during vertical jump and due to enhancement in work output and ground reaction force.

Muscle timing in injured and non-injured leg of athletes with chronic ankle instability in response to a visual stimulus during forward jumping

OBJECTIVE

The aim of this study was to investigate premotor time, motor time and reaction time of the injured and non-injured leg muscles of athletes with chronic ankle instability in response to a visual stimulus during forward jumping.

METHODS

Surface electromyography was performed on injured and non-injured leg of eight athletes with chronic ankle instability during forward jumping.

RESULTS

Results showed that premotor time of the peroneus longus was significantly longer in non-injured leg compared with injured leg (489.37 ± 220.22 ms vs. 306.46 ± 142.92 ms, P = 0.031); on the contrary, motor time of the peroneus longus was significantly shorter in non-injured leg compared with injured leg (569.04 ± 318.62 ms vs. 715.12 ± 328.72 ms, P = 0.022). No significant difference was noted in the timing of other calf muscles (P > 0.05).

CONCLUSION

According to the results of this study, rehabilitation protocols, regarding ankle instability, need to put greater emphasis on tasks that require proper timing of muscles and muscle re-education so that protocols could reduce residual symptoms after sprain and prevent recurrent sprains.

Characteristic muscle activity patterns during gait initiation in the healthy younger and older adults

It is thought that gait initiation (GI) might be an optimal task for identifying postural control deficiencies. Thus, the aim of this study was to clarify the strategies adopted by older subjects during this task. 16 healthy younger and 15 healthy older adults participated in the study. Subjects were instructed to begin forward stepping with their dominant limb in response to an auditory stimulus. The mean muscle activity, co-contraction index, and intra-subject coefficients of variation (intra-subject CVs) of dominant limb muscles in different phases of GI were measured. The level of association between the co-contraction index and intra-subject CV of muscles was also explored. This study showed that in the anticipatory phase, the younger group had larger amplitudes and more intra-subject CVs than older the group, particularly for the tibialis anterior muscle. However, the co-contraction index was greater in older subjects relative to younger subjects. During the weight transition phase, tibialis anterior, semitendinosus and vastus lateralis muscles of older adults had a lower amplitude as compared to younger adults. However, during the locomotor phase, the activity of tibialis anterior was greater in comparison to younger adults. Also, during this phase, similar to the anticipatory phase, the co-contraction index between tibialis anterior and gastrocnemius muscles was greater in older subjects relative to younger subjects. Additionally, the larger co-contraction index of some muscles was associated with smaller intra-subject CV. These findings suggest that muscle behaviors are altered with aging and older adults employ different strategies in the different phases of GI as compared to younger adults.

Cross-Cultural Adaptation of the Micheli Functional Scale to Persian Language for Evaluation of Low Back Pain in the Young Athletes

BACKGROUND

A clinical outcome tool is needed for the assessment of young athletes with low back pain.

OBJECTIVES

To translate and culturally adapt the Micheli functional scale (MFS), a self-report questionnaire developed to evaluate young athletes with low back pain (LBP) into Persian language and examine the reliability and validity of the Persian MFS (PMFS).

MATERIALS AND METHODS

A cross-sectional study was conducted to assess the psychometric properties of the PMFS. The PMFS was cross-culturally adapted into Persian language adopting forward/backward translation, expert panel review, and pre-testing. The PMFS was administered to young athletes with and without LBP. Main outcome measures were Persian MFS, Persian functional rating Index (PFRI), and visual analogue scale (VAS).

RESULTS

A sample of 100 young athletes with LBP with a mean age of 16.5 ± 2.5 years participated. Fifty young athletes without LBP completed the PMFS. There was no missing responses and floor or ceiling effects. There was a significant difference for the total PMFS scores between young athletes with and without LBP. A significant correlation was found between the total PMFS score and the VAS (r = 0.92) or the PFRI (r = 0.82; P < 0.001). A high internal consistency reliability (Cronbach α = 0.73), and excellent test-retest reliability (ICCagreement = 0.99, P < 0.001) were demonstrated for the PMFS. Factor analysis indicated a single-factor model for PMFS scores.

CONCLUSIONS

The Persian MFS is valid and reliable for use in Persian-speaking young athletes with LBP.

