A Comparison of Sensorimotor Integration and Motor Fitness Components between Collegiate Athletes with and without Long COVID: A Cross-Sectional Study with Pair-Matched Controls.

Background: Long COVID presents a concern for collegiate athletes, potentially impacting sensorimotor processing and motor fitness. This study aimed to assess these effects. Methods: This cross-sectional study involved 60 athletes diagnosed with Long COVID and 60 controls. Sensorimotor processing and integration were evaluated using neurophysiological variables (N13, P14, N20, P27, and N30), while motor fitness was assessed through balance, agility, and vertical jump testing. T-tests compared groups, and Pearson's correlations explored relationships. Results: Significant differences (p < 0.001) were observed in neurophysiological variables and motor fitness between Long COVID and control groups. Fatigue correlated positively (p < 0.001) with neurophysiological variables in Long COVID cases but not with motor fitness (p = 0.08, p = 0.07, p = 0.09). Conclusions: Collegiate athletes with Long COVID exhibit abnormal sensorimotor processing, integration, and diminished motor fitness compared to uninfected peers. The fatigue severity of Long COVID correlates with neurophysiological changes, suggesting a link between sensorimotor deficits and fatigue. Targeted interventions for sensorimotor deficits and fatigue management are crucial for athletes recovering from Long COVID. This study underscores the importance of addressing these issues to optimize the recovery and performance of collegiate athletes affected by Long COVID.

Utilizing machine learning to predict post-treatment outcomes in chronic non-specific neck pain patients undergoing cervical extension traction.

This study explored the application of machine learning in predicting post-treatment outcomes for chronic neck pain patients undergoing a multimodal program featuring cervical extension traction (CET). Pre-treatment demographic and clinical variables were used to develop predictive models capable of anticipating modifications in cervical lordotic angle (CLA), pain and disability of 570 patients treated between 2014 and 2020. Linear regression models used pre-treatment variables of age, body mass index, CLA, anterior head translation, disability index, pain score, treatment frequency, duration and compliance. These models used the sci-kit-learn machine learning library within Python for implementing linear regression algorithms. The linear regression models demonstrated high precision and accuracy, and effectively explained 30-55% of the variability in post-treatment outcomes, the highest for the CLA. This pioneering study integrates machine learning into spinal rehabilitation. The developed models offer valuable information to customize interventions, set realistic expectations, and optimize treatment strategies based on individual patient characteristics as treated conservatively with rehabilitation programs using CET as part of multimodal care.

Impact of the Order of Movement on the Median Nerve Root Function: A Neurophysiological Study with Implications for Neurodynamic Exercise Sequencing.

Background: Neurodynamic exercise is a common clinical practice used to restore neural dynamic balance. The order in which movements are performed during these exercises is believed to play a crucial role in their effectiveness. This study aimed to investigate the impact of different sequences of neurodynamic exercise on nerve root function, with a specific focus on the median nerve. Methods: Participants were assigned randomly to three experimental groups, each undergoing a different test sequence: standard, proximal-to-distal, and distal-to-proximal. Dermatomal somatosensory evoked potentials (DSSEPs) were recorded at key levels (C6, C7, C8, and T1). Results: The findings revealed a significant influence of the movement sequence on DSSEP amplitudes. The execution of neurodynamic exercise in the proximal-to-distal sequence was associated with a notable reduction in amplitudes (p < 0.05). Conversely, the distal-to-proximal sequence resulted in increased amplitudes compared to the standard sequence (p < 0.05). Conclusions: This study underscores the importance of carefully considering the order of movements during neurodynamic exercising, particularly when evaluating nerve roots that lack the protective perineurium. The choice of sequence appears to have a substantial impact on nerve function, with implications for optimizing clinical neurodynamic exercise techniques.

Are Rotations and Translations of Head Posture Related to Gait and Jump Parameters?

