Non-Invasive Radiofrequency Diathermy Neuromodulation Added to Supervised Therapeutic Exercise in Patellofemoral Pain Syndrome: A Single Blind Randomized Controlled Trial with Six Months of Follow-Up

The evidence-based treatment of patellofemoral pain (PFP) suggests that therapeutic exercise (TE) focused on improving muscle strength and motor control be the main conservative treatment. Recent research determined that the success of the TE approach gets improved in the short term by the addition of neuromodulation via radiofrequency diathermy (RFD). As there is no follow up data, the objective of this research is to assess the long-term effects of adding RFD to TE for the pain, function and quality of life of PFP patients. To this aim, a single-blind randomized controlled trial was conducted on 86 participants diagnosed of PFP. Participants who met the selection criteria were randomized and allocated into either a TE group or an RFD + TE group. TE consisted of a 20 min daily supervised exercise protocol for knee and hip muscle strengthening, while RFD consisted of the application of neuromodulation using a radiofrequency on the knee across 10 sessions. Sociodemographic data, knee pain and lower limb function outcomes were collected. The RFD + TE group obtained greater improvements in knee pain (p < 0.001) than the TE group. Knee function showed statistically significant improvements in Kujala (p < 0.05) and LEFS (p < 0.001) in the RFD + TE group in the short and long term. In conclusion, the addition of RFD to TE increases the beneficial effects of TE alone on PFP, effects that remain six months after treatment.

Supervised exercise with or without laser-guided feedback for people with non-specific chronic low back pain. A randomized controlled clinical trial

BACKGROUND

Among the most effective therapeutic interventions in non-specific chronic low back pain (NSCLBP), clinical practice guidelines highlight exercise therapy and patient education; However, regarding the combined intervention of exercise and Pain Neuroscience Education (PNE), there is no consensus on the most effective form of exercise.

OBJETIVE

To find out what changes occurred after the application of two exercise modalities [Supervised Exercise (SE) and Laser-Guided Exercise (LGE)] and PNE on pain, pain pressure thresholds, disability, catastrophizing, kinesiophobia and lumbar proprioception in subjects with NSCLBP.

METHODS

Single-blind randomized clinical controlled trial. 60 subjects with NSCLBP. Both groups performed a a total of 16 therapeutic exercise sessions and 8 Pain Neuroscience Education sessions. With the Laser-Guided Exercise Therapy group performing laser-guided exercises.

RESULTS

A significant decrease was observed for pain intensity for both groups between baseline and post-intervention and the 3 month follow-up (p < 0.001). There was a significant between-group difference between baseline and post-intervention scores in terms of pain intensity and kinesiophobia in favour of the LGE group.

CONCLUSION

Supervised exercise with or without laser feedback, when combined with PNE, reduces pain intensity, disability, pain catastrophizing, kinesiophobia and improves proprioception and PPTs in patients with NSCLBP. At a 3-month follow-up, the combination of LGE plus PNE is most effective for reducing pain intensity.

Effects of Radiofrequency Diathermy Plus Therapeutic Exercises on Pain and Functionality of Patients with Patellofemoral Pain Syndrome: A Randomized Controlled Trial

Although consensus has been reached about the use of therapeutic exercise in patellofemoral pain syndrome, several techniques used worldwide such as radiofrequency diathermy could be useful as complementary therapy. The objective of this randomized controlled trial was to compare the effects of adding radiofrequency diathermy to therapeutic exercises in patients with patellofemoral pain syndrome. Fifty-six participants were randomly assigned either to radiofrequency diathermy plus therapeutic exercises group (n = 29) or therapeutic exercises group (n = 27). Both groups received the same therapeutic exercises, and the diathermy group additionally received monopolar dielectric diathermy for three weeks (5-3-2 weekly sessions). Data related to intensity of pain, probability of neuropathic pain, functionality, and range of movement of the knee were measured at baseline and three weeks after the intervention. Comparing pre-treatment and values obtained at the third week, significant improvements were found in intensity of pain, neuropathic pain, functionality, and range of motion in both groups (p < 0.05). The diathermy plus exercises group had significantly better intensity of pain than the control group at the end of the three weeks (p < 0.01). The addition of diathermy by emission of radiofrequency to the therapeutic knee exercise protocol is more effective than a therapeutic exercise protocol alone in the relief of intensity of pain in patients with patellofemoral pain in the immediate post-treatment follow-up compared with baseline scores.