A pilot study on the effects of low frequency repetitive transcranial magnetic stimulation on lower extremity spasticity and motor neuron excitability in patients after stroke

PURPOSE

To evaluate the effect of low frequency, repetitive transcranial magnetic stimulation (rTMS) on the lower extremity spasticity and motor neuron excitability in patients after stroke.

METHODS

Seven patients after stroke aged 42-78 years were included in this pretest-posttest clinical trial. The rTMS at 1 Hz and duration of 20 min was applied to the intact leg motor cortex for five consecutive sessions. Primary outcome measures were the Modified Modified Ashwoth Scale (MMAS) and the H(max)/M(max) ratio. Measurements were taken at baseline (T0), after the last treatment (5th) session (T1), and at 1 week follow up (T2).

RESULTS

Clinically assessed ankle plantar flexor spasticity (p = 0.05) improved significantly after treatment at T1. Knee extensor spasticity scored 0 after treatment at T1 and T2. The H(max)/M(max) ratio showed no statistically significant improvement after treatment.

CONCLUSION

The pilot data indicate that the inhibitory rTMS of the intact leg motor cortex in patients after stroke may improve the lower extremity spasticity.

Effects of cyclic static stretch on fatigue recovery of triceps surae in female basketball players

Static stretch is a safe and feasible method which usually is used before exercise to avoid muscle injury and to improve muscle performance. The purpose of this study was to determine the effects of cyclic static stretch (CSS) on fatigue recovery of triceps surae (TS) in female basketball players. Nine athlete volunteers between 20 and 30 years participated in this study containing two sessions. After warm-up a pressure cuff was fastened above the knee joint and its pressure was increased to 140 mmHg. The subjects were asked to perform one maximum voluntary contraction (MVC) followed by a fatigue test including maximum isometric fatiguing contraction of TS. These steps were similar in both sessions. Then, a two-minute rest was included in the first session while 4 static stretches were performed to TS in the second session. After interventions, one MVC was done and the pressure cuff was released. During these steps, peak torque (PT) and electromyography (EMG) were recorded. The amount of lower leg pain was determined by the visual analogue scale (VAS). The value of PT increased significantly after CSS but its increase was not significant after rest. It seems that the effects of rest and CSS on the EMG parameters, PT and pain are similar.

The neurophysiological effects of dry needling in patients with upper trapezius myofascial trigger points: study protocol of a controlled clinical trial

INTRODUCTION

Dry needling (DN) is an effective method for the treatment of myofascial trigger points (MTrPs). There is no report on the neurophysiological effects of DN in patients with MTrPs. The aim of the present study will be to assess the immediate neurophysiological efficacy of deep DN in patients with upper trapezius MTrPs.

METHODS AND ANALYSIS

A prospective, controlled clinical trial was designed to include patients with upper trapezius MTrPs and volunteered healthy participants to receive one session of DN. The primary outcome measures are neuromuscular junction response and sympathetic skin response. The secondary outcomes are pain intensity and pressure pain threshold. Data will be collected at baseline and immediately after intervention.

ETHICS AND DISSEMINATION

This study protocol has been approved by the Research Council, School of Rehabilitation and the Ethics Committee of Tehran University of Medical Sciences. The results of the study will be disseminated in a peer-reviewed journal and presented at international congresses.

The effects of triceps surae fatigue on the torque and electromyographic parameters in athletes compared with non-athletes

BACKGROUND AND OBJECTIVES

The common description of muscular fatigue is the failure of muscle in maintaining a target force. Even in sustained contraction, when muscle force is held at a stable level, physiological, biomechanical and electromyographic changes can occur. The purpose of this study is to compare the effects of triceps surae (TS) fatigue on the torque, falling slope and electromyographic (EMG) parameters between athletes and non-athletes.

MATERIALS AND METHODS

Nineteen healthy women (10 non-athletes and 9 basketball players) participated in this study. After warm-up, subjects performed one maximum voluntary contraction (MVC) followed by fatigue test including sustained maximum isometric contraction of TS until the peak torque (PT) decreased to 50% of maximum value. Immediately after the test, subjects were asked to perform one MVC; then, root mean square (RMS), median frequency (MDF), median frequency slope (MDF slope), PT, falling slope (FSL) and the amount of pain were measured.