This study assessed the relationship between head posture displacements and biomechanical parameters during gait and jumping. One hundred male and female students (20 ± 3 yrs) were assessed via the PostureScreen Mobile® app to quantify postural displacements of head rotations and translations including: (1) the cranio-vertebral angle (CVA) (°), (2) anterior head translation (AHT) (cm), (3) lateral head translation in the coronal plane (cm), and (4) lateral head side bending (°). Biomechanical parameters during gait and jumping were measured using the G-Walk sensor. The assessed gait spatiotemporal parameters were cadence (steps/min), speed (m/s), symmetry index, % left and right stride length (% height), and right and left propulsion index. The pelvic movement parameters were (1) tilt symmetry index, (2) tilt left and right range, (3) obliquity symmetry index, (4) obliquity left and right range, (5) rotation symmetry index, and (6) rotation left and right range. The jump parameters measured were (1) flight height (cm), (2) take off force (kN), (3) impact Force (kN), (4) take off speed (m/s), (5) peak speed (m/s), (6) average speed concentric phase (m/s), (7) maximum concentric power (kW), (8) average concentric power (kW) during the counter movement jump (CMJ), and (9) CMJ with arms thrust (CMJAT). At a significance level of p ≤ 0.001, moderate-to-high correlations (0.4 < r < 0.8) were found between CVA, AHT, lateral translation head, and all the gait and jump parameters. Weak correlations (0.2 < r < 0.4) were ascertained for lateral head bending and all the gait and jump parameters except for gait symmetry index and pelvic symmetry index, where moderate correlations were identified (0.4 < r < 0.6). The findings indicate moderate-to-high correlations between specific head posture displacements, such as CVA, lateral head translation and AHT with the various gait and jump parameters. These findings highlight the importance of considering head posture in the assessment and optimization of movement patterns during gait and jumping. Our findings contribute to the existing body of knowledge and may have implications for clinical practice and sports performance training. Further research is warranted to elucidate the underlying mechanisms and establish causality in these relationships, which could potentially lead to the development of targeted interventions for improving movement patterns and preventing injuries.

Comparative effects of tensioning and sliding neural mobilization on peripheral and autonomic nervous system function: A randomized controlled trial.

Background: Although different types of neural mobilization (NM) exercises induce different amounts of longitudinal nerve excursion and strain, the question whether the increased longitudinal stress and nerve excursion from sliding or tensioning intervention may subtly affect the neural functions has not been answered yet. Objective: To compare the effects of tensioning NM versus sliding NM of the median nerve on peripheral and autonomic nervous system function. Methods: In this randomized controlled trial, 90 participants were randomly assigned to tensioning NM, sliding NM, or sham NM. The neurophysiological outcome measures included peak-to-peak amplitude of the dermatomal somatosensory evoked potential (DSSEP) for dermatomes C6, C7, C8, and T1. Secondary outcome measures included amplitude and latency of skin sympathetic response. All outcome measures were assessed pretreatment, immediately after the two weeks of treatment and one week after the last session of the treatment. Results: A 2-way repeated measures ANOVA revealed significant differences between the three groups. The post hoc analysis indicated that tensioning NM significantly decreased the dermatomal amplitude for C6, C7, C8, and T1 ( p < 0 . 005 ). Sympathetic skin responses in the gliding NM group showed lower amplitudes and prolonged latencies post-treatment when compared to tensioning NM group ( p < 0 . 05 ). In contrast, no significant changes were observed in the DSSEPs and skin sympathetic responses for participants in the sham treatment group ( p > 0 . 05 ). Conclusions: A tensioning NM on the median nerve had a possible adverse effect on the neurophysiology variables of the nerves involved in the neural mobilization. Thus, tensioning NM with the current parameters that place increased stress and strain on the peripheral nervous system should be avoided.

An Investigation of the Association between 3D Spinal Alignment and Fibromyalgia.

Fibromyalgia syndrome (FMS) is a common condition lacking strong diagnostic criteria; these criteria continue to evolve as more and more studies are performed to explore it. This investigation sought to identify whether participants with FMS have more frequent and larger postural/spinal displacements in comparison to a matched control group without the condition of FMS. A total of 67 adults (55 females) out of 380 participants with FMS were recruited. Participants with FMS were sex- and age-matched with 67 asymptomatic participants (controls) without FMS. We used a three-dimensional (3D) postural assessment device (Formetric system) to analyze five posture variables in each participant in both groups: (1) thoracic kyphotic angle, (2) trunk imbalance, (3) trunk inclination, (4) lumbar lordotic angle, and (5) vertebral rotation. In order to determine whether 3D postural measures could predict the likelihood of a participant having FMS, we applied the matched-pairs binary logistic regression analysis. The 3D posture measures identified statistically and clinically significant differences between the FMS and control groups for each of the five posture variables measured (p < 0.001). For three out of five posture measurements assessed, the binary logistic regression identified there was an increased probability of having FMS with an increased: (1) thoracic kyphotic angle proportional odds ratio [Prop OR] = 1.76 (95% CI = 1.03, 3.02); (2) sagittal imbalance Prop OR = 1.54 (95% CI = 0.973, 2.459); and (3) surface rotation Prop OR = 7.9 (95% CI = 1.494, 41.97). We identified no significant probability of having FMS for the following two postural measurements: (1) coronal balance (p = 0.50) and (2) lumbar lordotic angle (p = 0.10). Our study's findings suggest there is a strong relationship between 3D spinal misalignment and the diagnosis of FMS. In fact, our results support that thoracic kyphotic angle, sagittal imbalance, and surface rotation are predictors of having FMS.

