Comparison of breathing pattern and diaphragmatic motion in patients with unilateral cervical radiculopathy and asymptomatic group.

BACKGROUND: The associations between neck pain and respiratory dysfunction were clarified in patients with neck pain. There is dearth of evidence on pulmonary dysfunction and diaphragmatic excursion in patients with unilateral cervical radiculopathy (CR). The purpose of this study was to compare the breathing pattern and diaphragmatic excursion in patients with unilateral CR with those in an asymptomatic group. METHODS: Twenty-five patients with unilateral CR and 25 asymptomatic individuals aged between 30 and 55 participated in this study. Diaphragmatic motion, breathing pattern, active cervical range of motion and kinesiophobia were investigated in both groups by using fluoroscopy, manual assessment of respiratory motion (MARM), cervical range of motion device, and Tampa scale of kinesiophobia. Statistical significance was set at 0.05. RESULTS: No statistically significant differences were found between the two groups with regard to sex, age and body mass index. The mean excursion of the hemi diaphragm on the involved side (the side of CR) was significantly lower than that on the uninvolved side in patients with unilateral CR with a large effect size. The excursion of the involved hemi diaphragm in patients was reduced compared to the matched hemi diaphragm in the control group. There was no significant difference between the hemi diaphragms excursion in the control group. The results of the MARM variables showed that the volume of breathing and the percentage rib cage motion in normal and deep breathing were significantly different between the two groups, but there was no significant difference in the balance of breathing between the two groups. Additionally, the active cervical range of motion was reduced in these patients in comparison to the control group, and it was less on the involved side than on the uninvolved side. CONCLUSION: The results of this study revealed a dysfunctional breathing pattern in normal and deep breathing and a unilateral reduction in diaphragmatic excursion on the side of radiculopathy in patients with unilateral CR compared to the control group.

Consequences of extensile lateral approach to the calcaneal fractures on balance and isokinetic strength of muscle groups crossing the ankle joint.

BACKGROUND: Inherent characteristics of extensile lateral approach (ELA) for fixation of displaced intraarticular calcaneal fractures together with delayed or probably insufficient physical therapy programs may lead to weakness of the muscle groups crossing the ankle joint. Peroneal tendons might be involved more than others because of possible postoperative adhesions. The aim of this study was to evaluate the isokinetic strength of the muscle groups crossing the ankle joint and also to assess balance and functional ability in this group of patients. METHODS: Based on a pilot study, 23 patients undergone open reduction and internal fixation (ORIF) via ELA and 22 healthy subjects as the control group participated in this observational cross-sectional study. Patients more than 20 years of age with at least 12 months passed their unilateral closed intraarticular calcaneal fracture fixation without any postoperative complications like infection or wound dehiscence were included. Patients with history of concomitant lower extremity injury, spine trauma or surgery, cases underwent removal of calcaneal plates, and cases with neuromuscular or vestibular dysfunction were excluded. The outcome was assessed by isokinetic parameters such as peak torque, peak torque normalized to body weight, mean power and total work modified star excursion balance test, triple hop for distance test, and evertor-to-invertor (E/I) strength ratio. Isokinetic tests were performed at 60 and 120°/s. RESULTS: Greater strength was observed in all muscles in the control group at 60°/s (p < 0.05). Evertors and invertors were weaker in the operated group at 120°/s in comparison to the dorsiflexors and plantarflexors. Modified star excursion (p: 0.003) and triple hop tests (p: 0.001) were lower in the operated group. E/I ratio was not statistically significant between the two groups at 60°/s (p: 0.44) and 120°/s (p: 0.62). CONCLUSIONS: Strength deficit in all muscle groups crossing the ankle joint, and not evertors in isolation, in addition to balance and functional impairments would be seen one year following ORIF of calcaneal fracture via ELA. A long-term rehabilitation program emphasizing different kinds of contraction at low and high speeds and balance training in these patients is highly recommended.

Comparison of static and dynamic balance during early follicular and ovulation phases in healthy women, using simple, clinical tests: a cross sectional study.