Does Inspiratory Muscle Training Affect Static Balance in Soccer Players? A Pilot Randomized Controlled Clinical Trial

Inspiratory muscle training (IMT) is effective in improving postural stability and balance in different clinical populations. However, there is no evidence of these effects in soccer players. A single-blind, two-arm (1:1), randomized, placebo-controlled pilot study on 14 soccer players was performed with the main aim of assessing the effect of IMT on static balance, and secondarily, of examining changes in the respiratory muscle function. The experimental group (EG) received an IMT program with progressive intensity, from 20% to 80%, of the maximal inspiratory pressure (MIP). The sham group (SG) performed the same program with a fixed load of 20% of the MIP. Static balance and respiratory muscle function variables were assessed. A two-factor analysis of variance for repeated measures was used to assess differences after training. Statistical significance was set at p < 0.05. Significant increases were observed in the EG on length of sway under eyes open (from 2904.8 ± 640.0 to 3522.4 ± 509.0 mm, p = 0.012) and eyes closed (from 3166.2 ± 641.3 to 4173.3 ± 390.8 mm, p = 0.004). A significant increase in the maximal voluntary ventilation was observed for both groups (EG p = 0.005; SG p = 0.000). No significant differences existed between the groups. IMT did not improve the static balance in a sample of soccer players. Conducting a high-scale study is feasible and could refine the results and conclusions stemming from the current pilot study.

The Clinical Benefits of a Dynamic vs. Static Component as Part of a Comprehensive Warm-Up for Recreational Sports Players with Clinical Histories of Hamstring Injuries: A Randomized Clinical Trial

Background: Few previous studies have analyzed the effects of certain specific static and dynamic warm-up components on recreational sports players with a previous hamstring injury. Therefore, the aim of this study was to analyze changes in some modifiable and external risk factors after (immediately and in a follow-up assessment after 10 min) a static or dynamic warm-up program on recreational sports players with a previous hamstring injury. Methods: A total of 62 participants were randomized into 2 groups: static warm-up (SW) (n = 31) or dynamic warm-up (DW) (n = 31). Range of movement (RoM), perceived pain, the pressure−pain threshold, and joint position sense were assessed at baseline, immediately after the intervention and 10 min afterwards. The intervention for the SW (hot pack procedures in both hamstring muscles) lasted 20 min. The DW intervention consisted of a running exercise performed on a treadmill for 10 min. Results: Both groups showed statistically significant changes (p ≤ 0.05) in the primary outcomes (perceived pain and the pressure−pain threshold) at the three measurement times (this was also true for RoM for the SW group, with statistically significant differences only between times from the baseline to the 10-min follow-up; p ≤ 0.05, d = 0.23). The intra-group secondary outcome showed no statistically significant changes (p > 0.05) in both groups (except for the period from the baseline−immediately after in the DW group; p ≤ 0.05, d = 0.53). The comparison between groups showed no statistically significant differences for any of the variables analyzed. (p ≥ 0.05). Conclusion: The present findings suggest that both specific warm-up modalities seem to positively influence perceived pain on stretching and the pressure threshold; however, the significant reduction in the joint repositioning error and the larger effect sizes observed in the DW group suggest that this method has a greater beneficial impact in recreational sports players with clinical histories of hamstring injuries.

Analysis of heart rate variability during emergency flight simulator missions in fighter pilots

INTRODUCTION

Managing emergency situations in different simulated flight segments can entail a workload that could affect the performance of military pilots. The aim was to analyse the modifications in neurovegetative balance (using HR variability, HRV) of professional fighter pilots attending learning/training sessions on emergency situations in a flight simulator.

