The hip joint mobilization with movement technique improves muscle activity, postural stability, functional and dynamic balance in hemiplegia secondary to chronic stroke: a blinded randomized controlled trial.

BACKGROUND: People with stroke generally experience abnormal muscle activity and develop balance disorder. Based on the important role of the proximal joints of the lower extremity in balance maintenance, hip joint mobilization with movement technique can be applied to enhance normal joint arthrokinematics. Therefore, the present study aimed to investigate the effectiveness of hip joint mobilization with movement technique on stroke patients' muscle activity and balance. METHODS: Twenty patients aged between 35 and 65 years old with chronic stroke were randomly assigned either to an experimental group (n = 10) or to a control group (n = 10). Both groups participated in a 30-minute conventional physiotherapy session 3 times per week for 4 weeks. The experimental group received an additional 30-minute's session of hip joint mobilization with movement technique on the affected limb. The muscle activity, berg balance scale, time up and go, and postural stability were measured at baseline, 1-day and 2-week follow-up by a blinded assessor. RESULTS: The experimental group showed a significant improvement in berg balance scale, time up and go, and postural stability (p ≤ 0.05). The rectus femoris, tibialis anterior, biceps femoris, and medial gastrocnemius muscles' activations of the affected limb during static balance test markedly changed along with the biceps femoris, erector spine, rectus femoris, and tibialis anterior muscles during dynamic balance test after hip joint mobilization with movement technique. The mean onset time of rectus abdominus, erector Spine, rectus femoris, and tibialis anterior muscles activity significantly decreased in the affected limb after hip joint mobilization with movement technique compared to the control group (p ≤ 0.05). CONCLUSIONS: The results of the present study suggest that a combination of hip joint mobilization with movement technique and conventional physiotherapy could improve muscle activity and balance among chronic stroke patients. TRIAL REGISTRATION NUMBER: The study was registered in the Iranian Registry of Clinical Trials (No; IRCT20200613047759N1). Registration date: 2/08/2020.

Comparison of Manual Therapy Technique to Therapeutic Exercise in the Treatment of Patients With Subacromial Impingement Syndrome: A Randomized Clinical Trial.

OBJECTIVE: The purpose of this study was to compare the effects of manual therapy to therapeutic exercise on shoulder pain, disability, and range of motion (ROM) in patients with subacromial impingement syndrome (SAIS). METHODS: Sixty patients with SAIS were randomly assigned into the manual therapy (MT) and therapeutic exercise (TE) groups. Patients in the MT group were treated with joint mobilization, which was applied to the glenohumeral, acromioclavicular, sternoclavicular and scapulothoracic joints, and trigger point (TrP) inactivation using ischemic compression. Patients in the TE group performed therapeutic exercises. Shoulder pain, disability and active ROM (elevation, external rotation, and internal rotation) were assessed by the visual analog scale, the Shoulder Pain and Disability Index, and a goniometer, respectively. The outcomes were measured at baseline, after the intervention, and 1 month after the intervention. RESULTS: After the treatment, both groups had significant improvements in shoulder pain, disability, and ROM (P < .05). The MT group experienced a greater reduction in shoulder pain than the TE group (P < .001). However, in disability and ROM, both groups exhibited similar improvements in post-treatment and follow-up periods. CONCLUSION: Both MT and TE were effective in improving shoulder pain, disability, and ROM in patients with SAIS. Greater improvement in shoulder pain was observed in the MT group.

Comparison of Transcallosal Inhibition Between Hemispheres and Its Relationship with Motor Behavior in Patients with Severe Upper Extremity Impairment After Subacute Stroke.