Balance may be influenced by several factors. The menstrual cycle can be considered as an important factor which may affect postural control. This study was aimed to investigate the influence of early follicular and ovulation phases on static and dynamic balance indices. Thirty non-athlete healthy women with a regular menstrual cycle aged between 18 and 25 years participated in the study. Static balance was evaluated through single-leg stance test and dynamic balance was investigated with posteromedial direction of Y- balance test during early follicular and ovulation (24-48 hours after the peak of estrogen) phases of menstrual cycle. The balance tests were performed in a randomized order in each session. A paired t-test analysis was performed to compare the data during the early follicular and ovulation phases. The results indicated that both static and dynamic balance scores were higher in ovulation phase in comparison to early follicular phase (p < .001). It is worth noting to consider the balance fluctuations during different phases of menstrual cycle when prescribing exercise programs for healthy women or when they participate in sport or recreational activities.

Evaluation of validity and reliability of the Persian version of the functional index of hand osteoarthritis.

The Functional index of hand osteoarthritis (FIHOA) is a commonly used patient-reported outcome questionnaire designed to measure function in patients with hand osteoarthritis. The objective of this study was to evaluate the validity and reliability of the Persian version of the FIHOA. The Persian-translated version of FIHOA was administered to 72 native Persian-speaking patients in Iran with hand osteoarthritis. Thirty-six of the patients completed the questionnaire on two occasions 1 week apart. The physical component of the SF-36 and a numerical rating scale were used to evaluate the construct validity of the Persian version of FIHOA. Internal consistency was high (Cronbach's alpha = 0.89). Test-retest reliability for the total score was excellent (weighted kappa = 0.89, 95% CI 0.79-0.94). A significant positive correlation between total FIHOA score and numerical rating scale (r = 0.70) and a significant negative correlation between total FIHOA score and the physical component scale of the SF-36 (r = -0.76) were observed. The Persian version of the FIHOA showed adequate validity and reliability to evaluate functional disability in Persian-speaking patients with hand osteoarthritis.

Evaluation of the reliability and validity of the Persian version of Patient-Rated Elbow Evaluation questionnaire.

Elbow joint pathologies are highly prevalent in Persian-speaking countries. A reliable low-cost method like an appropriate questionnaire is mandatory for the early diagnosis of elbow joint disorders. Among designed questionnaires, Patient-Rated Elbow Evaluation (PREE) is an accepted commonly used scale evaluating pain and dysfunction of the patients. The aims of the study were to cross-culturally adapt and also to identify the psychometric properties of the Persian PREE. The original version of the PREE was translated and cross-culturally adapted to Persian according to the guidelines by Beaton et al. Seventy-three patients and thirty-nine healthy people were enrolled in the study. Test-retest reliability and internal consistency were evaluated using ICC, Cronbach's alpha, and item-total correlation, respectively. Construct validity was investigated using Disability of Arm, Shoulder, and Hand (DASH) questionnaire and physical component scale of SF-36 (PCS). To determine a cutoff point for discriminating patients from non-patients, receiver operating characteristic curve was plotted. The Persian PREE displayed high internal consistency (Cronbach's alpha = 0.91) and had acceptable ICC values in the subscales and total score (ICC > 0.90). A positive moderate correlation with DASH (r = 0.66, P < 0.001) and a negative moderate correlation with PCS of SF-36 (r = -0.44, P < 0.001) were observed. The cutoff point equal to 13.16 was determined for Persian PREE. The Persian PREE exhibited promising validity and reliability. The findings supported its applicability in clinical situations that were consistent with the original version.

Evaluation of Contralateral Limb Cross Education and High-Frequency Repetitive Transcranial Magnetic Stimulation on Functional Indices of the Affected Upper Limb in Subacute Phase of Stroke.

Background: Stroke is one of the causes of long-term morbidity. Despite rehabilitation strategies, most survivors live with motor deficits in the upper limbs. Objectives: The aim of the study was to compare the effect of contralateral cross education (CE) and high-frequency repetitive magnetic stimulation (HF-rTMS) on the function of upper extremity in subacute phase of stroke. Methods: Forty patients were randomly assigned into 4 groups. Group "A" received physical therapy (PT) for 10 sessions, 3 times per week. Group "B" received PT and HF-rTMS as follows: stimulation of 20 Hz for 5 s, intertrain interval for 50 s, 20 trains, 2000 pulses at 90% resting motor threshold, and conventional PT. Group "C" was treated with CE and PT. In group "D," HF-rTMS, CE, and PT were administered. Results: Significant differences were found in the Fugl-Meyer scale between "A" and "C" (P = 0.01), "A" and "D" (P = 0.02), and "B" and "C" groups (P = 0.01). In the box-block test, there were significant differences between "A" and "B" (P = 0.01), "A" and "C" (P < 0.001), "B" and "D" (P = 0.001), and "B" and "C" groups (P = 0.01). Statistical differences were observed in grip strength between "A" and "B" (P = 0.01) and "A" and "C" groups (P = 0.02). Conclusions: It is suggested that clinicians select the therapeutic methods in line with their expected goal. When the goal is to improve upper extremity function, CE+PT could be more effective than HF-rTMS+PT. Also, CE+PT and HF-rTMS+PT were more effective than CE+HF-rTMS+PT at improving grip strength. Therefore, combining several methods would not always lead to better results.