METHODS

A total of 18 pilots from the Spanish Air and Space Force were included. HRV was recorded simultaneously during diverse simulated emergency situations in three different flight segments: take-off, in-flight and landing.

RESULTS

The comparison between take-off and in-flight revealed a statistically significant increase (p<0.05) in percentage of consecutive RR intervals that differ by more than 50 ms from each other (pNN50), root mean square of the successive differences (rMSSD), standard desviation 1 and 2 (SD1 and SD2), and a statistically significant decrease (p<0.000) in stress score (SS) and in the sympathetic to parasympathetic ratio (S:PS). Between flight and landing, a statistically significant increase (p<0.05) in mean HR, minimum HR, maximum HR, SS and S:PS was shown, while experiencing a significant decrease (p<0.000) in pNN50, rMSSD and SD2. Finally, between take-off and landing, the variables which showed significant changes (p<0.05), with these changes being a significant increase, were mean HR, minimum HR, maximum HR, rMSSD, SD1 and SD2. SS and S:PS ratios showed a statistically significant decrease (p<0.000).

CONCLUSIONS

An emergency situation in a flight simulator manoeuvre produced an anticipatory anxiety response in pilots, demonstrated by low HRV, which increased during the flight segment and decreased during the landing segment of the flight.Trial registration number NCT04487899.

The Impact on the Stress-Associated Autonomic Response of Physiotherapy Students Receiving Interferential Current in an Electrotherapy Training Session

Electrical currents are didactic contents widely applied in the training of physiotherapy students, but the treatment is considered a stressful situation for both the patient who receives it and the student who applies it. The aim of this study was to evaluate the stress-associated autonomic response of physiotherapy students receiving interferential current by measuring and analysing heart rate variability. An observational case-control study was conducted. Ninety healthy male volunteers, all physiotherapy degree students, were enrolled while attending laboratory practice during the 2020-2021 academic year. Participants were randomly allocated to a sham electrotherapy group (44 subjects), in which heart rate variability was recorded for 10 min, both at rest and during the application of sham technique on the lower back (10 min), and an electrotherapy group (46 subjects), applying the same procedure with the electrical current flowing. Outcome measures included baseline (seated position) and postintervention (prone position) time domain parameter, diameters of the Poincaré plot 1 and 2, stress score, and sympathetic/parasympathetic ratio. The sham electrotherapy group exhibited significant increases in time domain parameter (p = 0.027) and diameters of the Poincaré plot 1 (p = 0.032), with a small effect size (d ≤ 0.5). The electrotherapy group exhibited significant increases in time domain parameter and diameters of the Poincaré plot 1 and 2 (p < 0.001) and decreases in the stress score and sympathetic/parasympathetic ratio (p < 0.001), with a large effect size (d > 0.8) other than for the time domain parameter (d = 0.42), indicating increased parasympathetic and decreased sympathetic activity. After interventions, there were significant differences between groups in diameters of the Poincaré plot 2 (p < 0.001), stress score (p = 0.01) and sympathetic/parasympathetic ratio (p = 0.003), with moderate effect size (d > 0.5). The application of the interferential current technique produces stress-associated autonomic response characterized by greater parasympathetic activity and decreased sympathetic activity. Further studies are needed to determine possible adverse effects.

What Are University Professors' Motivations? A Realistic Approach to Self-Perception of a Group of Spanish University Professors Belonging to the G-9 Group of Universities