OBJECTIVE: To compare corticospinal excitability and transcallosal inhibition between contralesional primary motor cortex (M1) and ipsilesional M1. We also investigated the correlation between transcallosal inhibition and upper extremity motor behavior. MATERIALS AND METHODS: 19 individuals with unilateral ischemic subacute stroke who had severe upper extremity impairment participated in this study. Corticospinal excitability was assessed by measuring the resting motor threshold, active motor threshold and motor evoked potential amplitude. Transcallosal inhibition was investigated by measuring the duration and depth of the ipsilateral silent period (ISP). The data from the two hemispheres were compared and the relationships of transcallosal inhibition with upper extremity motor impairment, grip strength and pinch strength were analyzed. RESULTS: Resting motor threshold (p = 0.001) and active motor threshold (p = 0.001) were lower and motor evoked potential amplitude was higher (p = 0.001) in the contralesional M1 compared to the ipsilesional M1. However, there were no differences between the two M1s in ISP duration (p = 0.297) or ISP depth (p =0. 229). Transcallosal inhibition from the contralesional M1 was positively associated with motor impairment (ISP duration, p = 0.003; ISP depth, p = 0.017) and grip strength (ISP duration, p = 0.016; ISP depth, p = 0.045). CONCLUSIONS: Symmetric transcallosal inhibition between hemispheres and positive association of transcallosal inhibition from contralesional M1 with upper extremity motor behavior indicate that recruitment of contralesional M1 may be necessary for recovery in patients with severe upper extremity impairment after subacute ischemic stroke.

Unilateral Strength Training of the Less Affected Hand Improves Cortical Excitability and Clinical Outcomes in Patients With Subacute Stroke: A Randomized Controlled Trial.

OBJECTIVES: To investigate whether unilateral strength training helps improve cortical excitability and clinical outcomes after stroke. DESIGN: Randomized controlled trial. SETTING: Rehabilitation sciences research center. PARTICIPANTS: Patients with subacute stroke (N=26) were randomly assigned to a control group (n=13) or the experimental group (n=13). INTERVENTIONS: Participants in both groups received conventional physiotherapy. The experimental group also received unilateral strength training of the less affected wrist extensors. Interventions were applied for 4 weeks (12 sessions, 3 d/wk). MAIN OUTCOME MEASURES: Cortical excitability in both the ipsilesional hemisphere (ipsiH) and contralesional hemisphere (contraH) was assessed by measuring resting motor threshold (RMT), active motor threshold (AMT), motor evoked potential (MEP), and cortical silent period (CSP) at baseline and after the 4-week intervention period. Clinical outcomes were obtained by evaluating wrist extension strength in both the more affected and less affected hands, upper extremity motor function, activities of daily living (ADL), and spasticity. RESULTS: The experimental group showed greater MEP amplitude (P=.001) in the ipsiH and shorter CSP duration in both the ipsiH (P=.042) and contraH (P=.038) compared with the control group. However, the reductions in RMT and AMT in both hemispheres were not significantly different between groups. Improvements in wrist extension strength in the more affected (P=.029) and less affected (P=.001) hand, upper extremity motor function (P=.04), and spasticity (P=.014) were greater in the experimental group. No significant difference in ADLs was detected between groups. CONCLUSIONS: A combination of unilateral strength training and conventional physiotherapy appears to be a beneficial therapeutic modality for improving cortical excitability and some clinical outcomes in patients with stroke.

Comparison of Upper Trapezius and Infraspinatus Myofascial Trigger Point Therapy by Dry Needling in Overhead Athletes With Unilateral Shoulder Impingement Syndrome.

CONTEXT: Chronic musculoskeletal disorders in the shoulder joint are often associated with myofascial trigger points (MTrPs), particularly in the upper trapezius (UT) muscle. Dry needling (DN) is a treatment of choice for myofascial pain syndrome. However, local lesions and severe postneedle soreness sometimes hamper the direct application of DN in the UT. Therefore, finding an alternative point of treatment seems useful in this regard. OBJECTIVE: To compare the efficacy of UT versus infraspinatus (ISP) DN on pain and disability of subjects with shoulder pain. The authors hypothesized that ISP DN could be as effective as the direct application of DN in UT MTrP. DESIGN: Single-blind randomized clinical trial. SETTING: Sports medicine physical therapy clinic. PARTICIPANTS: A total of 40 overhead athletes (age = 36 [16] y; 20 females and 20 males) with unilateral shoulder impingement syndrome were randomly assigned to the UT DN (n = 21) and ISP DN (n = 19) groups. INTERVENTION: An acupuncture needle was directly inserted into the trigger point of UT muscle in the UT DN group and of ISP muscle in the ISP DN group. DN was applied in 3 sessions (2-day interval between each sessions) for each group. MAIN OUTCOME MEASURES: Pain intensity (visual analog scale), pain pressure threshold, and disability in the arm, shoulder, and hand were assessed before and after the interventions. RESULTS: Pain and disability decreased significantly in both groups (P < .001) and pain pressure threshold increased significantly only in the ISP group (P = .02). However, none of the outcome measures showed a significant intergroup difference after treatments (P > .05). CONCLUSIONS: Application of DN for active MTrPs in the ISP can be as effective as direct DN of active MTrPs in the UT in improving pain and disability in athletes with shoulder pain, and may be preferred due to greater patient comfort in comparison with direct UT needling.

