Effect of Whole-Body Vibration Exercise on Hamstrings-to-Quadriceps Ratio, Walking Performance, and Postural Control in Children With Hemiparetic Cerebral Palsy: A Randomized Controlled Trial.

OBJECTIVE: The purpose of this study was to investigate the effect of whole-body vibration (WBV) exercises combined with traditional physiotherapy on the hamstrings-to-quadriceps (H:Q) ratio, walking ability, and control of posture in children with hemiparetic cerebral palsy (CP). METHODS: A total of 34 children with spastic hemiparetic CP (boys and girls) participated in this 2-arm, parallel, randomized controlled trial. The inclusion criteria were spasticity ranging from 1 to 1+, gross level skills (I and II), at least 1 meter tall, standing alone, and walking forward and backward. They were randomly allocated to the control group (traditional physiotherapy) and study group and were treated by the same physiotherapy program combined with WBV training (3 times per week for 2 successive months). Quadriceps and hamstring muscle strength, walking performance, and postural control were evaluated before and after intervention by a blinded assessor. RESULTS: The post-intervention values of the hamstring and quadriceps muscle force, gross motor function, and stability indices of the 2 groups were higher than the pre-values (P < .05). In addition, the post-values of the study group were higher than those of the control group (P < .05). Regarding the H:Q ratio, there was no significant difference between pre-values or the post-values of both groups (P = .948 and P = .397, respectively). There were no significant differences between the pre- and post-values of each group (P = .500 and P = .195, respectively). CONCLUSION: Eight weeks of WBV training combined with traditional physiotherapy was more effective than traditional physiotherapy alone in improving walking ability and postural control. Furthermore, the combined intervention strengthened the quadriceps and hamstring muscles, with no change in the H:Q ratio in children with hemiparetic CP.

Innovative Use of Biodex Balance System to Improve Dynamic Stabilization and Function of Upper Quarter in Recreational Weightlifters: A Randomized Controlled Trial.

Background and Objectives: Following an injury, upper-body strength and proprioception training is typically suggested. To our understanding, no prior research has looked into the impact of balance training on upper-body strength and stability. So, this study investigated the effects of Biodex balance training on enhancing the dynamic stability, strength, and function of the upper quarter (UQ) in recreational weightlifters. Materials and Methods: Fifty male weightlifters were randomly assigned into two groups. The experimental group received an upper-extremity Biodex balance training program three times/week for eight weeks, while the control group underwent a regular weightlifting training routine. Pre- and post-test scores of the upper-quarter dynamic stability, strength, and function were measured for both groups using the shoulder active repositioning accuracy test, two-minute push-up test, and the upper-quarter Y-balance test (UQ-YBT) and one-arm hop test, respectively. Results: Post-test values were significantly greater for the normalized UQ-YBT test than pre-test values in both groups (p < 0.05). Post-test values of the experimental group were significantly greater than the control group (p < 0.05). Regarding the shoulder active repositioning accuracy test and the time of the one-arm hop test, post-test values were significantly lower than pre-test values for both groups (p < 0.05), and post-test values of the experimental group were significantly lower than those of the control group (p < 0.05). The post-test value of the two-minute push-up test of each group was significantly higher than the pre-test value (p < 0.05), without any significant difference between both groups (p > 0.05). Conclusions: Adding upper-body Biodex balance training to a regular weightlifting training routine was effective in enhancing the upper quarter's dynamic stability and function.

Effect of Whole-Body Vibration Exercise on Power Profile and Bone Mineral Density in Postmenopausal Women With Osteoporosis: A Randomized Controlled Trial.