Comparing position sense and isokinetic strength of the muscles of elbow joint between aikidokas and non-athlete people.

BACKGROUND: Aikido is a martial art comprises of locking techniques and falls. During the locking techniques, the elbow joint is forced into extended position. Moreover, the elbow hits the ground during the falling techniques. These might compromise joint position sense (JPS). The objectives of this study were to compare JPS and strength of the muscles of elbow joint between Aikidokas and a non-athlete group and to evaluate the correlation between JPS and muscle strength among Aikidokas. METHODS: All male Jiyushinkai style Aikidokas and a healthy matched non-athlete group participated in this cross-sectional study. Passive JPS at a speed of 4°/s and the isokinetic strength of elbow flexors and extensors were assessed. RESULTS: Evaluating the isokinetic parameters revealed no significantly difference between the groups in either flexion or extension at speeds of 60 (P-value range: 0.2-0.99) and 120 °/s (P-value range: 0.05-0.96). Also, the groups had no significant difference regarding different types of reconstruction error including constant error (P-value range: 0.38-0.91), variable error (P-value range: 0.09-0.87), and total variability (P-value range: 0.30-0.80). Moreover, very weak to weak correlation was observed between isokinetic parameters and passive JPS (r-value range: 0.01-0.39). CONCLUSIONS: JPS was not impaired in Aikidokas in spite of the repetitive stress applied to the elbow joint during the performance of Aikido techniques. The lack of significant difference in isokinetic between Aikidokas and healthy non-athletes, and the absence of an acceptable correlation between IPS and muscle strength in Aikidokas, might be attributed to the soft nature of Aikido.

The sono-elastography evaluation of the immediate effects of neurodynamic mobilization technique on median nerve stiffness in patients with carpal tunnel syndrome.

OBJECTIVES: The stiffness of median nerve increases in carpal tunnel syndrome (CTS) even at mild stage of syndrome which could be regarded as a diagnostic criterion. The aim of this study was to evaluate the immediate effects of neurodynamic technique on median nerve stiffness and cross-sectional area (CSA) at wrist and elbow in individuals with CTS. MATERIAL AND METHODS: It was a quasi-experimental study. Twenty patients were recruited for this study. They were included if aged 18-65 years and diagnosed with CTS based on electrodiagnostic and clinical findings. The exclusion criteria were previous surgeries at wrist or elbow. Patients were assessed by shear wave sono-elastography before and immediately after one session of neurodynamic mobilization technique (NDM). The primary outcome measure was the stiffness of the median nerve at wrist and the secondary outcomes were nerve stiffness at elbow and CSA of nerve at wrist and elbow. RESULTS: Median nerve stiffness and CSA decreased significantly at wrist immediately after a session of NDM. These parameters also decreased at elbow but were not statistically significant. CONCLUSION: One session of NDM reduced the stiffness and CSA of median nerve at wrist in patients with CTS as detected by sono-elastography verifying that sono-elastography is able to quickly detect the immediate biomechanical changes of the median nerve.

Comparison of flexion relaxation phenomenon between female yogis and matched non-athlete group.

BACKGROUND: Trunk flexion is a common exercise during daily activities. Flexion relaxation phenomenon (FRP) occurs during forward bending in which there is a sudden silence of erector spinae (ES) muscles. The pattern of forward bending differs in yoga practitioners. This learned pattern probably predisposes yogis to injuries. The hypothesis of this study was that FRP differs in yogis in comparison to non-yogis individuals. METHODS: This observational cross-sectional study was performed on 60 women assigned into yogis and non-athlete groups. Each participant was asked to bend forward and then return to the initial position. ES activity was recorded at L3 level, 4 cm from mid line during the trial. Trunk inclination and lumbar flexion angles were calculated at FRP onset and cessation moments. RESULTS: The FRP occurred in 80% of yoga practitioners in comparison to 96.7% in the control group. Trunk inclination angle was significantly greater at FRP initiation in yogis compared to control group. Lumbar flexion angle was not different between the groups. CONCLUSIONS: It is concluded that the altered pattern of forward bending observed in yogis may change patterns of ES muscles activity if it becomes part of a person's daily lifestyle which might predispose these muscles to fatigue and subsequent injuries; however, further studies are warranted for clarification.