Improving Balance in Older People: A Double-Blind Randomized Clinical Trial of Three Modes of Balance Training.

The aim of this study was to examine and compare the effects of conventional, multisensory, and dual-task exercises on balance ability in a group of older community dwellers over a four-week period. Forty-four older people were randomly assigned to one of the three training groups. The score on the Fullerton Advanced Balance (FAB) scale, gait stability ratio, and walking speed were evaluated at baseline and after four weeks of training. All three groups showed significant (p < .001) improvement in the FAB scores following the three training programs (on average, 3 points for the conventional and multisensory groups and 3.8 points for the dual-task group). The improvements were comparable across the three intervention groups (p = .23). There were no statistically significant differences, neither within nor between groups, in the gait stability ratio and walking speed across the three training groups. In a four-week period, all the training modes were effective in improving balance of older adults, with no significant superiority of one mode of training over another.

The effect of manual therapies on tension-type headache in patients who do not respond to drug therapy: a randomized clinical trial.

BACKGROUNDS: Tension-Type Headache (TTH) is one of the most common types of headache. In patients with TTH, manual therapy can be used to treat myofascial pain. OBJECTIVES: This study aimed to evaluate the effect of manual therapy on TTH in patients who did not respond to drug therapy. METHODS: A total of 24 patients with TTH were randomly enrolled into this prospective trial. The participants were divided into an intervention and a control group. The intervention group received the common medication and manual therapy, while the control group only received the common medication. Headache pain intensity, frequency, and duration, tablet count, and Neck Disability Index (NDI) were measured in both groups before, after, and one week after the intervention. RESULTS: There were significant differences between the two groups (treatment, control) regarding pain intensity (3.04, 6.75, P = 0.0001; effect size (ES) = 1.85), headache frequency (2.33, 5, P = 0.004; ES = 1.48) and duration (91.29, 284.74, P = 0.002; ES = 1.48), tablet count (1.83, 4.91, P = 0.01; ES = 1.04), and NDI (7.33, 20.16, P = 0.003; ES = 1.37). Within group differences were recorded in intervention group only for all dependent variables immediately after intervention and one week after the intervention (p < 0.05). CONCLUSION: Manual therapy reduced headache pain intensity, frequency and duration, tablet count, and NDI score in patients with TTH.

Sacroiliac joint manipulation attenuates alpha-motoneuron activity in healthy women: a quasi-experimental study.

OBJECTIVE: To determine whether sacroiliac joint (SIJ) manipulation decreases α-motoneuron activity and increases the pressure pain threshold (PPT) over the posterior superior iliac spine (PSIS) in healthy women. DESIGN: Quasi-experimental study. SETTING: A university medical center. PARTICIPANTS: Healthy young women (N=20) aged 18 to 30 years were recruited from among the students of a university medical center after a request for volunteers. INTERVENTIONS: Joint manipulation consisted of the supine rotational glide manipulation for the sacroiliac region. PPT measurements from the PSIS and Hoffman-reflex (H-reflex) amplitudes from the tibial nerve on the same side were recorded before and after joint manipulation. PPT was monitored for 15 minutes and H-reflex for 20 minutes after the procedure. MAIN OUTCOME MEASURES: Changes in tibial nerve H-reflex amplitude and PPT values after SIJ manipulation. RESULTS: SIJ manipulation attenuated α-motoneuronal activity significantly (P<.05) but transiently, since the decrease was seen only for 20 seconds after the intervention. There was no positive significant difference in the PPT after SIJ manipulation at any time during postintervention follow-up. CONCLUSIONS: SIJ manipulation produced a transient attenuation of α-motoneuron excitability in healthy women. These findings demonstrate that our manipulation technique can lead to a short-term reduction in muscle tone as a result of changes in sensory discharge, predominantly in la afferents. SIJ manipulation did not significantly affect the PPT in healthy women.

Biomechanical Analysis of the Pelvis Angular Excursion in Sagittal Plane in Response to Asymmetric Leg Loading Tasks in Females with and without Non-specific Chronic Low Back Pain.