Universities face challenges on a number of levels. In this scenario, university professors play an important role as facilitators of knowledge. The main objective of this study was to analyse the motivations that influence the professional performance in a sample of 102 university professors from nine Spanish public universities (Male: 54 (52.9%); Female: 48 (47.1%)). For this purpose, a questionnaire of 22 closed-ended Likert-type questions was designed, in which scores ranged from 0 to 10 (do not agree at all, strongly agree). Following analysis, the final questionnaire was composed of 17 items, and showed good internal consistency (Cronbach’s alpha = 0.858). The validity analysis showed a value of 0.822 (>0.5) in the sample adequacy measure of Kaiser–Meyer–Olkin and Bartlett’s sphericity test (p < 0.0001). The exploratory factor analysis showed a clustering in four factors (two for intrinsic motivations and two for extrinsic motivations), explaining 64.33% of the total variance. Comparisons between each factor score by gender (male and female) showed statistically significant differences for factor F1 (higher for females) and F2 (higher for males). Finally, Q1 and Q13 showed a statistically significant correlation (p ≤ 0.05) with years of teaching experience. The motivations of Spanish university professors appear to be associated with the age and gender of the teacher.

Treatment of Patellofemoral Pain Syndrome with Dielectric Radiofrequency Diathermy: A Preliminary Single-Group Study with Six-Month Follow-Up

Background and Objectives: Notwithstanding patellofemoral pain syndrome (PFPS) being one of the most common causes of pain in the front of the knee in outpatients, few studies have shown the effects of radiofrequency on knee pain and function in this population. The aim of the present study was to determine whether outpatients diagnosed with PFPS obtained improvement in pain and function after treatment by dynamic application of monopolar dielectric diathermy by emission of radiofrequency (MDR). Materials and Methods: An experimental study was conducted with 27 subjects with PFPS. Subjects were treated with 10 sessions of MDR in dynamic application. The visual analogue scale (VAS), the Kujala scale, the DN4 questionnaire, the lower extremity function scale (LEFS), the range of movement (ROM) in knee flexion and extension and the daily drug intake were measured pre- and post-intervention and at the time of the follow-up (six months). Results: Statistically significant differences were found in pain perception (VAS: F_1,26 = 92.43, p < 0.000, ŋ² = 0.78 and DN4: F_1.26 = 124.15, p < 0.000, ŋ² = 0.82), as well as improvements in functionality (LEFS: F_1.26 = 72.42, p < 0.000, ŋ² = 0.74 and Kujala: F_1.26 = 40.37, p < 0.000, ŋ² = 0.61]) and in ROM (Flexion: F_1.26 = 63.15, p < 0.000, ŋ² = 0.71). No statistically significant changes in drug intake were found. Conclusions: The present study shows that the dynamic application of MDR seems effective in reducing pain and increasing functionality and knee flexion in patients with PFPS, after a follow-up of six months.

Immediate clinical benefits of combining therapeutic exercise and interferential therapy in adults with chronic neck pain: a randomized controlled trial

BACKGROUND

Therapeutic exercise is highly recommended for the management of non-specific neck pain and has shown promising results combined with interferential current therapy. Yet, the clinical relevance of the pooled effect of these approaches remains uncertain.

AIM

To investigate the immediate clinical effect size of combining therapeutic exercise and interferential therapy, compared with the isolated use of therapeutic exercise, in adults with chronic non-specific neck pain.

DESIGN

Randomized, single-blinded, controlled, superiority trial.

SETTING

Outpatients, primary care center.

POPULATION

Forty-nine adults with chronic non-specific neck pain.

METHODS

Participants with neck pain (grades I or II) lasting for more than 12 weeks were allocated to a therapeutic exercise plus interferential currents group (n = 25) or to a therapeutic exercise only group (n = 24). All individuals underwent treatment 5 times a week for 2 weeks. The primary outcome was current neck pain intensity (11-point numeric pain rating scale). Secondary outcomes included neck disability (Neck Disability Index) and active cervical range-of-movement (CROM device). Measurements were taken at baseline and immediately after treatment. An intention-to-treat analysis was carried out. To quantify the effect size of the interventions, the relative risk, the absolute and relative risk reduction, and the number needed to treat were calculated.

RESULTS

A significant time*group effect was found for pain intensity, disability, and neck flexion and right rotation (all, p < 0.05). In the analysis for treatment benefit, the number needed to treat was 2 (95% CI: 2 to 4, p < 0.001) for neck pain and disability, and 3 (95% CI: 2 to 11, p = 0.029) for neck flexion.