Evaluating the Validity and Reliability of the Persian Version of American Orthopedic Foot and Ankle Society Midfoot Scale.

BACKGROUND: The use of a valid and reliable outcome scoring system is crucial for evaluating the result of different treatment interventions. The aims of this study were to translate and culturally adapt the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot scoring system into the Persian language and assess its validity and reliability. METHOD: In total, 57 patients with midfoot injuries were enrolled. Forward-backward translation and cultural adaptation methods were used to develop the Persian version of AOFAS midfoot scoring system. Reliability and internal consistency were assessed using intraclass correlation coefficient (ICC) and Cronbach's alpha. The discriminant and convergent validities of the scoring system were assessed using the total score of the mental and physical component of SF-36. RESULTS: The mean age of the participants was 46.2 ± 16.3 years. The intra-observer reliability of the totals core of the Persian version of AOFAS midfoot scoring system was 0.96 (confidence interval [CI]: 0.92-0.97) and the inter-observer reliability of the scoring system was 0.90 (CI: 0.86-0.95). The Persian version of AOFAS midfoot scoring system had acceptable convergence with physical component scoring system of SF-36 and its subscales (0.57); moreover, it had acceptable discriminant validity with the mental component of SF-36 and its subscales (0.36). CONCLUSION: The Persian version of AOFAS midfoot is a reliable and valid instrument and could be used by Persian language clinicians and researchers. LEVEL OF CLINICAL EVIDENCE: 3.

Cross-cultural adaptation, reliability and validity of the Persian version of the Victorian Institute of Sport Assessment-Achilles questionnaire (VISA-A).

PURPOSE: Achilles tendinopathy is a prevalent overuse injury among athletes and in those with a sedentary lifestyle. Current evidence indicates that the Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire is a valid, reliable and disease-specific outcome measure for assessing the clinical symptoms in patients with Achilles tendinopathy. The objective of this study was to translate and cross-culturally adapt the VISA-A questionnaire into Persian (VISA-A-P) and evaluating its psychometric properties. MATERIALS AND METHODS: Cultural adaptation of VISA-A-P was conducted according to Beaton's guideline. The final version of VISA-A-P was handed to 61 patients for analysis of psychometric properties. Test-retest reliability, internal consistency, concurrent validity, item-total correlation, and floor/ceiling effect were evaluated in patients with Achilles tendinopathy. To assess test-retest reliability, 35 patients refilled the VISA-A-P twice within 5-7 days. Known-group validity was evaluated using 50 healthy individuals. RESULTS: VISA-A-P showed excellent test-retest reliability (ICC = 0.90), excellent internal consistency (Cronbach's alpha = 0.95), strong correlation with FAAM, and moderate to strong correlation with FAOS questionnaires. There was a significant difference between the average score of patients (34.55 ± 18.24) and the healthy group (73.1 ± 20.10). VISA-A-P showed neither ceiling nor floor effect. CONCLUSIONS: The VISA-A-P is a reliable and valid instrument for measuring the symptoms in Persian speaking populations with Achilles tendinopathy.Implications for rehabilitationAchilles tendinopathy is a debilitating overuse injury that insidiously affects tendoAchilles.VISA-A-P revealed acceptable validity and reliability and it could be used by Persian speaking clinicians and researchers to assess pain and function in people with Achilles tendinopathy.

A Comparison between Effects of Neurofeedback and Balance Exercise on Balance of Healthy Older Adults.