BACKGROUND: Controlling pelvic excursions is the focus of stabilization exercises such as legs loading tasks in rehabilitation of non-specific chronic low back pain (NSCLBP) patients. Progression of these exercises is based on the ability to perform tasks with minimal sagittal pelvic excursions. In spite of emphasis on minimizing pelvic motions, no previous studies have investigated kinematic analysis of the pelvic excursions during leg loading exercises in NSCLBP patients. OBJECTIVE: This study aims to investigate the sagittal pelvis excursion during performing asymmetric leg loading tasks in individuals with and without NSCLBP. MATERIAL AND METHODS: In this cross-sectional study, kinematic data were collected from 15 NSCLBP patients and 15 asymptomatic participants by a motion analysis system during right and left leg loading tasks with 2 levels of difficulty. Pelvis segments were modeled using Visual3D motion analysis software. Maximum pelvic excursion in the sagittal plane was calculated during each task. Mixed model analysis of variances (group, task difficulty level, side) was performed for statistical analysis. RESULTS: The maximum sagittal pelvic excursion values of all tasks in NSCLBP were smaller than those in the control group; however, no significant main effects and interactions were found between two groups. CONCLUSION: These results suggest that NSCLBP patients completed loading tasks without differences in sagittal pelvic excursions as compared to controls. Assessment of NSCLBP patients only based on pelvic angular excursion may not be sufficient for clinical decision making. Furthermore, asymptomatic individuals may need to practice for controlling pelvic excursion during leg loading exercises similar to the CLBP patients.

A comparison between whole-body vibration and conventional training on pain and performance in athletes with patellofemoral pain.

INTRODUCTION: Patellofemoral pain (PFP) is the most common cause of anterior knee pain in athletes, which affects their performance especially during single leg activities. The aim of this study was to compare the effects of whole-body vibration training (WBVT) and conventional training (CT) on pain and performance in athletes with PFP. METHODS: 30 athletes with unilateral PFP were randomly assigned to the WBVT (6 women, 9 men) or CT (7 women, 8 men) group. All participants received training for 4 weeks in 12 sessions. The outcomes of pain and performance were measured at three points in time: baseline, immediately after training and 2 weeks after training. Pain was assessed with the Numeric Pain Rating Scale (NPRS). Performance was measured with the leg-press test and the Kujala Patellofemoral Score (KPS). RESULTS: In both groups, pain intensity decreased significantly (p < 0.001) and the KPS and number of leg presses increased significantly (p < 0.001) with time. There was no significant difference between groups for changes in the pain score (p = 0.896), KPS (p = 0.463) or leg press (p = 0.796) results. CONCLUSION: Whole-body vibration training had the same effect as exercise therapy on pain reduction and on improvements in performance in athletes with PFP.

Comparison between dry needling plus manual therapy with manual therapy alone on pain and function in overhead athletes with scapular dyskinesia: A randomized clinical trial.

Muscles' trigger points can induce scapular dyskinesia (SD) which interferes with overhead athletes' professional training. We aimed to evaluate effects of dry needling (DN) alone and plus manual therapy (MT) on pain and function of overhead athletes with SD. 40 overhead athletes (15 male, 25 female) aged 18-45 with at least 3 points Numeric Rating Scale (NRS) pain intensity during training were recruited and randomly allocated to the treatment group: MT followed by DN on trigger points of Subscapularis, Pectoralis minor, Serratus anterior, upper and lower Trapezius muscles; or the control group: MT alone. The effect of shoulder trigger points DN plus MT with MT alone on pain, function, Pain Pressure Threshold (PPT) and SD in athletes with SD were compared. Both the examiner and the therapist were blinded to group assignment. Both groups were analyzed. Pain, disability and SD were improved in treatment group (P < .05). On the other hand, when only MT was applied, despite reduction in pain and disability (P < .001), scapular slide only improved in hands on waist position. Comparing the differences between groups showed a substantial reduction in pain (P < .001) and disability (P = .02) with significant improvement in scapular dyskinesia in treatment group (P = .02). Moreover, PPT significantly increased in the control group (P = .004). No adverse effects reported by the participants during this study. DN is an easy and applicable method that can synergistically reduce pain, disability and dyskinesia when it is combined with manual techniques to treat shoulder dysfunctions.

