Comparing shoulder proprioception, upper extremity dynamic stability, and hand grip strength in overhead athletes with and without scapular dyskinesis.

INTRODUCTION: Scapular dyskinesis is prevalent among asymptomatic athletes, particularly those involved in overhead activities, and can significantly impact their neuromuscular control. These changes may impair upper extremity function and strength, elevating the risk of injury. Therefore, it is imperative to investigate how scapular dyskinesis affects shoulder proprioception, upper extremity dynamic stability, and hand grip strength in overhead athletes. This study compared these parameters between overhead athletes with and without scapular dyskinesis. METHODS: The study included twenty asymptomatic professional overhead athletes with scapular dyskinesis and twenty without scapular dyskinesis, identified using the lateral scapular slide test. In this cross-sectional study, shoulder active joint position sense, serving as shoulder proprioception, was measured using an isokinetic dynamometer. Upper extremity dynamic stability and hand grip strength were evaluated using an upper quarter modified star excursion balance test (UQ-mSEBT) and a handheld dynamometer. RESULTS: The study found that the shoulder active joint position sense was significantly lower in the scapular dyskinesis group compared to the group without scapular dyskinesis (PExternal Rotation = 0.003, PInternal Rotation < 0.001, and PForward Flexion = 0.002). However, the two groups had no significant differences in UQ-mSEBT and hand grip strength scores. CONCLUSIONS: The results showed that scapular dyskinesis could affect the sense of shoulder active joint position among asymptomatic overhead athletes. However, it did not affect their upper extremity dynamic stability and hand grip strength.

Investigating the lumbar proprioception and core muscles recruitment pattern while getting up from a chair with weight lifting in patients with chronic functional constipation: cross-sectional study.

INTRODUCTION AND HYPOTHESIS: Patients with chronic functional constipation have some problems such as weakness of pelvic floor muscles, and a lack of coordination of pelvic floor and abdominal muscles has been seen. The goal of this study was to investigate the lumbar proprioception and the core muscle recruitment pattern. METHODS: The study type is a cross-sectional case-control study. There were 30 participants (case, n = 15, and control, n = 15). Electromyography of the core muscles was recorded while the subjects were getting up from the chair accompanied by lifting a weight, to check the pattern of muscle recruitment. Moreover, the lumbar proprioception was evaluated by an isokinetic device in both groups. The study was analyzed using independent t test and Mann-Whitney U test, and a nonparametric Friedman test was performed followed by Bonferroni pairwise comparison. RESULTS: The comparison of muscle activity delay between the two groups showed that there was a significant difference between the two groups regarding the abdominal muscles, anal sphincter, and erector spinae (p < 0.05). However, there was no significant difference in the rectus femoris and gluteal muscles between the two groups (p > 0.05). Moreover, the proprioception of the lumbar region showed a significant difference (p < 0.05) between the two groups. CONCLUSIONS: The results of this study demonstrated that the lumbar proprioception sense was reduced in the case group. This result can be justified, based on the problems in constipation (lack of coordination of muscles, weakness of pelvic floor muscles). The coordination of core muscles changed in patients with chronic functional constipation during a functional task.

Effects of neurorehabilitation with and without dry needling technique on muscle thickness, reflex torque, spasticity and functional performance in chronic ischemic stroke patients with spastic upper extremity muscles: a blinded randomized sham-controlled clinical trial.

PURPOSE: Evaluation the effects of dry needling on sonographic, biomechanical and functional parameters of spastic upper extremity muscles. METHODS: Twenty-four patients (35-65 years) with spastic hand were randomly allocated into two equal groups: intervention and sham-controlled groups. The treatment protocol was 12-sessions neurorehabilitation for both groups and 4-sessions dry needling or sham-needling for the intervention group and sham-controlled group respectively on wrist and fingers flexor muscles. The outcomes were muscle thickness, spasticity, upper extremity motor function, hand dexterity and reflex torque which were assessed before, after the 12th session, and after one-month follow-up by a blinded assessor. RESULTS: The analysis showed that there was a significant reduction in muscle thickness, spasticity and reflex torque and a significant increment in motor function and dexterity in both groups after treatment (p < 0.01). However, these changes were significantly higher in the intervention group (p < 0.01) except for spasticity. Moreover, a significant improvement was seen in all outcomes measured one-month after the end of the treatment in the intervention group (p < 0.01). CONCLUSIONS: Dry needling plus neurorehabilitation could decrease muscle thickness, spasticity and reflex torque and improve upper-extremity motor performance and dexterity in chronic stroke patients. These changes were lasted one-month after treatment.Trial Registration Number: IRCT20200904048609N1IMPLICATION FOR REHABILITATIONUpper extremity spasticity is one of the stroke consequences which interfere with motor function and dexterity of patient hand in activity of daily livingApplying the dry needling accompanied with neurorehabilitation program in post-stroke patients with muscle spasticity can reduce the muscle thickness, spasticity and reflex torque and improve upper extremity functions.