BACKGROUND: Balance ability is a crucial component of independent daily activities among the older adultss. Balance impairment is one of the major risk factors for falls and related complications. OBJECTIVE: The present study aims to investigate and compare the effect of neurofeedback training and balance training on balance and fall risk among older adults. MATERIAL AND METHODS: In this randomized controlled trial, a total of 48 older adults aged more than 65 years were recruited and randomly assigned into two groups, neurofeedback group (n=24) and balance exercise group (n=24). Prior to the intervention, the static balance, dynamic balance, and fall risk were measured using Biodex D balance system and Fullerton Advanced Balance scale. Subjects in neurofeedback group received neurofeedback training for 12 sessions of 30-min, every other day. Moreover, subjects in balance exercise group received balance training for four weeks in 12 sessions (45-minute) every other day. After the intervention, balance measurements were repeated in both groups. The significance level was set at p<0.05. RESULTS: Static balance and dynamic balance were shown to significantly improve, after the interventions (p<0.001). Furthermore, fall risk was significantly reduced, after the trial (p<0.001). In addition, the therapeutic effect of neurofeedback training was not less significant than exercises on balance in the older adults (p<0.001). CONCLUSION: The findings suggest that both neurofeedback training and balance training improved balance ability among the older adults. Results also show the therapeutic effect of neurofeedback training on balance in older people. However, further research is required to accurately investigate the long-term effects of these two treatment methods among the older adults.

Dry needling trigger points around knee and hip joints improves function in patients with mild to moderate knee osteoarthritis.

INTRODUCTION: Dry needling may be an effective method to alleviate pain and improve range of motion. Controversial results have been found in previous studies using dry needling in knee problems. So, the aim of current study is to exert dry needling technique on unilateral muscles around the hip and knee joints and evaluate its effects on knee osteoarthritic patients. METHOD: For this double-blind randomized clinical trial, 40 female patients with mild to moderate knee osteoarthritis (aged 45-70 years old) were recruited. They entered the study if they had any trigger points around the hip or knee joints of the examined side and randomized into two groups. Pain, sensitivity of trigger points, balance and function measured by visual analogue scale, algometer, Y-balance test, timed up and go, self-paced walk tests beside KOOS questionnaire respectively before and after intervention. The intervention group received 3 sessions of dry needling on marked trigger points while the sham group received sham treatment consisting of only the plastic cover of a needle. Both groups reexamined 2 weeks after primary evaluation. RESULTS: Comparing results before and after implementing dry needling revealed significant improvements in all measured variables in treatment group whereas, pain and timed up and go increased and peak pain pressure decreased in sham group. Between group comparison revealed significant differences in all variables. CONCLUSION: Using 3 sessions of dry needling can increase functional activity, sensitivity and balance and decrease pain in patients with knee osteoarthritis in short term.

The Effect of Acupressure on Fasting Blood Glucose and Glycosylated Hemoglobin Levels in Diabetic Patients: A Randomized Controlled Trial.

BACKGROUND: Diabetes is the most common endocrine disorder. Non-pharmacological methods can be used for treatment of these patients. The present study aimed to investigate the effect of acupressure point on fasting blood glucose and glycosylated levels of diabetic patients. METHODS: This clinical trial was conducted on 102 patients who referred to Motahari Clinic of Shiraz during May-June in 2018. The participants were selected based on simple random sampling and divided into three groups via permuted block randomization. The control group only received the pharmacological treatments. The intervention group received acupressure at ST36 point in addition to medications. The placebo group also received medications and acupressure at a fake point. The intervention was carried out for six minutes (three minutes for each lower extremity), three sessions a week for 12 weeks. Fasting blood glucose and glycosylated hemoglobin levels were checked in all patients immediately after the intervention. The data were analyzed using Chi-square, paired t-test, and ANOVA by the SPSS statistical software, version 21, and P<0.05 was considered statistically significant. RESULTS: The results showed no significant differences among the three groups' blood glucose mean levels before (P=0.89) and after the intervention (P=0.36). However, a significant difference was observed in the intervention group's glycosylated hemoglobin mean levels before (8.61±1.96) and after the intervention (8.1±1.62) (P=0.02). CONCLUSION: In sum, the study indicated that acupressure could only be effective in reducing the glycosylated hemoglobin in the intervention group. Thus, further larger studies are recommended to evaluate the effectiveness of this technique. Trial Registration Number: IRCT20111224008505N47.

The Effect of High-Frequency Repetitive Transcranial Magnetic Stimulation on Functional Indices of Affected Upper Limb in Patients with Subacute Stroke.