Effects of kinesio tape on kinesiophobia, balance and functional performance of athletes with post anterior cruciate ligament reconstruction: a pilot clinical trial.

BACKGROUND: Anterior cruciate ligament trauma is one of the most common knee injuries in professional athletes. This study aimed to investigate the effects of kinesio taping on kinesiophobia, balance, and functional performance in athletes after anterior cruciate ligament reconstruction. METHODS: This randomized, placebo-controlled clinical trial was performed on 20 athletes with anterior cruciate ligament reconstruction (mean age 32.3 ± 6.2 years) at the time of return to sport. The subjects were randomly assigned to the kinesio tape (KT) group (n = 10) or placebo KT group (n = 10).While subjects under taped, the following outcomes were measured at baseline, 10 minutes after the intervention, and 2 days later. Kinesiophobia, balance, strength, and functional / agility performance were assessed by the Tampa Scale, Y balance test (YBT), single-leg hops, and 10-yard extremity functional test, respectively. RESULTS: The results did not show a significant difference between-group post-intervention differences in kinesiophobia (Mean between-group difference = - 6.30, 95% CI = - 4.35 to 1.42, P-value = 0.17). Likewise, no significant statistical difference was observed between two study groups in terms of YBT scores (Mean between-group difference ranged over = - 6.30, 95% CI = - 1.1 to 4.7, the effect sizes ranged over = 0.01 to 0.31), P-value > 0.05), Single Leg Hop (Mean between-group difference = - 0.48, 95% CI for difference ranged over = - 10.3 to 9.3, effect size = 0.001, P-value = 0.918), and 10 Yard test scores (Mean between-group difference = - 0.30, 95% CI = (- 1.3 to 0.75), effect size = 0.02, P-value = 0.55) at 2 days after the KT. In the KT and placebo KT groups, RMANOVA indicated that the differences in all variables scores were significant over time with large effect sizes (effect size ranged over = 0.94-0.99; all P-value < 0.001). CONCLUSION: This study gives no support for any beneficial effect of kinesio taping on the reduction of kinesiophobi or improvement of balance score and functional performance in athletes with post anterior cruciate ligament reconstruction. TRIAL REGISTRATION: This study was registered in the Iranian Clinical Trial Center with the code IRCT20190130042556N1, registered 12 February 2019.

The effect of spinal manipulation on brain neurometabolites in chronic nonspecific low back pain patients: a randomized clinical trial.

BACKGROUND: In patients with chronic nonspecific low back pain (NCLBP), brain function changes due to the neuroplastic changes in different regions. AIM: The current study aimed to evaluate the brain metabolite changes after spinal manipulation, using proton magnetic resonance spectroscopy (1H-MRS). METHODS: In the current study, 25 patients with NCLBP aged 20-50 years were enrolled. Patients were randomly assigned to lumbopelvic manipulation or sham. Patients were evaluated before and 5 weeks after treatment by the Numerical Rating Scale (NRS), the Oswestry Disability Index (ODI), and 1H-MRS. RESULTS: After treatment, severity of pain and functional disability were significantly reduced in the treatment group vs. sham group (p < 0.05). After treatment, N-acetyl aspartate (NAA) in thalamus, insula, dorsolateral prefrontal cortex (DLPFC) regions, as well as choline (Cho) in the thalamus, insula, and somatosensory cortex (SSC) regions, had increased significantly in the treatment group compared with the sham group (p < 0.05). A significant increase was further observed in NAA in thalamus, anterior cingulate cortex (ACC), and SCC regions along with Cho metabolite in thalamus and SCC regions after treatment in the treatment group compared with the baseline measures (p < 0.05). Also, a significant increase was observed in Glx (glutamate and glutamine) levels of thalamus (p = 0.03). There was no significant difference in terms of brain metabolites at baseline and after treatment in the sham group. CONCLUSION: In the patient with low back pain, spinal manipulation affects the central nervous system and changes the brain metabolites. Consequently, pain and functional disability are reduced.

Comparison of manipulation and stabilization exercises in patients with sacroiliac joint dysfunction patients: A randomized clinical trial.