The effect of the combined use of complex decongestive therapy with electrotherapy modalities for the treatment of breast cancer-related lymphedema: a randomized clinical trial.

BACKGROUND: We evaluated the effects of combined complex decongestive therapy (CDT) with electrotherapy modalities (ultrasound and faradic currents) in patients with breast cancer-related lymphedema (BCRL), investigating upper extremity circumference, volume, pain, and functional disability. METHODS: Thirty-nine patients with unilateral BCRL were randomly allocated to three groups (n = 13) as the following: The control group received CDT, the ultrasound group received CDT and therapeutic ultrasound, and the faradic group received CDT and faradic current. All the participants underwent treatment for 10 sessions. The outcomes including volume, circumference (measured at five points), pain intensity, and functional disability of the affected upper extremity were evaluated at baseline and after the treatment. RESULTS: Following the treatment, an improvement was noted in lymphedema volume, pain, and functional disability in all the three groups and there was a significant difference between the groups (P < 0.05). However, changes in limb circumference at the end of the treatment were not significantly different among the three groups in any sites (P > 0.05). CONCLUSION: The combination of electrotherapy modalities, faradic current or ultrasound, with CDT can result in a greater reduction in lymphedema volume, pain, and functional disability in patients with BCRL. TRIAL REGISTRATION: IRCT, IRCT201310292391N14, registered 03/01/2016.

Quantitative Electroencephalography and Surface Electromyography Correlations upon Predictable and Unpredictable Perturbation in Older Adults.

Background: Quantitative Electroencephalography (qEEG) is a non-invasive method used to quantify electrical activity over the cortex. QEEG provides an accurate temporal resolution of the brain activity, making it a useful tool for assessing cortical function during challenging tasks. Objective: This study aimed to investigate postural adjustments in older adults in response to an external perturbation. Material and Methods: In this observational study, nineteen healthy older adults were involved. A 32-channel qEEG was employed to track alterations in beta power on the electrodes over the two sensory-motor areas. Integrated electromyographic activity (IntEMG) of the leg muscles was evaluated in response to perturbations under predictable and unpredictable conditions. Results: The results indicated higher beta power during late-phase in the Cz electrode in both conditions. IntEMG was significantly greater in the tibialis anterior muscle during both conditions in the CPA epoch. In predictable condition, a positive correlation was found between the beta power over C4 (r = 0.560, p = 0.013) and C3 (r = 0.458, p = 0.048) electrodes and tibialis anterior muscle amplitude, and between beta power in C4 and gastrocnemius amplitude (r = 0.525, p = 0.021). In unpredictable condition, there was a positive correlation between beta power over the C4 and the tibialis anterior amplitude (r = 0.580, p = 0.009) and also it over the C3 and the tibialis anterior amplitude (r = 0.452, p = 0.049). Conclusion: Our findings demonstrate that sensorimotor processing occurs in the brain during response to perturbation. Furthermore, cortical activity appeared to be greatest during the recruitment of the muscles upon late-phase in older adults.

Effect of inhibitory kinesiotaping on spasticity in patients with chronic stroke: a randomized controlled pilot trial.