OBJECTIVE: The purpose of this study was to investigate the effect of whole-body vibration (WBV) on muscle work and bone mineral density (BMD) of the lumbar vertebrae and femur in postmenopausal women. METHODS: Forty-three postmenopausal women with low BMD were randomly assigned to WBV and control groups. Both groups received calcium and vitamin D supplementations once daily, while the WBV group additionally received WBV exercise (twice/wk) for 24 successive weeks. Qualisys gait analysis system was used to measure hip power generation by hip extensors (H1S) and flexors (H3S), hip power absorption by hip flexors (H2S), knee power absorption by quadriceps during loading response (K1S) and preswing (K3S), knee power absorption by hamstring (K4S), knee power generation by quadriceps (K2S), ankle power absorption by dorsiflexors (A1S) and plantar flexors (A2S), and ankle power generation by plantar flexors (A3S). Also, dual-energy X-ray absorptiometry was used to measure BMD of the lumbar vertebrae and femur before and after the intervention. RESULTS: There were significant increases (P < .05) in the hip muscle work (H1S, H2S, and H3S), knee muscle work (K1S, K2S, K3S, and K4S), ankle muscle work (A1S, A2S, and A3S) during gait, and BMD of the lumbar vertebrae and femur of the WBV group. However, there were no significant changes (P > .05) in the control group. The posttreatment values of the hip, knee, and ankle muscle work and BMD of the WBV group were significantly (P < .05) higher than the posttreatment values of the control group. CONCLUSION: Whole-body vibration training improved the leg muscle work and lumbar and femoral BMD in postmenopausal women with low BMD.

Effectiveness of backward walking training on walking ability in children with hemiparetic cerebral palsy: a randomized controlled trial.

OBJECTIVE: To compare the effects of backward walking training and forward walking training on spatiotemporal gait parameters, and gross motor function measures in children with cerebral palsy. DESIGN: Randomized controlled clinical trial. SETTING: Physical therapy clinics. SUBJECTS: A total of 30 children with hemiparetic cerebral palsy of both sexes (10 to 14 years of age, classified as I or II by gross motor function classification system) participated in this study. They were randomly assigned into two equal groups. INTERVENTIONS: Both groups received a conventional physical therapy program for 12 successive weeks (three sessions per week). The experimental group additionally received (25 min) backward walking training. The control group additionally received (25 min) forward walking training. OUTCOME MEASURES: Baseline, posttreatment, and follow-up assessment for spatiotemporal gait parameters and gross motor functions were evaluated by using three dimensional gait analysis system and gross motor function measures. RESULTS: There was a significant improvement in step length, walking velocity, cadence, stance phase, and swing phase percentage and gross motor function measures (Dimensions D and E) of the experimental group (0.55 ±0.16, 0.53 ±0.19, 121.73 ±2.89, 54.73 ±1.67, 44.40 ±1.40, 90.20 ±6.44, 82.47 ±12.82), respectively, than the control group (0.39 ±0.13, 0.46 ±0.20, 125.80 ±2.96, 50.27 ±1.62, 49.47 ±1.55, 82.47 ±7.05, 80.47 ±12.61), respectively, ( p < 0.05). The significant improvement of all measured outcomes of the experimental group was maintained at 1 month follow-up assessment ( p < 0.05). CONCLUSION: In addition to a conventional physical therapy program, backward walking training is more effective than forward walking training on spatiotemporal gait parameters, and gross motor function measures in children with hemiparetic cerebral palsy.

The Impact of Forward Head Posture on Neck and Ankle Joint Position Sense: A Cross-Sectional Study.

BACKGROUND: Forward head posture (FHP) decreases the neck position sense and creates tension in the neck muscles, which inversely affects the mechanics of the distal joints through body myofascia. Thus, this study investigated the effects of FHP on neck and ankle joint position sense, and conducted a comparison between the joint position sense of the right and left ankle. METHODS: Fifty-seven subjects were assigned according to the craniovertebral angle (CVA) into the FHP group (CVA <49°; n = 27) or the control group (CVA >49°; n = 30). Head and ankle joint repositioning accuracy was measured by using a cervical range-of-motion device and an isokinetic dynamometer, respectively. RESULTS: There was a significant increase in the joint position error (JPE) of the cervical flexion, extension, and right and left side bending motions of the FHP group compared to the control group (P < .05). There were significant increases in the JPE of the right and left ankle dorsiflexion and plantarflexion of the FHP group compared to the healthy group (P < .05). Moreover, the JPE of the right ankle dorsiflexion and plantarflexion of the FHP group were significantly higher than the left ankle (P < .05). CONCLUSIONS: The FHP decreases the position sense of cervical flexion, extension, and right and left side bending motions, and the plantarflexion and dorsiflexion of both ankle joints, especially the right ankle joint.