RESULTS

In both groups shift of MDF slope to negative values, significant decrease of MDF and RMS occurred at the end of the fatigue test (P < 0.05). Immediately after the test, PT decreased significantly in both groups (P < 0.05), however, decrease of FSL was significant in non-athletes (P < 0.05) but not in athletes. After fatigue test, increase in Pain was significant in both groups (P < 0.05). Before fatigue test, at the end, and immediately after the test, MDF of non-athletes was more than athletes. There was no significant difference in RMS between the two groups.

CONCLUSION

Our findings suggest that TS fatigue affects EMG parameters, PT and pain in athletes and non-athletes similarly.

The beneficial effects of adding low level laser to ultrasound and exercise in Iranian women with shoulder tendonitis: a randomized clinical trial

OBJECTIVES

A randomized, double-blind, clinical trial study was conducted with the aim of determining the efficacy of adding laser (830 nm) to ultrasound (US) and exercise for the management of shoulder tendonitis.

METHODS

42 subjects (n=21, in adding laser group and n=21, in US and exercise group) received a course of 10 sessions treatment over one month in the shoulder region. Outcome measures such as Visual Analogue Scale (VAS), Tenderness Severity Scale (TSS), Constant Murley Score (CMS) and Manual Muscle Testing (MMT) were performed before treatment and at the end of 4 weeks treatment. In addition, follow up were performed 2 months after the end of treatment based on the degree of pain improvement.

RESULTS

VAS, TSS and CMS improved significantly (P=0.001) in both groups, however the muscle strengths only improved significantly in adding laser group (P< 0.01).

CONCLUSION

It seems that both protocols of physical therapy interventions were effective in relieving the signs and symptoms of shoulder tendonitis. Furthermore, adding low level laser therapy (LLLT) to the US and exercise was more efficient in improving the muscle strength in patients with shoulder tendonitis over a period of three months. However, it should be emphasized that, the current results might be due to the effects of laser and exercise instead of laser, us and exercise (as we had no independent group for US).

Whole-body vibration and the prevention and treatment of delayed-onset muscle soreness

CONTEXT

Numerous recovery strategies have been used in an attempt to minimize the symptoms of delayed-onset muscle soreness (DOMS). Whole-body vibration (WBV) has been suggested as a viable warm-up for athletes. However, scientific evidence to support the protective effects of WBV training (WBVT) on muscle damage is lacking.

OBJECTIVE

To investigate the acute effect of WBVT applied before eccentric exercise in the prevention of DOMS.

DESIGN

Randomized controlled trial.

SETTING

University laboratory.

PATIENTS OR OTHER PARTICIPANTS

A total of 32 healthy, untrained volunteers were randomly assigned to either the WBVT (n  =  15) or control (n  =  17) group.

INTERVENTION(S)

Volunteers performed 6 sets of 10 maximal isokinetic (60°/s) eccentric contractions of the dominant-limb knee extensors on a dynamometer. In the WBVT group, the training was applied using a vibratory platform (35 Hz, 5 mm peak to peak) with 100° of knee flexion for 60 seconds before eccentric exercise. No vibration was applied in the control group.

MAIN OUTCOME MEASURE(S)

Muscle soreness, thigh circumference, and pressure pain threshold were recorded at baseline and at 1, 2, 3, 4, 7, and 14 days postexercise. Maximal voluntary isometric and isokinetic knee extensor strength were assessed at baseline, immediately after exercise, and at 1, 2, 7, and 14 days postexercise. Serum creatine kinase was measured at baseline and at 1, 2, and 7 days postexercise.

RESULTS

The WBVT group showed a reduction in DOMS symptoms in the form of less maximal isometric and isokinetic voluntary strength loss, lower creatine kinase levels, and less pressure pain threshold and muscle soreness (P < .05) compared with the control group. However, no effect on thigh circumference was evident (P < .05).

CONCLUSIONS

Administered before eccentric exercise, WBVT may reduce DOMS via muscle function improvement. Further investigation should be undertaken to ascertain the effectiveness of WBVT in attenuating DOMS in athletes.