BACKGROUND: There is no consensus regarding the positive effect of kinesiotaping (KT) on spasticity. All previous studies have measured spasticity by Modified Ashworth Scale (MAS) scale which is a subjective clinical assessment. OBJECTIVE: To investigate the effect of inhibitory KT on the spasticity of plantar flexor muscles using both Hoffmann-reflex (H-reflex) and MAS scale. H-reflex is a neurophysiological technique that objectively evaluates spasticity by reflecting the excitability of motor neurons. METHODS: Thirty patients were randomly assigned into inhibitory KT (n = 15) and control (n = 15) groups. The inhibitory KT group received KT from insertion to the origin of gastrocsoleus muscle . Spasticity was assessed at baseline and 30 min and 48 h after taping by H-reflex and MAS scale. The control group received no taping and spasticity was assessed at baseline and 30 min and 48 h after the baseline. RESULT: There was a significant time × group effect for the maximal peak-to-peak amplitude of the Hmax/Mmax ratio (p = .007), indicating that Hmax/Mmax ratio decreased significantly after 48 h in the inhibitory KT in comparison with the baseline (P = .001) and 30 min after-intervention (p = .002); meanwhile, it did not change significantly in the control group (P > .05). However, none of the groups showed a statistically significant change in MAS score (P > .05). CONCLUSIONS: Application of inhibitory KT was found to be able to reduce the Hmax/Mmax ratio in patients with stroke. As a result, inhibitory KT could have beneficial effects on spasticity.

Proposing a set of ethical guidelines for Iranian physiotherapists: results of a modified Delphi technique.

The code of ethical conduct for physiotherapy services must be compatible with the local culture. The ethical guidelines proposed here were developed through a literature review, focus group discussions, and finally a modified Delphi technique to achieve consensus after the data were analysed. At first, the collection of different ethical codes yielded 132 items. In the second stage, repetitive items were discarded, some new items were added, and the various codes were categorised into three domains. Overall, 175 items were considered in the Delphi stage. Subsequently, the items were reduced to 134 in total - 59 in the treatment domain, 41 in research, and 34 in the education domain. The resulting code of ethics will support patients, researchers, students, and teachers in the field of physical therapy with sensitivity to current Iranian legislation and culture.

The effects of virtual reality training on clinical indices and brain mapping of women with patellofemoral pain: a randomized clinical trial.

BACKGROUND: Virtual reality training (VRT) is a new method for the rehabilitation of musculoskeletal impairments. However, the clinical and central effects of VRT have not been investigated in patients with patellofemoral pain (PFP). To comprehensively assess the effects of VRT on clinical indices and brain function, we used a randomized clinical trial based on clinical and brain mapping assessment. METHODS: Twenty-six women with PFP for more than 6 months were randomly allocated to 2 groups: intervention and control. The intervention consisted of lifestyle education + 8 weeks VRT, in 24 sessions each lasting 40 min of training, whereas the control group just received lifestyle education. The balance was the primary outcome and was measured by the modified star excursion balance test. Secondary outcomes included pain, function, quality of life, and brain function which were assessed by visual analogue scale, step down test and Kujala questionnaire, SF-36, and EEG, respectively. Pre-intervention, post-intervention and follow-up (1 month after the end of the intervention) measurements were taken for all outcome measures except EEG, which was evaluated only at pre-intervention and post-intervention). Analyses of variance was used to compare the clinical outcomes between the two groups. The independent t-test also was used for between group EEG analyses. RESULTS: Balance score (P < 0.001), function (P < 0.001), and quality of life (P = 0.001) improved significantly at post-intervention and 1 month follow-up in the VRT group compared with the control group. VRT group showed a significantly decreased pain score (P = 0.004). Alpha (P < 0.05) and theta (P = 0.01) power activity also increased in the brain of the VRT group. CONCLUSION: This study demonstrated that long term VRT was capable of improving both clinical impairments and brain function in patients with PFP. Therefore, therapists and clinicians can use this method as a more holistic approach in the rehabilitation of PFP. TRIAL REGISTRATION: IRCT, IRCT20090831002391N40 . Registered 23 / 10 / 2019.

Kinematic cluster analysis of the crouch gait pattern in children with spastic diplegic cerebral palsy using sparse K-means method.