BACKGROUND: Repetitive transcranial magnetic stimulation (rTMS) is a novel technique that may improve recovery in patients with stoke, but the role of rTMS as an applied and practical treatment modality for stroke rehabilitation has not been established yet. OBJECTIVE: This study was conducted to determine the effects of a rehabilitation program (RP) in conjunction with rTMS on functional indices of the paretic upper limb in the subacute phase of stroke. MATERIAL AND METHODS: In this experimental study, twenty patients in the subacute phase of stroke were randomly assigned into two groups: The high frequency rTMS (HF-rTMS) in conjunction with RP (experimental group), and the RP group (control group). The experimental group received 10 sessions of 20 Hz rTMS on the affected primary motor cortex and the other group received 10 sessions of RP. In experimental group, RP for the paretic hand was conducted following rTMS session. Box and block test (BBT), Fugl-Meyer Motor Assessment for upper limb (FMA-UL), grip strength and pinch strength were used to assess motor function before the first session and after the last session of treatment. RESULTS: Significant improvement in BBT, FMA-UL, grip strength and pinch strength was observed in both groups. Improvement of BBT and grip strength was significantly greater in the experimental group rather than the control group (p<0.05). FMA-UL score and the pinch strength were greater in the experimental group, although the differences were not statistically significant. CONCLUSION: HF-rTMS in conjunction with RP is effective to improve the function of upper limb. It seems HF-rTMS is a novel feasible and safe technique for hemiparesis patients in the subacute phase of stroke.

Comparison of the prevalence of myofascial trigger points of muscles acting on knee between patients with moderate degree of knee osteoarthritis and healthy matched people.

INTRODUCTION: Trigger points have been implicated in the development of several musculoskeletal disorders. Trigger points harbored in lower limb muscles might represent a ubiquitous source of pain in patients with knee osteoarthritis (OA). This study was carried out to evaluate the prevalence of Myofascial Trigger Points (MTrPs) in muscles acting on the knee in patients with OA. METHODS: Thirty-seven patients aged at least 55 years old with a moderate degree of OA (grade III of Kellgren and Lawrence scale) were recruited. Thirty asymptomatic people, matched on age and body mass index, were considered as the control group. Ten muscles acting on the knee joint were selected. Taut bands were also identified using a skin rolling method. A pressure of 3 kg/cm2 was used to identify myofascial trigger points in all muscles except the popliteus (8 kg/cm2). RESULTS: Chi-square was performed to compare the prevalence of trigger points between the groups. The McNemar test was administered to compare the prevalence of trigger points in the right and left sides of participants. Prevalence of the trigger points was significantly higher in patients with knee OA compared with asymptomatic people in all muscles except for right (p = 0.17) and left (p = 0.41) rectus femoris, right (p = 0.61) and left (p = 0.22) sartorius and left biceps femoris (p = 0.08). Comparison of the prevalence of MTrPs bilaterally revealed that only the right and left sartorius differed significantly (p = 0.008). CONCLUSIONS: The prevalence of MTrPs in the muscles acting on the knee joint is higher in patients with a moderate degree of knee OA compared with asymptomatic subjects.

Comparison of dry needling and ischaemic compression techniques on pain and function in patients with patellofemoral pain syndrome: a randomised clinical trial.

BACKGROUND: To compare the effectiveness of ischaemic compression (IC) applied directly to the knee versus dry needling (DN) with respect to pain, functional status and sensitivity to mechanical stimulation of vastus medialis obliquus (VMO) myofascial trigger points (MTrPs) in patients with patellofemoral pain syndrome (PFPS). METHODS: A total of 54 patients with unilateral PFPS aged 20-30 years were selected randomly from patients referred to physical therapy clinics of Babol University of Medical Sciences in Iran. Twenty-seven patients were allocated to either IC or DN groups. Three sessions of treatment were applied over 1 week with follow-up at 1 week, 1 month and 3 months. Primary outcome measures comprised the Kujala questionnaire score for functional status, numerical pain rating scale (NPRS) for pain intensity and pressure pain threshold (PPT) for sensitivity to mechanical stimulation; these were measured and recorded before treatment and 1 week, 1 month and 3 months after the last treatment session. RESULTS: There were no statistically significant differences in the between-group comparisons of any variables at the various follow-up points. Both groups (n = 27 participants each) had significant improvements (p < 0.05) in pain, functional status and PPT values at follow-up. CONCLUSIONS: There were no differences in markers of pain, function or pressure sensitivity over a 3-month follow-up period between patients with PFPS treated with DN and IC. Temporal improvements in both groups suggested that the two techniques may be similarly effective for the treatment of PFPS.