Optimal duration of stretching of the hamstring muscle group in older adults: a randomized controlled trial.

BACKGROUND: "Flexibility" is defined as "the range of movement or motion of a single or multiple joints." Its limits decline significantly with age, reaching maximum flexibility in the mid-to-late twenties for males and females, respectively. Conclusions regarding appropriate stretching time duration are mainly based on mechanical factors such as range of motion (ROM) and flexibility and tend to ignore the adverse neural mechanical tension that may be created during stretching exercises. It appears that longer-duration stretching increases flexibility for geriatric populations. AIM: To explore the effect of variable stretching intervals on neural function and ROM. DESIGN: Double blind randomized controlled trial. SETTING: University research laboratory. POPULATION: One hundred participants, 60-65 years old, with a diagnosis of tight hamstring muscles, bilaterally, were randomly assigned to either a control group or one of three intervention groups. METHODS: Participants who were randomly placed in one of the three intervention groups, were further randomized by selection of right or left limb for intervention. Intervention groups consisted of either 15-, 30-, or 60-s stretches to hamstring muscles; whereas the control group was given a sham stretch for 20 seconds. Main Outcome Measures included the neurophysiological outcome measures; peak to peak amplitude of somatosensory evoked potential for dermatomes L4, L5, and S1. Secondary outcome measures included knee ROM. All outcome measures were assessed before, immediately after, and 24 hours after the treatment session. Mixed linear model analysis was used to evaluate group, time, and group x time interaction effects for outcome measures. RESULTS: Stretching for 30 and 60 s gave significant increase in ROM compared to control (4.64 [95% CI: 3.35, 5.93]; P<0.01) (10.30 [95% CI: 9.01, 11.6]; P<0.01) and the improvement was persistent at 24-hours' follow-up (P<0.01). However, the analysis showed significant reduction in dermatomal somatosensory evoked potentials' amplitudes for L4 (-1.19 [95% CI: -1.35, 1.02]; P<0.01), L5 (-1.34 [95% CI: -1.56, -1.13]; P<0.01), S1 (-0.99 [95% CI: -1.16, -0.83]; P<0.01) after 60-s static hamstring muscle stretch. The reduction was persistent at 24-hours' follow-up (P<0.01). CONCLUSIONS: Stretching hamstring for 30 seconds was optimal in increasing the knee range of motion and minimizing the negative effects on the neural function of the involved nerve roots. Thus, 60-second static hamstring muscle stretching, places increased stress and strain on the nervous system and should be avoided. CLINICAL REHABILITATION IMPACT: It is well established that stretching is an effective intervention to treat many neuromuscular and musculoskeletal problems. However, which exact parameters to follow during stretching procedures remains controversial. Our findings indicate that 60-s static stretching of hamstring at end ranges of motion, likely place increased stress and strain on the nerve roots and central nervous system, and should be avoided.

Demonstration of Autonomic Nervous Function and Cervical Sensorimotor Control After Cervical Lordosis Rehabilitation: A Randomized Controlled Trial.