CONCLUSIONS

Adding interferential therapy to therapeutic exercise is clinically more effective than therapeutic exercise alone to immediately improve neck pain and disability, but not active cervical range-of-movement, in adults with persistent neck pain.

CLINICAL REHABILITATION IMPACT

Our results suggest that this multimodal intervention can be a useful strategy for rehabilitation of patients with non-specific neck pain. This is the first study on this topic reporting findings in terms of clinical relevance, which is key to transfer research evidence into practice.

Construction, Factor Structure, and Internal Consistency Reliability of the Hospital Physical Therapy Perceived Satisfaction Questionnaire (H-PTPS)

Patient satisfaction is a crucial aspect in the evaluation of the quality of health care provided by health services and units, especially in patients that require physical rehabilitation. This study aims to design and analyze the factor structure and internal consistency reliability of the Hospital Physical Therapy Perceived Satisfaction Questionnaire (H-PTPS) measuring the level of physical therapy patient satisfaction in hospital rehabilitation services. This study has a multicenter cross-sectional survey design. This study used the structural validity and internal consistency domains from COSMIN (consensus-based standards for the selection of health status measurement instruments) guideline. The H-PTPS questionnaire consists of 20 closed questions. A sample of 384 adult patients from physical therapy units from three Spanish public hospitals completed this questionnaire. A factor structure and internal consistency reliability analysis were performed. The factor analysis including the 20 items of the H-PTPS showed an adequacy index of 0.922 according to the Kaiser–Meyer–Olkin measure and the Barlett test allowed us to reject the null hypothesis (p < 0.001). In the rotated component matrix, four specific factors were obtained, explaining 66.75% of the accumulated variance. All factors present satisfactory internal reliability, achieving Cronbach’s alpha indices and Omega coefficients higher than 0.74. The H-PTPS questionnaire has shown a four-factor solution with satisfactory reliability evaluating the satisfaction of Spanish patients treated in physical therapy units in the hospital rehabilitation services.

Monopolar dielectric diathermy by emission of radiofrequency in Patellofemoral pain. A single-blind-randomized clinical trial

Despite the high incidence of patellofemoral pain syndrome (PFPS), few studies show the effects of radiofrequency on pain and functionality in these patients. For this reason, the aim of this study was to determine the efficacy of monopolar dielectric diathermy by emission of radiofrequency (MDR) in dynamic applications aimed at treating pain and improving function in patients with PFPS. For this purpose, a single-blind randomized clinical trial was conducted. Eighty-four participants with PFPS were evenly divided into an experimental group (EG) and a control group (CG). All subjects receive 10 min of daily home exercises along 3 weeks, and in addition, the subjects of the EG received 10 sessions based on the dynamic application of MDR. Variables measured included Visual Analogue Scale (VAS), DN4 questionnaire, Lower Extremity Functionality Scale (LEFS), Kujala scale, Range of Movement (ROM) in knee flexion and extension and drug intake. The EG showed a statistically significant reduction in pain (VAS = 4.8 [5.5-4.1] [p < .001]; DN4 = 3.8 [4.4-3.2] [p < .001]), and an increase in functionality (LEFS = 16 [19-13] [p < .001]; Kujala = 19 [23-14] [p < .001]) and in ROM (flexion 18º [21º-16º] [p < .001]). No statistically significant changes in drug intake were found. Based on this data, the dynamic application of MDR seems effective in reducing pain and increasing functionality and flexion in patients with PFPS. Diathermy by emission of radiofrequency could be recommended as complement or main therapy in the treatment of PFPS.

The Effect of Proprioceptive Exercises on Balance and Physical Function in Institutionalized Older Adults: A Randomized Controlled Trial

OBJECTIVES

To evaluate the efficacy of a proprioceptive exercise program on functional mobility, musculoskeletal endurance, dynamic and static balance, gait, and risk of falls in institutionalized older adults.

DESIGN

Randomized, single-blind, controlled trial.

SETTING

A Spanish nursing home in the autonomous community of Extremadura, Spain.