The impact of anthropometric measures on plantar pressure distribution in male handball players and non-athletes: A cross-sectional study.

BACKGROUND: Increasing body anthropometry brings substantial spinal stress, which influences the spinal curvatures; this in turn may affect the foot plantar pressure distribution. OBJECTIVES: This study investigated the impact of body anthropometry on static plantar pressure distribution and their relationship among handball players and non-athletes subjects. METHODS: Thirty handball players aged from 21 to 26 years, and thirty age-matched non-athletes subjects aged from 21 to 28 years participated in this study. The spinal lordosis and kyphosis angles, trunk length, pelvic tilting, and pelvic rotation were evaluated using Formetric 4-dimensions and the Pedoscan device was used to assess the plantar pressure distribution. RESULTS: The handball players were significantly taller, heavier, and have a long trunk length than non-athletes group (p < 0.05), and a significantly increased thoracic kyphosis, forefeet pressure distribution compared to non-athletes group (p < 0.05). The handball players had a significantly increased forefeet pressure distribution compared to the rearfeet pressure distribution (p < 0.05), a high positive correlation between body height, and both trunk length and kyphosis angle (r = 0.932, 0.665 respectively), and the body height showed a high positive correlation with the forefeet pressure distribution (r = 0.665). There was a high positive correlation between the handball players' thoracic kyphosis and forefeet pressure distribution (r = 0.751). CONCLUSION: Increasing the handball players' body height was related to increased thoracic kyphosis and forefeet pressure distribution compared to non-athletes subjects. Additionally, the kyphotic posture of handball players is associated with increasing the total forefeet pressure distribution compared to the total rearfeet pressure distribution.

Chronic low back pain changes the latissmus dorsi and gluteus maximus muscles activation pattern and upward scapular rotation: A cross-sectional study.

BACKGROUND: Patients with chronic low back pain (LBP) have an impaired dynamic spinal stability, which may lead to arm injuries. OBJECTIVES: To examine the latissimus dorsi and gluteus maximus muscles activation pattern and the upward scapular rotation in patients with chronic LBP. METHODS: Sixty-one right-handed males were divided into two groups: chronic LBP group (n= 31) and healthy controls (n= 30). The electromyography (EMG) activities of the right and left latissimus dorsi and gluteus maximus were recorded. The upward scapular rotation in different shoulder positions (neutral, 45∘, 90∘, 135∘ abduction and end range) was measured in both groups. RESULTS: The LBP group has a bilateral significant increased EMG of latissimus dorsi (p< 0.05) and significantly decreased EMG of gluteus maximus (p< 0.05) compared to the control group, without significant differences between the right and left sides (p> 0.05). There was a significant increase in upward scapular rotation in the LBP group relative to the control group in all shoulder abduction positions on both sides. The left side upward scapular rotation was more significant than the right (p< 0.05). CONCLUSION: Chronic LBP increased the latissimus dorsi muscle activities and decreased the gluteus maximus activities. It furthermore increased the upward scapular rotation in different shoulder abduction positions.

Isokinetic Assessment of Shoulder Joint Strength Ratios in Male Recreational Weightlifters: A Cross-Sectional Study.

Background: Isokinetic strength imbalance is a risk factor for movement dysfunctions and injuries related to shoulder complex. The effects of recreational weightlifting on developing the imbalances between the shoulder muscles are not yet known. Objectives: To investigate the isokinetic concentric shoulder muscle strength values (peak torque normalized to body weight) in recreational weightlifters (RWL) and to compare the shoulder muscles agonist/antagonist ratios with nonweightlifters. Methods: Thirty male RWL with mean age, weight, height, and body mass index (BMI) of 21.56 years, 84.25 kg, 175.34 cm, and 26.51 kg/m2, respectively, matched with nonweightlifters served as a control group. The normalized concentric peak torque values of shoulder flexors, extensors, abductors, adductors, and internal and external rotators were measured at angular velocity 120°/sec by using Biodex isokinetic system. Moreover, the agonist/antagonist strength ratio for all muscle groups were calculated. Results: The normalized peak torques of RWL group were significantly greater than the control group (p < 0.05). The abductor/adductor and external rotator/internal rotator ratios of the RWL were significantly lower than the control group (p = 0.008 and 0.009, respectively). Conversely, there was no significant difference between both groups in relation to the flexor/extensor ratio (p = 0.259). Conclusion: These results suggested that the recreational weightlifting exercises place trainees at risk of muscle imbalances. Therefore, the restoration of a normal concentric abductor/adductor and external rotator/internal rotator strength ratios may decrease the risk of possible shoulder injury.

