The Effect of Additional Neuromuscular Training on Peri-Ankle Muscle Morphology and Function in Chronic Ankle Instability Subjects: A Randomized Controlled Trial.

BACKGROUND: Lateral ankle sprain is one of the most common musculoskeletal issues during sports and activities of daily living. This study investigated the effect of combined neuromuscular training and conventional training (including strengthening, range of motion, and balance exercises) on muscle morphology, dynamic balance, perceived ankle instability, and functional capacity in persons with chronic ankle instability (CAI). HYPOTHESIS: The combination of neuromuscular and conventional training programs might result in additional benefits on the morphology of muscle, dynamic balance, and functional capacity in subjects with CAI. STUDY DESIGN: A single-blind parallel-arm randomized controlled trial. LEVEL OF EVIDENCE: Level 2. METHODS: A total of 34 participants with CAI were divided randomly into experimental (EG) and control groups (CG). The EG received conventional and neuromuscular training, while the CG underwent conventional training. Cross-sectional areas of the peroneus longus and tibialis anterior muscles were measured using ultrasonography. Measurements included reaching direction distance, ankle instability, and the foot and ankle outcome score, all evaluated before and immediately after 12 intervention sessions and 4 weeks later in the follow-up phase. RESULTS: Repeated-measures analysis of variance (ANOVA) revealed significant improvement in the EG, particularly in the cross-sectional area of the tibialis anterior muscle on the injured side and the posteromedial reaching direction displacement of the Y balance test. Moreover, the EG's foot and ankle outcome scores increased significantly compared with the CG (P < 0.05). However, the group effect size ranged from minor to moderate (Hedges g, 0.40-0.73). CONCLUSION: Combining neuromuscular and conventional training programs yields greater benefits than conventional training alone regarding tibialis anterior muscle morphology, posteromedial dynamic balance, and functional capacity in persons with CAI. CLINICAL RELEVANCE: The combination of neuromuscular and conventional training programs could enhance muscle morphology, dynamic balance, perceived ankle instability, and functional capacity in persons with CAI.

The Effect of Balance Training on Functional Outcomes in Patients with Knee Osteoarthritis: A Systematic Review.

Background: Knee osteoarthritis (OA) is a common musculoskeletal disorder that is associated with balance impairment. Recent studies have used balance exercises for improvement of balance and functional performance among knee OA patients. The purpose of this study was analyzing the effects of balance training in patients with knee OA. Methods: This review included clinical trials in which the effect of balance training on functional measures was assessed compared to other physiotherapy interventions or control groups in patients with knee OA. To this aim, Electronic databases (PubMed, SCOPUS, EMBASE, PEDro, CINAHL, and WOS) were searched from 1 January 1990 to 30 June 2021. Two independent reviewers selected the studies, extracted the data, and assessed the quality of the studies. Results: Fifteen articles of clinical trials were eligible to include in this review. Most studies used patient-reported outcome measures, and some studies used performance-based functional outcome measures for the evaluation of functional outcomes. The findings of studies showed that physical function in knee OA patients could have clinical improvements significantly after receiving balance training. However, studies assessing the effect of balance training on muscle strength of the quadriceps and the hamstring had conflicting results. Also, the finding of studies showed that more significant improvement in postural stability and balance in the balance training group rather than the control group. Conclusion: The results of the current systematic review demonstrate balance exercises significantly improve balance and functionality in knee OA patients. However, the effect of balance training on muscle strength was not clearly revealed due to few studies.

Reliability of musculoskeletal ultrasonography for peri-ankle muscles in subjects with unilateral chronic ankle instability.