PARTICIPANTS

An initial sample was created by recruiting 148 older adult volunteers. The final sample (N=42) was randomly divided into 2 groups.

INTERVENTIONS

Both the control and experimental group received physical therapy treatment based on a combination of adapted exercises and other physical therapy techniques (physical therapy intervention program) for a period of 12 weeks. This program consisted of 45 minutes (group intervention) plus 100 minutes (individual intervention) a week, for a total of 36 sessions (29 hours). The experimental group received a proprioceptive training program during the same intervention period, which was conducted twice weekly (24 sessions), with each session lasting 55 minutes.

MAIN OUTCOME MEASURES

Timed Up and Go (TUG), Cooper, Tinetti, 1-leg stance, and the Morse Fall Scale (MFS).

RESULTS

Analysis of variance showed a time × group interaction in TUG score (F=10.41, P=.002), Cooper test (F=5.94, P=.019), Tinetti score (F=6.41, P=.015), and MFS scores (F=5.24, P=.028). Differences between groups were achieved for TUG scores (d=0.76), Tinetti scores (d=1.12), 1-leg stance test scores (d=0.77), and MFS scale scores (d=0.85). In the experimental group, within-group analyses showed pre- to post-treatment differences for TUG scores (d=0.72), Cooper test scores in meters (d=0.18), Tinetti scores (d=0.60), 1-leg stance scores (d=0.55), and MFS scores (d=0.42).

CONCLUSIONS

A proprioceptive exercise program demonstrated significant improvements compared with the control group in areas such as functional mobility, musculoskeletal endurance, balance, gait, and risk of falls in institutionalized older adults. This study may help to enhance our understanding of the impact of a specific protocol for a proprioceptive rehabilitation program.

Immediate effects and one-week follow-up after neuromuscular electric stimulation alone or combined with stretching on hamstrings extensibility in healthy football players with hamstring shortening

OBJECTIVE

To assess the immediate and mid-term (after 7 days) effects of electric current combined with simultaneous muscle stretching (EME technique) per comparison to the isolated use of the same current (without applying simultaneous muscle stretching), over the hamstring extensibility in football players with hamstring shortening, and to estimate the clinical benefit of the interventions according to the muscular extensibility.

METHODS

Forty-eight participants were randomized to receive one session of EME technique (n = 26) or one session of the electrical current (EC) alone (n = 22). The measurement of the hamstrings extensibility through the active knee test was carried out before and immediately after each intervention and one week later.

RESULTS

A significant interaction group x time was observed (F_2,84 = 7.112, p = 0.001; partial eta squared = 0.145). The hamstrings extensibility changed significantly immediately after the EME technique (147.3° ± 16.4° to 153.5° ± 14.2°, p < 0.05), but not after the EC only (144.2 ± 10.2° to 141.7 ± 7.8°, p > 0.05). One week after the intervention no significant differences were found to the baseline values in both groups. The number needed to treat to prevent one new case of hamstring shortening was 3.

CONCLUSION

The combination of electric current with simultaneous stretching is an effective technique to acutely increase the hamstring extensibility of football players with hamstring shortness.

A comparison of acute effects between Kinesio tape and electrical muscle elongation in hamstring extensibility

BACKGROUND

To improve hamstring extensibility some methods have been analyzed and compared for determining their acute and chronic effectiveness.

OBJECTIVE

To compare the immediate effect of electrical muscle elongation (EME) versus Kinesio tape (KT) in hamstring muscle extensibility.

METHODS

One hundred and twenty adult amateur athletes with hamstring shortness (straight leg raise test angle <80◦) were randomly assigned to a group: group 1 (EME session of 4 KHz interferential current, bipolar technique and AMF = 100 Hz, n = 40), group 2 (KT, n = 40) or group 3 (control group, no intervention, n = 40). Hamstring extensibility was assessed before and after the intervention through the active knee extension test. Results: Significant improvements were found in both EME and KT groups whereas no changes were detected in the control group. However, no significant differences between both techniques were detected. The EME group showed large effect size (d = 0.843) while the KT group reached medium effect size (d = 0.431).