Pulmonary Function and Aerobic Capacity Responses to Equine Assisted Therapy in Adolescents with Idiopathic Scoliosis: A Randomized Controlled Trial.

BACKGROUND: Idiopathic scoliosis is a common spinal malalignment that negatively impacts the respiratory system and physical conditioning in adolescents. Equine-assisted therapy comprises therapeutic horseback riding that optimizes physical performance and mobility in a range of contexts. However, the influence of equine-assisted therapy on pulmonary function remains unclear. OBJECTIVE: To examine the impact of 10 weeks of hippotherapy combined with Schroth exercises on pulmonary function and aerobic capacity in adolescents with idiopathic scoliosis. METHODS: A randomized controlled trial including 45 patients, randomly assigned to experimental and control groups, was performed. Patients in the experimental group received 15 30-min sessions of hippotherapy over a period of 10 weeks. The 2 groups attended a 60-min session of Schroth exercises 3 times/week for 10 weeks. Pulmonary function and functional capacity were assessed before and after the intervention. RESULTS: Pre- and post-intervention variables (FVC, FEV1, FEV1/FVC, MVV and 6MWT) revealed significant improvement in both groups (p < 0.05). The improvement in the experimental group was significantly higher than in the control group (p < 0.05). CONCLUSION: The addition of hippotherapy to Schroth exercises resulted in improved pulmonary function and aerobic capacity in adolescents with idiopathic scoliosis.

The Effects of Stabilization Exercises Combined With Pelvic Floor Exercise in Women With Nonspecific Low Back Pain: A Randomized Clinical Study.

Objective: The purpose of this study was to investigate the effects of stabilization exercises (SEs) combined with pelvic floor muscle (PFM) exercises versus SE alone on pain intensity, functional disability, and static and dynamic endurance of trunk muscles in women with nonspecific low back pain (LBP). Methods: A total of 48 women with nonspecific LBP (26-45 years) participated in the study. They were randomly allocated into 2 groups. Group A received SEs combined with PFM exercises and physical therapy modalities, and group B received the same intervention without PFM exercises for 6 successive weeks (3 times/wk). Pain intensity, functional disability, and static and dynamic trunk muscle endurance were measured before and after treatment program. Results: After treatment, both groups revealed significant improvements in pain intensity and functional disability scores (P ˂ .05), and significant increases in static and dynamic endurance of trunk flexor and extensor muscles (P ˂ .05). Moreover, there was higher significance in group A compared to group B regarding pain intensity, functional disability scores, and static and dynamic endurance of trunk muscles (P ˂ .05). Conclusion: In this study, the addition of PFM exercise to the SE and physical therapy modalities was more effective in reducing pain intensity, improving functional disability, and increasing the static and dynamic trunk muscle endurance in women with nonspecific LBP compared to SE alone.

A 10-Week Program of Combined Hippotherapy and Scroth's Exercises Improves Balance and Postural Asymmetries in Adolescence Idiopathic Scoliosis: A Randomized Controlled Study.