CONTEXT: Sagittal-plane cervical spine alignment has emerged as one of the most important clinical outcomes in health care. Nevertheless, the quantity and quality of research on the role that cervical sagittal alignment plays in improving sensorimotor and autonomic nervous functions are limited. OBJECTIVE: To investigate the immediate and long-term effects of cervical lordosis restoration and correction of anterior head translation (AHT) on pain, disability, autonomic nervous system function, and cervical sensorimotor control in athletes with chronic nonspecific neck pain. DESIGN: Randomized controlled clinical trial. SETTING: University research laboratory. PATIENTS OR OTHER PARTICIPANTS: A total of 110 patients (59 males, 51 females) with chronic nonspecific neck pain and a defined hypolordotic cervical spine and AHT posture. INTERVENTION(S): Patients were randomly assigned to the control or intervention group. Both groups received a multimodal program; the intervention group also received Denneroll cervical traction. Treatments were applied 3 times per week for 10 weeks. MAIN OUTCOME MEASURE(S): Outcome measures were cervical lordosis from C2 to C7, AHT, neck disability index, pain intensity, smooth-pursuit neck-torsion test, overall stability index, left- and right-rotation head repositioning accuracy, and amplitude and latency of skin sympathetic response. The measures were assessed 3 times: at baseline, after 10 weeks of treatment, and at 1-year follow-up. RESULTS: The general linear model with repeated measures indicated group × time effects in favor of the intervention group for the following management outcomes: cervical lordosis, AHT, neck disability index, pain intensity, smooth-pursuit neck-torsion test, overall stability index, left- and right-rotation head repositioning accuracy, and amplitude and latency of the skin sympathetic response (P values < .001). CONCLUSIONS: Restoration of cervical sagittal alignment in the athletic population had a direct influence on pain, disability, autonomic nervous system dysfunction, and sensorimotor control. Our results should guide treatment planning for athletes and optimize their recovery time. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov: NCT04306640.

Optimal duration of stretching exercise in patients with chronic myofascial pain syndrome: A randomized controlled trial.

OBJECTIVE: To explore the effect of variable durations of stretching on neural function, pain, and algometric pressure in patients with chronic myofascial pain syndrome. DESIGN: Randomized controlled trial. PATIENTS: A total of 100 participants diagnosed with chronic myofascial pain syndrome were randomly assigned to a control group or 1 of 3 intervention groups. METHODS: The 3 experimental groups received different durations of cervical spine stretching: 15, 30 or 60 s. The control group did not stretch. Primary outcome measures included peak-to-peak somatosensory-evoked potential for dermatomes C6, C7 and C8. Secondary outcome measures included central somatosensory conduction time (N13-N20), pain intensity, and pressure-pain threshold algometric measurements. All outcome measures were assessed immediately after and 2 h after the treatment session. RESULTS: Post hoc analysis indicated that stretching for 60 s significantly decreased the dermatomal amplitude for C6, C7 and C8 (p < 0.001) and significantly increased the central conduction time, indicating negative effect (p < 0.001). Stretching for 30 and 60 s resulted in greater improvement in pain intensity and algometric pressure than stretching for 15 s or no stretch (control) p < 0.001. CONCLUSION: Stretching cervical muscles involved in chronic myofascial pain syndrome for 30 s was optimal in achieving stretching benefits and minimizing the negative effects on the neural function of the involved nerve roots and central nervous system.

Is forward head posture relevant to autonomic nervous system function and cervical sensorimotor control? Cross sectional study.

BACKGROUND: There is a growing interest concerning the understanding of the sagittal configuration of the cervical spine as a clinical outcome. However, evaluating sensorimotor control and autonomic nervous system for participants with forward head posture (FHP) compared to strictly matched control participants with normal head alignment has not been adequately addressed. METHODS: Sensorimotor control variables include smooth pursuit neck torsion test(SPNT), Overall stability index (OSI) and left and right rotation repositioning accuracy. Autonomic nervous system function includes amplitude and latency of skin sympathetic response (SSR). We measured these variables in 80 participants with definite forward head posture (Craniovertebral angle less than 50 degrees) and 80 participants with age, gender, and BMI matched normal head alignment (Craniovertebral angle (CVA) more than 50 degrees). Differences in variable measures were examined using the parametric t-test. Pearson correlation was used to evaluate the relationship between FHP, sensorimotor control, and autonomic nervous system function. RESULTS: The unpaired t-test analysis showed that there were statistically significant differences between the FHP group and control group for all of the sensorimotor measured variables including SPNT, OSI and left and right rotation repositioning accuracy (P < 0.001). Also, there was a significant difference in neurophysiological findings, including SSR amplitude (P = .005), but there was no significant difference for SSR Latency (P = .7). The CVA significantly correlated with all measured variables (P < 0.001). CONCLUSIONS: Participants with FHP exhibited abnormal sensorimotor control and autonomic nervous system dysfunction compared to those with normal head alignment.