CONCLUSIONS

Both electrical muscle elongation and Kinesio tape are effective techniques in the short-term in amateur athletes with decreased hamstring extensibility. The higher increase of hamstring extensibility, with a better clinical effect was achieved with the application of electrical muscle elongation. However, no significant differences were found when comparing the effectiveness of both techniques.

Effect of interferential current therapy on pain perception and disability level in subjects with chronic low back pain: a randomized controlled trial

Objective:

To assess the short-term efficacy of transregional interferential current therapy on pain perception and disability level in chronic non-specific low back pain.

Design:

A randomized, single-blinded (the assessor collecting the outcome data was blinded), controlled trial.

Setting:

A private physiotherapy research clinic.

Subjects:

A total of 64 individuals, 20 men and 44 women, mean (SD) age was 51 years (11.93), with low back pain of more than three months, with or without pain radiating to the lower extremities above the knee, were distributed into a control ( n = 20) or an experimental group ( n = 44). A 2:1 randomization ratio was used in favour of the latter.

Interventions:

A transregional interferential current electrotherapy protocol was performed for participants in the experimental group, while the control group underwent a ‘usual care’ treatment (massage, mobilization and soft-tissue techniques). All subjects received up to 10 treatment sessions of 25 minutes over a two-week period, and completed the intervention and follow-up evaluations.

Outcome measures:

Self-perceived pain was assessed with a Visual Analogue Scale. Secondary measure included the Oswestry Low Back Disability Index. Evaluations were collected at baseline and after the intervention protocol.

Results:

Significant between-group differences were found for interferential current therapy on pain perception ( p = 0.032) and disability level ( p = 0.002). The observed differences in the between-group mean changes were of 11.34 mm (1.77/20.91) and 13.38 points (4.97/21.78), respectively.

Conclusions:

A two-week transregional interferential current treatment has shown significant short-term efficacy, when compared with a ‘usual care’ protocol, on self-perceived pain and functionality in subjects with chronic low back pain.

[THE EFFECT OF A HAMSTRING STRECHING PROTOCOL ON HAMSTRING EXTENSIBIITY IN ADOLESCENT STUDENTS: INFLUENCE OF THE CLASS SESSION WEEKLY DISTRIBUTION]

INTRODUCTION

students who do hamstring stretching exercises, twice per week on alternate days, have showed significant increases on extensibility. Objetive: to compare the effects of a hamstring stretching program includes in the physical education classes in booth groups of adolescent, which had a different class session weekly distribution (non-consecutive sessions vs. consecutive sessions).

METHOD

fifty-eight adolescent students did a static-active stretching program on hamstring in the warm-up of both weekly physical education sessions for five weeks. The total duration of the stretching was five minutes. Students were divided in two groups: group A, with 30 students, had consecutive sessions (monday-tuesday), and the group B, with 29 students, had non-consecutive sessions (tuesday-friday). Hamstring extensibility was evaluated with the sit-and-reach test before (pre-test) and after (post-test) the intervention program.

RESULTS AND DISCUSSION

there was found a significant increase in the sit-and-reach score in the group A (+2,15 cm) (p = 0.003) and in the group B (+2,31 cm) (p < 0.001). No significant differences were found between groups in the pre-test and the post-test (p > 0.05).

CONCLUSIONS

the implementation of an intervention program for five weeks, twice sessions a week, induded increases on hamstring extensibility in students. The class session weekly distribution does not affect the results.

[Effectiveness of acupuncture in spasticity of the post-stroke patient. Systematic review]

OBJECTIVE

To determine the effectiveness of acupuncture for reducing spasticity in post-stroke patients.

DESIGN

Literature review.

DATA SOURCE

The literature search was performed using scientific databases from January 2000 to January 2013.

SELECTION OF STUDIES

Out of the 110 studies that were found, nine random and controlled trials were included. Inclusion criteria were based on clinical trials in which participants were over 18 years old, who were suffering with post-stroke spasticity, and one of the experimental groups was treated with acupuncture.