INTRODUCTION: The most frequent type of spine abnormality throughout adolescence was adolescent idiopathic scoliosis (AIS). Hippotherapy improved posture, balance and gait of different musculoskeletal conditions. Therefore, this study aims to see how hippotherapy combined with Schroth exercises affected postural asymmetry and dynamic balance in AIS compared to traditional physiotherapy (Schroth exercises) alone. MATERIALS AND METHODS: In this randomized controlled trial, fifty-two patients with AIS (10-18 years, 37 girls and 15 boys) participated. They were arbitrarily allocated into two groups: experimental (19 female/8 male; aged 14.74 ± 1.79 years; Cobb angle 18.59 ± 2.66 degrees) and control (18 female/7 male; aged 15.04 ± 1.81 years; Cobb angle 19.32 ± 2.69 degrees) groups. Both groups received Schroth exercises for 10 weeks, three days/week. The experimental group additionally received hippotherapy training. Pre-treatment and post-treatment assessment for the scoliotic, kyphotic angle, pelvic obliquity, pelvic torsion and vertical spinal rotation and the anteroposterior, mediolateral and overall stability indices were assessed using the formetric system 4D and Biodex Balance System, respectively. RESULTS: After intervention, both groups illustrated significant improvements in all examined variables (p < 0.05). The experimental group illustrated significant improvements in scoliotic angle, kyphotic angle, pelvic obliquity, pelvic torsion and vertical spinal rotation and the stability indices compared to the control group (p < 0.05). CONCLUSION: In adolescence idiopathic scoliosis, hippotherapy training combined with Schroth exercises improves posture asymmetry and balancing ability more effectively than Schroth exercises alone.

Combination taping technique versus ankle foot orthosis on improving gait parameters in spastic cerebral palsy: A controlled randomized study.

BACKGROUND: One of the important goals in the treatment of spastic cerebral palsy is to maintain efficient and effective walking in order to be independent in activities and participate in society. OBJECTIVE: To compare the efficacy of foot combination taping of kinesio tape and athletic tape vs ankle foot orthosis in correcting spatiotemporal gait parameters in children with spastic diplegia. METHODS: Thirty-six children with spastic diplegia were randomly assigned into 3 groups; control, combination taping, and ankle foot orthosis groups. Children in the control group, in addition to those in both experimental groups, continued with conventional physical therapy, 1 h, 3 times per week for 4 weeks. Spatiotemporal gait parameters were assessed with the GAITRite system before and after the application of interventions. RESULTS: Significant increases in walking velocity, step length, stride length, right single support duration, and left single support duration of the ankle foot orthosis and combination taping groups than pre-intervention values. [AQ9] Moreover, the post--intervention values of the double support duration of the ankle foot orthosis and combination taping groups were significantly lower than pre-intervention values. There were no significant differences between the post-intervention values of the ankle foot orthosis and combination taping groups for all parameters. CONCLUSION: The results demonstrated that combination taping is an effective alternative technique to ankle foot orthosis to improve spatiotemporal parameters in children with spastic diplegic in combination with conventional physiotherapy.

The relationship between trunk and pelvis kinematics during pregnancy trimesters.

PURPOSE: Pregnancy is characterized by many musculoskeletal changes that affect daily living activities and walking. The purpose of this study was to examine the effect of pregnancy on pelvic and trunk kinematics, and their relationship during the three pregnancy trimesters. METHODS: Three-dimensional pelvis and trunk motions were measured using Qualisys Gait Analysis System in the first, second and third trimesters of pregnancy. The maximum anterior pelvic tilt and maximum trunk flexion during stance phase, pelvic tilt, obliquity and rotation, as well as trunk flexion-extension, lateral bending and rotation were measured. RESULTS: Repeated-measures analysis of variance showed a significant increase in the maximum anterior pelvic tilt during stance phase ( p = 0.005), and a significant decrease in the pelvic obliquity ( p = 0.011), maximum trunk flexion during stance phase ( p = 0.0006), trunk lateral bending ( p = 0.005) and trunk rotation ( p = 0.004). A significant negative correlation was found between maximum anterior pelvic tilt and maximum trunk flexion in the first (r = -0.72, p = 0.008), second (r = -0.61, p = 0.03), and third (r = -0.61, p = 0.03) trimesters of pregnancy. Also, there was a significant positive correlation found between pelvic obliquity and trunk lateral bending in the first (r = 0.76, p = 0.04), second (r = 0.59, p = 0.04), and third (r = 0.59, p = 0.04) trimesters of pregnancy. CONCLUSIONS: The pregnant women walk with an increased maximum anterior pelvic tilt, a decreased maximum trunk flexion, a decreased pelvic obliquity, as well as a decreased trunk lateral bending and rotation. Pregnancy does not affect the relationship between pelvis and trunk motions.