Changes in Knee Vastii Muscle Activity in Women with Patellofemoral Pain Syndrome During the Menstrual Cycle.

BACKGROUND: Changes in hormonal levels during the menstrual cycle are known to affect muscle electromyographic (EMG) activity, but no studies have investigated the effect of hormonal changes on the EMG activity of muscles around the knee in patients with patellofemoral pain syndrome (PFPS). OBJECTIVE: To evaluate the EMG activity of the vastus medialis obliquus (VMO) and vastus lateralis (VL) muscles during toe rise and heel rock tasks in different phases of the menstrual cycle in women with PFPS. DESIGN: Cross sectional study. SETTING: Rehabilitation Research Center at the School of Rehabilitation Sciences of Shiraz University of Medical Sciences. PARTICIPANTS: Ten women with PFPS between 18 and 40 years of age. INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: The VL/VMO amplitude ratio and differences between onset (onset VL-onset VMO) of vastii muscle activity were measured in the affected limb during rise and rock tasks in the follicular and ovulatory phases of the menstrual cycle. The signals were analyzed with MATLAB software. RESULTS: During both tasks, there were no significant changes in onset differences in vastii muscles between the ovulatory and follicular phases. However, the amplitude ratio (VL/VMO) was significantly lower in the ovulatory phase compared to the follicular phase (P = .035 for rise tasks and .010 for rock tasks). CONCLUSION: The menstrual cycle may affect some EMG parameters. These factors can be taken into account when planning sports and rehabilitation training programs.

Comparison of grip and pinch strength in young women with and without hyperkyphosis: A cross-sectional study.

BACKGROUND: Hyperkyphosis is a common postural defect with high prevalence in the 20 to 50 year old population. It appears to compromise proximal scapular stability. Grip and pinch strength are used to evaluate general upper extremity function. OBJECTIVE: The aim of this study was to compare pinch and grip strength between young women with and without hyperkyphosis. METHODS: Thirty young women (18-40 years old) with hyperkyphosis and 30 healthy women matched for age and body mass index participated in the study. Hyperkyphosis was confirmed by measuring the kyphosis angle with a flexible ruler. Grip strength was measured with the Waisa method and a dynamometer. Pinch strength was assessed with a pinch meter. RESULTS: Grip (P= 0.03) and pinch strength (P= 0.04) were significantly lower in women with hyperkyphosis compared to the control group. Kyphosis angle correlated weakly with grip (r= 0.26) and pinch strength (r= 0.23). CONCLUSIONS: Hyperkyphotic posture has led to decreased grip and pinch strength compared to people without hyperkyphosis.

Evaluating the Cross-Cultural Adaptation, Reliability, and Validity of the Persian Versions of the Copenhagen Neck Function Disability Scale and Neck Bournemouth Questionnaire.

STUDY DESIGN: A cross-sectional study. OBJECTIVE: To evaluate cross-cultural adaptation and psychometric properties of the Copenhagen Neck Function Disability Scale (CNFDS) and Neck Bournemouth Questionnaire (NBQ) in patients with chronic nonspecific neck pain. SUMMARY OF BACKGROUND DATA: CNFDS and NBQ are among the most popular scales to investigate aspects of life in patients with chronic neck pain. To date, the Persian versions of these scales have not been validated. METHODS: Following the translation process, the questionnaires were given to 106 patients with chronic nonspecific neck pain. To evaluate reliability, Cronbach alpha and test-retest reliability were evaluated. To investigate construct validity, the Neck Disability Index (NDI) and Neck Pain Disability Scale (NPDS) were used. Internal consistency of the scales was evaluated with exploratory factor analysis. RESULTS: No missing data were observed for the NBQ, and missing data affected 0% to 3% of the CNFDS items. There were no floor or ceiling effects. Cronbach alpha was 0.92 for the CNFDS and 0.95 for the NBQ. Test-retest reliability was estimated as 0.86 for the CNFDS and 0.91 for the NBQ. The CNFDS correlated very well with the NDI pain subscale, and the NPDS. The NBQ correlated very well with the NPDS and NDI, and correlated well with the CNFDS and its subscales. Exploratory factor analysis detected three dimensions for the CNFDS and confirmed unidimensionality of the NBQ. CONCLUSION: The Persian versions of the CNFDS and NBQ have acceptable validity and reliability for use with Persian-speaking patients with chronic nonspecific neck pain. LEVEL OF EVIDENCE: 2.