BACKGROUND: Crouch gait pattern is a common gait pattern in children with diplegic cerebral palsy with excessive knee flexion throughout stance phase. Few studies have grouped this pattern of gait and usually have examined only the features of gait in the sagittal plane and mostly lower extremities without considering pelvis and trunk behavior. Studies usually categorize the gait pattern according to important variables from the researcher's point of view. Sparse K-means is high dimensional clustering methods that perform clustering and variable selection simultaneously even with low sample size and large number of variables. Our aim was to define existing clusters of crouch gait pattern in children with spastic diplegic cerebral palsy. METHODS: Cluster analysis was applied on the lower extremity, pelvis and trunk gait kinematics data of 64 limbs of children with crouch gait pattern and 64 limbs of typically developing children. Eighty-nine kinematic variables were used as input variables for clustering. FINDINGS: Four clusters of crouch gait pattern were defined. Sparse K-means identified influential variables and identified the knee and hip flexion as a major factor in clustering. Kinematic of the trunk, pelvis and ankle was determined in each cluster. Trunk and pelvis kinematic features were strongly correlated with the knee and hip joint flexion severity. INTERPRETATION: Obtained clusters were confirmed observationally. With increasing knee flexion, the kinematic of the trunk and pelvis were further away from the patterns of typically developing individuals. The clusters ranking appear to be reasonable based on the crouch severity.

Effects of whole body vibration with exercise therapy versus exercise therapy alone on flexibility, vertical jump height, agility and pain in athletes with patellofemoral pain: a randomized clinical trial.

BACKGROUND: Patellofemoral pain (PFP) is the most prevalent orthopedic problem in active young adults. Due to its multifactorial etiology, a variety of therapeutic measures have been adopted to treat PFP, including exercise therapy, electrotherapy, and manual therapy. It has also been suggested that whole body vibration (WBV) can improve neuromuscular function in persons with knee problems. The aim of the present study was to evaluate the effects of adding WBV to routine exercise programs on flexibility, vertical jump height, agility and pain in athletes with PFP. METHODS: Twenty-four male athletes with PFP were randomized into two groups of WBV + exercise (n = 12) or exercise only (n = 12). Participants received their interventions during 4 consecutive weeks (12 sessions). Pain intensity, flexibility and agility were assessed respectively as score on a numerical rating scale, the sit-and-reach test, and a modified T-test, and vertical jump height was measured to the nearest centimeter. The tests were done before and after the interventions, and the results were compared between the two groups. Independent t-tests and paired t-tests were used for between- and within-group comparisons, respectively. RESULTS: After the interventions, all variables for vertical jump height, flexibility, agility and pain intensity improved significantly in both groups (p < 0.05). The flexibility test showed significantly greater improvement in the WBV + exercise group (p<0.001), whereas for vertical jump height, agility and pain intensity, there were no statistically significant differences between groups (p>0.05). CONCLUSIONS: The present findings showed that exercise therapy with and without WBV can significantly decrease pain and increase agility, vertical jump height and flexibility in athletes with PFP. Adding WBV to routine exercise therapy, however, can augment the effects of the latter on flexibility. TRIAL REGISTRATION: IRCT, IRCT20090831002391N39. Registered 7 February 2018, https://en.irct.ir/search/result?query=IRCT20090831002391N39 .

Can the Positional Release Technique Affect Central Sensitization in Patients With Chronic Tension-Type Headache? A Randomized Clinical Trial.

OBJECTIVES: To investigate whether the positional release technique (PRT) affects central sensitization in patients with chronic tension-type headache (TTH). DESIGN: Randomized controlled trial with concealed allocation, assessor blinding, and intention-to-treat analysis. SETTING: Two university neurology clinics. PARTICIPANTS: Patients (N=32) with TTH and myofascial trigger points (MTrP) in their cervical muscles. INTERVENTIONS: Patients in the PRT group received 10 treatment sessions for each of their MTrPs over the course of 5 weeks. All participants could use ibuprofen 200 mg for their headaches during the study. MAIN OUTCOME MEASURES: The primary outcome measure was brain metabolite profile. The secondary outcome measures were headache frequency and intensity, McGill score, and pressure pain threshold (PPT), which were evaluated in each participant during 5 weeks with proton magnetic resonance spectroscopy, patients' self-reports, the McGill Pain Questionnaire, and a pressure algometer. RESULTS: Analysis of the data from 26 patients showed that headache frequency (P=.001), headache intensity (P=.002), McGill score (P=.003), and local PPT (P=.003) changed significantly after PRT. The myo-inositol/creatine concentration ratio in the somatosensory cortex (P=.041) decreased significantly in the control group. Furthermore, there were significant differences between groups in headache frequency (P<.001), headache intensity (P<.001), McGill score (P<.001), local PPT (P=.004), distal PPT (P=.041), and glutamate-glutamine/creatine concentration ratio in the thalamus (P=.014). CONCLUSIONS: These findings indicate that PRT did not affect central sensitization in patients with TTH despite the improvement in clinical symptoms.