BACKGROUND: Manual therapy and exercise therapy are two common treatments for low back pain. Although their effects have been discussed in several studies, the superiority of one over the other for patients with sacroiliac joint dysfunction is still unclear. OBJECTIVES: The aim of this study was to compare the effects of manipulation (M) and stabilization exercises (S) in patients with subacute or chronic sacroiliac joint dysfunction. METHODS: The participants in this randomized controlled trial study were patients with subacute or chronic sacroiliac joint dysfunction for more than 4 weeks and less than 1 year. A total of 40 patients were randomized with a minimization method to the M (n = 20) or S (n = 20) group; 15 patients in each group received treatment. The treatment program lasted 2 week in group M and 4 weeks in group S. Pain and the Oswestry Disability Index (ODI) were recorded before and immediately after the treatment period. RESULTS: Both groups showed significant improvement in assessed pain and ODI (P < 0.05). There were no statistically significant differences between groups in post-intervention assessed pain or ODI (P > 0.05). CONCLUSIONS: Despite the improvements seen after both manipulation and stabilization exercise therapies in patients with sacroiliac joint dysfunction, there was no significant between-group difference in the treatment effects. This result suggests that neither manual therapy nor stabilization exercise therapy is superior for treating subacute or chronic sacroiliac joint dysfunction.

Dry needling versus friction massage to treat tension type headache: A randomized clinical trial.

Tension type headache (TTH), the most common type of headache, is known to be associated with myofascial pain syndrome and the existence of myofascial trigger points. There are several treatment options for myofascial trigger points. In this study we compared the effectiveness of dry needling and friction massage to treat patients with TTH. A convenience sample of 44 patients with TTH participated in this randomized clinical trial. The frequency and intensity of headache, pressure pain threshold at the trigger point site, and cervical range of motion were recorded. Then the participants were randomly assigned to one of two treatment groups for dry needling or friction massage, delivered in 3 sessions during 1 week. The participants were evaluated 48 h after the last treatment session. Analysis of covariance, paired t-test and Wilcoxon's test were used for statistical analysis. The results showed that both treatment methods significantly reduced headache frequency and intensity, and increased pain threshold at the trigger points. However, neither treatment had any effect on cervical range of motion except for extension, which increased in the dry needling group. Between-group comparisons showed that dry needling increased pain threshold significantly more than friction massage. There were no significant differences between groups in any other outcome variables. Dry needling and friction massage were equally effective in improving symptoms in patients with TTH. The decreases in frequency and intensity of headache were similar after both dry needing and friction massage.

Comparing spinal manipulation with and without Kinesio Taping® in the treatment of chronic low back pain.

OBJECTIVES: Chronic non-specific low back pain (CNLBP) is a prevalent problem among athletes that can cause long-lasting disability and time lost from sporting activities. Thus far, a variety of methods have been suggested to address this problem, including spinal manipulation (SM) and Kinesio Tape® (KT). The aim of this study was to investigate whether adding KT to SM can provide any extra effect in athletes with CNLBP or not. METHOD: Forty-two athletes (21males, 21females) with CNLBP were randomized into two groups of SM (n = 21) and SM plus KT (n = 21). Pain intensity, functional disability level and trunk flexor-extensor muscles endurance were assessed by Numerical Rating Scale (NRS), Oswestry pain and disability index (ODI), McQuade test, and unsupported trunk holding test, respectively. The tests were done before and immediately, one day, one week, and one month after the interventions and compared between the two groups. RESULTS: After treatments, pain intensity and disability level decreased and endurance of trunk flexor-extensor muscles increased significantly in both groups. Repeated measures analysis, however, showed that there was no significant difference between the groups in any of the evaluations. CONCLUSIONS: The findings of the present study showed that adding KT to SM does not appear to have a significant extra effect on pain, disability and muscle endurance in athletes with CNLBP. However, more studies are needed to examine the therapeutic effects of KT in treating these patients. CLINICAL TRIAL REGISTRY NUMBER (IRCT.IR): IRCT2016020624149N5.

Spinal manipulation in the treatment of patients with MRI-confirmed lumbar disc herniation and sacroiliac joint hypomobility: a quasi-experimental study.