Reliability of isokinetic normalized peak torque assessments for knee muscles in post-stroke hemiparesis

The purpose of this study was to establish test-retest reliability of measurement procedures for quantifying isokinetic concentric peak torque (PT) at the knee using normalization methods post-stroke. A second aim was to estimate the change required to show clinically significant improvements in knee muscles strength. The isokinetic normalized PT (NPT) values for the knee extensors and flexors were measured in each participant at two different angular velocities during two sessions 1 day apart. Thirty participants with mild to moderate hemiparesis after stroke who were able to walk were tested. The normalized PT measures for the knee muscles of the affected lower extremity were highly reliable (intraclass correlation coefficients ranged from 0.85 to 0.98; p<0.05). Size of relative changes (the percent smallest real difference, SRD%) for extensors NPT (ranged from 22.35% to 25.68%) were lower than flexors NPT (ranged from 74.01% to 76.31%), indicating that the affected isokinetic knee flexors had more random variation than the knee extensors. This study supports the use of isokinetic dynamometers for the assessment of knee muscle strength in participants with chronic mild to moderate post-stroke hemiparesis and to measure clinical improvements. Established measurement error and smallest real differences in normalized PT will aid interpretation of real changes in muscle strength in this clinical population.

A comparative study of whole body vibration training and conventional training on knee proprioception and postural stability after anterior cruciate ligament reconstruction

OBJECTIVE

To compare the effect of a whole body vibration training (WBVT) programme with a conventional training (CT) programme on knee proprioception and postural stability after anterior cruciate ligament (ACL) reconstruction.

METHODS

Twenty athletes with unilateral ACL reconstruction were randomly assigned to the WBVT or CT group; all participants received 12 sessions of WBVT or conventional training. Absolute error in joint repositioning for two target angles (30 degrees and 60 degrees ) was measured with the Biodex dynamometer; bilateral dynamic postural stability (anteroposterior, mediolateral and overall stability indices) was measured with the Biodex Stability System pre-intervention and post-intervention.

RESULTS

The improvement in postural stability in the WBVT group was significantly greater than that in the CT group (p< or =0.05). The p values of the changing scores of open overall, open anteroposterior, open mediolateral, closed overall, closed anteroposterior and closed mediolateral stability indices were 0.002, 0.010, 0.0001, 0.001, 0.0001 and 0.046, respectively. In addition, there were significant differences in all averages of absolute angular error at 60 degrees and 30 degrees between the WBVT and CT groups in both knees (p = 0.001 in healthy knees and p = 0.001 and p = 0.0001 in reconstructed knees), apart from the healthy knees at the 30 degrees target position, which was not significant (p = 0.131).

CONCLUSIONS

Whole body vibration training improved proprioception and balance in athletes with reconstructed ACL.

A randomized, single blind placebo controlled clinical trial on the effect of continuous ultrasound on low back pain

Low back pain (LBP) is a very common problem in primary care and a major cause of disability. There is no evidence for the efficacy of therapeutic modalities such as ultrasound in LBP In a randomized, single blind placebo controlled clinical trial, we aimed to evaluate the effect of continuous ultrasound (US) in patients with non specific LBP Of the fifty eight patients recruited, 10 patients (8 women and 2 men) randomly allocated to ultrasound (n=5) or placebo controlled (n=5) groups. The patients were treated by either US or sham-US for ten sessions, three days per week, every other day. The outcome measures were Functional Rating Index (FRI), Hmax/Mmax ratio and range of motion (ROM), which were measured at baseline, after 5 treatment sessions and at the end of treatment. To analyze the data, The Mann Whitney U test and Wilcoxon Signed Rank test were used. After treatment, both US and placebo groups showed statistically significant decrease in FRI scores indicating improvement in functional ability (p = 0.042 and p = 0.043, respectively). The mean changes of FRI during the second five treatment sessions and after the end of treatment was significantly better in the US group than in the placebo group (p = 0.016 and p = 0.032, respectively). Before and after treatment, the mean H reflex latency and Hmax/Mmax ratio, right and left side were similar in the groups (p > 0.05), and no significant changes were observed in the treatment groups (p > 0.05). After treatment, the extension and lateral flexion range of motion significantly increased in the US group (p = 0.04), but the back movements in the placebo group did not show significant changes (p > 0.05). The present study supports the significant effect of US on LBP, and suggests that US may improve the functional ability of patients with non specific low back pain.