Effects of a Virtual Reality Dance Training Program on Kyphosis Angle and Respiratory Parameters in Young Women With Postural Hyperkyphosis: A Randomized Controlled Clinical Trial.

CONTEXT: Thoracic hyperkyphosis, one of the most common spinal deformities, may lead to undesirable pulmonary outcomes. OBJECTIVE: To study, the efficacy of virtual reality exercise training on thoracic hyperkyphosis and respiratory parameters in young women. DESIGN: Randomized clinical trial. SETTING: Laboratory setting. PARTICIPANTS AND INTERVENTION: Participants were randomly assigned to one of two 4-week exercise training groups: regular training (RT), which involved stretch and strength training, or virtual reality with RT (VRRT), which involved dance training with the Xbox 360 Kinect® game in addition to the exercises, which the RT group received. MAIN OUTCOME MEASURES: The authors measured kyphosis angle with a Flexicurve ruler and recorded respiratory parameters (forced vital capacity [FVC] and forced expiratory volume in 1 s [FEV1]) with a spirometer in each participant at baseline and postintervention. Separate 2 × 2 repeated-measure analysis of variances were used to analyze differences between means for kyphosis angle, FEV1, and FVC. Based on the significant interactions between time and group, the paired t test was used to compare the results at baseline and postintervention, and the independent sample t test was used to compare the differences in changes between groups. Level of significance was considered at P < .05 except for paired t test that was adjusted to P < .025 for each variable in 2 groups. RESULTS: The results showed statistically significant interactions between time and group for kyphosis angle, FEV1, and FVC. Postintervention thoracic kyphosis angle decreased and FVC increased significantly in both groups and FEV1 improved significantly in virtual reality with RT group. The improvements in thoracic kyphosis, FVC, and FEV1 in the virtual reality with RT group were significantly greater (P < .001) than in the RT group. CONCLUSION: Dance training with the Xbox 360 Kinect game was an effective therapy in improving thoracic kyphosis angle, FVC, and FEV1 in young women with thoracic hyperkyphosis.

The comparison of pinch strength among female typists and female non-typists.

BACKGROUND: Typing is a common activity involving repetitive motion that can increase the risk of work-related injuries. To the best of our knowledge, the effect of typing on the pinch strength has not been investigated so far. OBJECTIVE: To investigate the pinch strength amongst female typists and non-typists. METHOD: Thirty female typists and 30 female non-typists, aged 20-30 years old, participated in this prospective study. The pinch strength of the second, third, fourth and fifth fingers of the dominant hand was measured in a sitting position, using a pinch gauge. The data were analyzed using independent sample t-test. RESULTS: The results showed that there were significant differences in the pinch strength of the second, third and fourth fingers between the two groups. The strength of these fingers was reduced more than that in female non-typists. CONCLUSION: Our results suggest that pinch strength might have decreased in female typists due to sharing common attentional resources, muscle fiber composition, and muscle fiber fatigue.

The effect of Kinesio Taping on postural control in subjects with non-specific chronic low back pain.

PURPOSE: The aim of this study was to investigate the possible alterations in postural control during upright standing in subjects with non-specific chronic low back pain and the effect of Kinesio taping on the postural control. METHODS: Twenty subjects with non-specific chronic low back pain and twenty healthy subjects participated in this study. The center of pressure excursion was evaluated before the intervention for both groups, and immediately after intervention for the low back pain group. Independent sample t-test, Mann-Whitney test and repeated measure ANOVA were used for the statistical analysis of the data. RESULTS: There were significant differences in the center of pressure excursion between the low back pain group versus the healthy group. The results of the ANOVA demonstrated a statistically significant difference in the mean COP displacement and velocity before Kinesio Taping, immediately after, and 24 h after in the low back pain group. CONCLUSIONS: There are poor postural control mechanisms in subjects with non-specific chronic low back pain. Kinesio taping seems to change postural control immediately and have lasting effects until the day after.