BACKGROUND: Ankle sprain is a common problem among active people and athletes. It causes reduces their activity of daily living and quality of life. Because of the impaired muscle strength and neuromuscular and postural control, it seems that the morphological criteria of peri-ankle muscles are changed. OBJECTIVE: This study aimed to develop a reliable method for measuring tibialis anterior (TA) and peroneus longus (PL) muscles in the injured and intact side of lower limbs in people with unilateral chronic ankle instability (CAI). STUDY DESIGN: Cross-sectional study. METHOD: This study was intra-tester reliability by ultrasound imaging to measure ultrasonography characteristics contains thickness, width, fiber length, pennation angle, and cross-sectional area (CSA) of TA, and PL in both limbs of 25 subjects at three separate times. Intra-class correlation coefficients (ICC), limits of agreement (LOA), standard error of measurement (SEM), and minimal detectable change (MDC) were calculated to analyzed relative and absolute intra-tester reliability, respectively. RESULTS: The present study showed good to excellent relative reliability for both injured and intact sides (ICC 0.88-0.98), less proportional measurement error (ß coefficient of LOA≈ 0), and suitable absolute reliability. CONCLUSION: Musculoskeletal ultrasonography is a reliable method for the measurement of peri-ankle muscle morphology such as thickness, width, CSA, fiber length, and pennation angle.

What psycho-social factors determine intimate partner violence of men against women? A social cognitive theory-based study.

Despite the multidimensionality of intimate partner violence (IPV) against women, there is a lack of research on the perspectives of men toward the phenomenon. Our aim in this cross-sectional study was to examine the predictability of social cognitive theory in explaining men's violent behaviors against women. We find among a sample of 576 Iranian married men showed a reciprocal determinism between outcome expectancy, attitude toward IPV, and observational learning in formation of men's IPV against women. Therefore, the interactive associations of cognitive and environmental factors, as a comprehensive approach, should be considered while studying the determinants of IPV against women among men.

Prevalence of Work-Related Musculoskeletal Disorders in Iranian Physical Therapists: A Cross-sectional Study.

OBJECTIVE: The purpose of this study was to determine the prevalence of musculoskeletal disorders among Iranian physical therapists. METHODS: A cross-sectional study was carried out. An online survey was completed by Iranian physiotherapists from June 2017 to August 2017. A total of 333 online questionnaires were sent, and 319 questionnaires were fully completed and used for data analysis. The Persian version of the Nordic Questionnaire was the main outcome measurement. This questionnaire identified work-related pain or discomfort in 9 parts of the body, including: (1) neck, (2) shoulder, (3) elbow, (4) wrists, (5) upper back, (6) lumbar, (7) thighs, (8) knee, and (9) ankle. RESULTS: The findings of this study showed the prevalence of musculoskeletal disorders was 94% in Iranian physiotherapists. Lumbar (65%), neck (57.4%), shoulder (50.2%), upper back (49%), and knee (45.5%) were the most prevalent regions of these disorders. While ankle (19.7%) and elbow (21.6%) disorders showed the lowest prevalence. CONCLUSION: The prevalence of work-related musculoskeletal disorders was high in Iranian physiotherapists, especially in the lumbar, neck, shoulder, and upper back regions.

Electromiography comparison of distal and proximal lower limb muscle activity patterns during external perturbation in subjects with and without functional ankle instability.

Ankle sprain is one of the most common injuries among athletes and the general population. Most ankle injuries commonly affect the lateral ligament complex. Changes in postural sway and hip abductor muscle strength may be generated after inversion ankle sprain. Therefore, the consequences of ankle injury may affect proximal structures of the lower limb. The aim is to describe and compare the activity patterns of distal and proximal lower limb muscles following external perturbation in individuals with and without functional ankle instability. The sample consisted of 16 women with functional ankle instability and 18 healthy women were recruited to participate in this research. The external perturbation via body jacket using surface electromyography, amplitude and onset of muscle activity of gluteus maximums, gluteus medius, tibialis anterior, and peroneus longus was recorded and analyzed during external perturbation. There were differences between the onset of muscles activity due to perturbation direction in the two groups (healthy and functional ankle instability). In the healthy group, there were statistically significant differences in amplitude of proximal muscle activity with distal muscle activity during front perturbation with eyes open and closed. In the functional ankle instability group; there were statistically significant differences in amplitude of proximal muscle activity with distal muscle activity during perturbation of the front and back with eyes open. There were statistically significant differences in the onset of muscle activity and amplitude of muscle activity, with-in and between groups (P<0.05). Therefore, in the presence of functional ankle instability, activation patterns of the lower limb proximal muscles may be altered.