DATA EXTRACTION

The variables were the passive resistance to stretching of the affected limb, and the degree of personal dependence. The variables were assessed by the Modified Ashworth Scale and Barthel Index.

METHODS

The search was performed in the PUBMED, COCHRANE Library, PEDro, Dialnet, CSIC, CINAHL, databases. Search terms included the combination of keywords "acupuncture"; "muscle spasticity"; "stroke".

RESULTS

Passive resistance to stretching, the degree of personal dependence, and motor function of the affected limb showed statistically significant improvements in at least one study included; however, these improvements are not clinically relevant changes. Passive resistance improved in the elbow, ankle, knee, and wrist. An increased joint range was observed, except for the elbow, forearm, and thumb. Improved of the patient dependency was also observed.

CONCLUSIONS

Although improvements relative to the reduction of spasticity are shown, the results have failed to demonstrate the effectiveness of the technique for this ailment. It would take a greater number of studies to calculate the size of the reported effects with homogeneous procedures in the design as well as in the duration, frequency, and measurement tools.

[CRITERION-RELATED VALIDITY OF SIT-AND-REACH TEST AS A MEASURE OF HAMSTRING EXTENSIBILITY IN OLDER WOMEN]

INTRODUCTION

lumbo-sacral posture and the sit-andreach score have been proposed as measures of hamstring extensibility. However, the validity is influenced by sample characteristics.

OBJECTIVE

to determine the validity of lumbo-horizontal angle and score in the sit-and-reach test as measures of hamstring extensibility in older women.

METHOD

a hundred and twenty older women performed the straight leg raise test with both leg, and the sit-and-reach test (SR) in a random order. For the sitand- reach test, the score and the lumbo-sacral posture in bending (lumbo-horizontal angle, L-Hfx) were measured.

RESULTS AND DISCUSSION

the mean values of straight leg raise in left and right leg were 81.70 ± 13.83º and 82.10 ± 14.36º, respectively. The mean value of EPR of both legs was 81.90 ± 12.70º. The mean values of SR score and L-Hfx were -1.54 ± 8.09 cm and 91.08º ± 9.32º, respectively. The correlation values between the mean straight leg raise test with respect to lumbo-sacral posture and SR score were moderate (L-Hfx: r = -0.72, p < 0.01; SR: r = 0.70, p < 0.01). Both variables independently explained about 50% of the variance (L-Hfx: R2 = 0.52, p < 0,001; SR: R2 = 0.49, p < 0,001).

CONCLUSIONS

the validity of lumbo-sacral posture in bending as measure of hamstring muscle extensibility on older women is moderate, with similar values than SR score.

[The effect of a warm-up protocol on the sit-and-reach test score in adolescent students]

INTRODUCTION

Sit-and-reach tests are often used in physical education classes for measurement of hamstring extensibility in students, without a standar protocol to perform it.

OBJETIVE

To analyze the effect of a warm-up protocol based on locomotion activities and stretching in the sit-and-reach scores in adolescent students.

METHOD

A total of 47 teenagers students (17 boys and 30 girls) performed the sit-and-reach test before, immediately after, and 5 and 10 minutes after completing a structured warm-up. The warm-up consisted on a part of continuous running, dynamic locomotor and mobility activities as well as static stretching of lower limbs (quadriceps, hamstrings, adductors, iliopsoas and gastrocnemius), with a total duration of 8 minutes. Between measurements after warm-up, the participants remained standing without performing any exercise and/or stretching.

RESULTS AND DISCUSSION

After warm-up there was a significant improvement in the sit-and-reach score (+ 2.15 cm) (p < 0.001), being slightly higher at 5 and 10 minutes (+ 2.49 cm at 5 minutes and + 2.61 cm at 10 minutes) (p < 0.001 with respect to the pre-test).

CONCLUSIONS

A warm-up protocol performed before the sit-and-reach test, comprised by locomotion, dynamic activities and stretching, improves significantly the distance achieved in this test.