Efficacy of combined endurance-resistance training versus endurance training in patients with heart failure after percutaneous coronary intervention: A randomized controlled trial.

BACKGROUND: This study aimed to compare the effects of combined endurance-resistance training (CT) versus endurance training (ET) on some cardiovascular markers in patients with heart failure after percutaneous coronary intervention (PCI). MATERIALS AND METHODS: The study applied a randomized, controlled design in which 75 patients with heart failure who had undergone PCI were randomly assigned to one of three groups: ET, CT, and control. The ET group performed ET for 45 min, three times a week for 7 weeks. The CT group performed the same ET for 30 min followed by a resistance exercise protocol. The control group received usual care. Functional capacity, N-terminal pro-brain natriuretic peptide (NT-pro BNP), and high sensitivity C-reactive protein (hs-CRP) levels were measured. RESULTS: After the intervention, functional capacity was improved (P < 0.001) and NT-pro BNP level was significantly reduced (P = 0.004 in the CT group, P = 0.002 in the ET group). Hs-CRP level was significantly reduced only in the ET group (P = 0.030). The control group showed no significant changes in any cardiovascular parameters (P ≥ 0.05). Changes in functional capacity (P < 0.001) in both training groups were significantly different from the control group. No significant differences were found between the ET and CT groups regarding changes in all outcomes after exercise training (P ≥ 0.05). CONCLUSION: Exercise training is safe and feasible in post-PCI patients, even in those with reduced ejection fraction. CT was as effective as ET in reducing NT-pro BNP level and improving functional capacity in heart failure patients after PCI.

Effect of dual tasking on anticipatory and compensatory postural adjustments in response to external perturbations in individuals with nonspecific chronic low back pain: Electromyographic analysis.

BACKGROUND: In patients with chronic low back pain (CLBP), postural control is a demanding task in terms of attention. Although the attentional demands of postural control have been investigated in these patients, the attentional demands of postural recovery during dual task performance have not been evaluated in patients with nonspecific CLBP. OBJECTIVE: To investigate the effect of dual tasking on anticipatory and compensatory postural adjustments in response to an external perturbation in patients with nonspecific CLBP. METHODS: Twenty-five patients with nonspecific CLBP of at least 3 months' duration and 25 healthy persons were exposed to predictable and unpredictable external perturbations. The attentional demands of postural adjustments were evaluated while participants simultaneously performed a cognitive task. Onset latency and integrated electromyographic activity of the trunk and leg muscles were compared between dual task (postural recovery and backward digit span memory) and single task conditions (postural recovery only). RESULTS: The results showed delayed activation of the tibialis anterior (agonist) and early activation of the gastrocnemius (antagonist) muscles during the dual task in patients with nonspecific CLBP compared to healthy participants. Integrated electromyographic activity was significantly greater in the dual task than the single task condition in the gastrocnemius (antagonist) muscle in patients with nonspecific CLBP compared to healthy persons during unpredictable perturbations. CONCLUSION: The impaired ankle muscle activities during a cognitive task suggest that postural control recovery following external perturbation requires attentional resources in patients with nonspecific CLBP. This may increase the risk of re-injury in people with nonspecific CLBP while they perform an attentionally demanding task in more difficult circumstances.

A Comparison Between the Effects of Scapulothoracic Mobilization Plus Physical Therapy With Physical Therapy Alone in Patients With Mechanical Neck Pain: A Randomized Clinical Trial.

OBJECTIVE: The purpose of this study was to compare the effects of scapulothoracic (ST) mobilization plus physical therapy (PT) with PT alone in patients with mechanical neck pain. METHODS: This double-blinded randomized clinical trial was conducted at Shiraz School of Rehabilitation Sciences and involved 46 patients with mechanical neck pain and scapular dyskinesia. The patients were randomly assigned to the ST mobilization + PT group (scapulothoracic mobilization and physical therapy) or the PT group (physical therapy treatment) by a computer-generated randomized table of numbers. Both groups received 5 sessions of treatment during 1 week. Pain intensity and grip strength were evaluated 3 times: baseline, after the first session, and after the fifth session. Furthermore, functional disability of the upper limbs and the neck were evaluated before and at the fifth session. RESULTS: The results showed that the pain intensity was reduced and grip strength increased significantly after the first session (P = .01) and at the end of the treatment (P = .01) in the ST mobilization + PT group in comparison with the PT group. Also, the mean difference of upper limb (P = .01) and neck disability (P = .02) decreased significantly in the ST mobilization + PT group in comparison with the PT group. CONCLUSION: Scapulothoracic mobilization in combination with physical therapy may be superior to physical therapy alone in reducing pain intensity, maximizing grip strength, and reducing upper limb and neck disability in mechanical neck pain.