Background: To investigate the effect of lumbar and sacroiliac joint (SIJ) manipulation on pain and functional disability in patients with lumbar disc herniation (LDH) concomitant with SIJ hypomobility. Methods: Twenty patients aged between 20 and 50 years with MRI-confirmed LDH who also had SIJ hypomobility participated in the trial in 2010. Patients who had sequestrated disc herniation were excluded. All patients received five sessions of spinal manipulative therapy (SMT) for the SIJ and lumbar spine during a 2-week period. Back and leg pain intensity and functional disability level were measured with a numerical rating scale (NRS) and the Oswestry Disability Index (ODI) at baseline, immediately after the 5th session, and 1 month after baseline. Results: A significantly greater mean improvement in back and leg pain was observed in the 5th sessions and 1 month after SMT. Mean changes in ODI in the 5th session and 1 month after treatment also showed significant improvement. The MCIC for NRS and ODI scores in the present study were considered 20 and 6 points, respectively. Therefore, the mentioned improvements were not clinically significant in the 5th session or at 1-month follow-up. Conclusion: Five sessions of lumbar and SIJ manipulation can potentially improve pain and functional disability in patients with MRI-confirmed LDH and concomitant SIJ hypomobility. Trial registration: Irct.ir (Identifier: IRCT2017011924149N33), registered 19 February 2017 (retrospectively registered).

The therapeutic effect of low-level laser on repair of osteochondral defects in rabbit knee.

INTRODUCTION: Low level laser therapy (LLLT) has been shown to enhance collagen production and wound healing but its effect on cartilage repair from biomechanical point of view is not known yet. The aim of present study was to evaluate the biomechanical behaviour of repairing osteochondral defect in rabbits which received a pulsed low-level gallium-arsenide (Ga-As) laser irradiation. MATERIALS AND METHODS: Osteochondral defects with 5mm diameter and 4mm in depth induced by drilling in right femoral patellar grooves of 41 adolescent male rabbits. They were divided into experimental and control groups. Experimental group received pulsed Ga-As (890nm) laser irradiation with energy density of 4.8J/cm(2). The rabbits in control group received placebo LLLT with shut-down equipment. The control defects were allowed to heal spontaneously. Each group were divided into three subgroups: A, B and C. Subgroups A, B and C were sacrificed on 4, 8, and 16 weeks after surgery. The knee joint were removed, and the defects were examined biomechanically by in situ-indentation method. The thickness, instantaneous and equilibrium indentation stiffness was measured during the test. Data were analysed using ANOVA and independent sample t-test. RESULT: While no difference was observed in the repaired cartilage biomechanical properties among 4th, 8th, 16th weeks in study groups. The equilibrium indentation stiffness of experimental group was significantly higher in 8th week in comparison with control group. CONCLUSION: LLLT significantly enhances the stiffness of repairing tissue in the 8th week post injury in osteochondral defects in rabbits.

Comparison of ischemic compression and lumbopelvic manipulation as trigger point therapy for patellofemoral pain syndrome in young adults: A double-blind randomized clinical trial.

OBJECTIVE: To compare the effectiveness of ischemic compression (IC) directly to the vastus medialis obliquus (VMO) versus lumbopelvic manipulation (LPM) in improving pain, functional status and sensitivity to mechanical stimulation of the VMO trigger point in patients with patellofemoral pain syndrome (PFPS). PARTICIPANTS: 40 patients with unilateral PFPS aged 20-30 years were selected randomly among patients with unilateral PFPS referred to physical therapy clinics of Shiraz University of Medical Sciences in Shiraz, Iran, between March 2014 and July 2014. 30 young adults participated. Participants were blinded to treatment allocation, and 15 patients were allocated to either IC or LPM. INTERVENTIONS: Patients in both groups were treated in three sessions per week. IC consisted of three sets of continuous pressure applied for on the myofascial trigger point (MTrP) of VMO. LPM consisted of supine rotational glide manipulation of the ipsilateral lumbopelvic region of the involved knee. MAIN OUTCOME MEASURES: Numeric pain rating scale (VAS) for pain intensity, Kujala questionnaire for functional status, and pressure pain threshold (PPT) for sensitivity to mechanical stimulation. All three were recorded before treatment, 1 week, 1 month and 3 months after the last session. RESULTS: Both groups showed significant improvement (p < 0.05, 95% confidence interval) in pain, functional status and PPT values. However, the IC group showed greater improvements, and outcome measures remained significantly better than in the LPM group during post-intervention follow-up. CONCLUSIONS: Both groups showed improvements throughout the study and follow-up period. However, the IC showed better short-term and long-term effectiveness than LPM for treating PFPS.