Evaluation of Static and Dynamic Balance Tests in Single and Dual Task Conditions in Participants With Nonspecific Chronic Low Back Pain.

OBJECTIVE: The purpose of this study was to investigate static and dynamic balance tests in single, dual cognitive, and dual manual task conditions in participants with and without nonspecific chronic low back pain. METHODS: In this case control study, 40 patients (age range 18-50 years) with nonspecific chronic low back pain for at least 3 months and 40 healthy participants matched for age, weight, height, and sex participated in this study. Balance performance was evaluated using static (One Leg Stance) and dynamic (Modified Star Excursion Balance Test, 10-m walk test, and Timed Up and Go) balance tests. All tests were performed in three conditions: single task (balance only), dual cognitive task (balance and counting numbers backward), and dual manual task (balance and carrying a cup of water). RESULTS: The results indicated that different balance tests were impaired in dual task conditions compared with single task in each group. Cognitive and balance performances were not significantly different between nonspecific chronic low back pain and healthy participants in all clinical balance tests. CONCLUSION: It seems that the static and dynamic balance performance under dual task conditions (excluding the Modified Star Excursion Balance Test) was impaired in each group. Dual tasking did not differ between nonspecific chronic low back pain participants with low level of pain and disability compared with healthy participants.

Comparison the effects of two types of therapeutic exercises Frenkele vs. Swiss ball on the clinical balance measures in patients with type II diabetic neuropathy.

BACKGROUND: The number of diabetic patients is increasing in the world. Peripheral neuropathy is the most important problem of diabetes. Neuropathy eventually leads to balance impairment which is the main cause of falling down in these patients However, not sufficient evidences available to compare different protocols for improving balance in diabetic patients. OBJECTIVE: This study aimed to compare the effects of two therapeutic exercises on clinical balance measures in patients with type II diabetic peripheral neuropathy. METHODS: The study was performed on 60 patients with diabetes categorized randomly into three groups: an intervention group (N=20) that received ball training exercise, another intervention group (N=20) that received Frenkel exercise and a control group (N=20) that received no interventions. Exercise training session was performed for 3 weeks. Then, clinical balance measures were computed in the three groups. Paired t-test and one-way ANOVA were used to analyze the collected data. RESULTS: Both types of therapeutic exercise programs significantly improved balance in single leg stance, star excursion test, and Berg balance scale test (P˂0.05) compared to the control group. Besides, this was more significant in the ball training group (P˂0.05). CONCLUSIONS: To improve balance in diabetic neuropathy, Swiss ball exercise is preferred compared to Frenkel training.

Effects of Plantar Flexor Muscle Static Stretching Alone and Combined With Massage on Postural Balance.

OBJECTIVE: To evaluate and compare the effects of stretching and combined therapy (stretching and massage) on postural balance in people aged 50 to 65 years. METHODS: Twenty-three subjects participated in this nonrandomized clinical trial study. Each participant randomly received plantar flexor muscle stretching (3 cycles of 45 seconds with a 30-second recovery period between cycles) alone and in combination with deep stroking massage (an interval of at least 30 minutes separated the two interventions). The data were recorded with a force platform immediately after each condition with eyes open and closed. The center of pressure displacement and velocity along the mediolateral and anteroposterior axes were calculated under each condition. The data were analyzed with multiple-pair t-tests. RESULTS: The center of pressure displacement and velocity along the mediolateral axis increased after both stretching and the combined intervention. There were significant differences in both values between participants in the stretching and combined interventions (p<0.05). CONCLUSION: Plantar flexor muscle stretching (for 45 seconds) combined with deep stroking massage may have more detrimental effects on postural balance than stretching alone because each intervention can intensify the effects of the other.