Effectiveness of Percutaneous Needle Electrolysis to Reduce Pain in Tendinopathies: A Systematic Review With Meta-Analysis.

CONTEXT: Tendon injuries are common disorders in both workers and athletes, potentially impacting performance in both conditions. This is why the search for effective treatments is continuing. OBJECTIVE(S): The objective of this study was to analyze whether the ultrasound-guided percutaneous needle electrolysis technique may be considered a procedure to reduce pain caused by tendinosis. EVIDENCE ACQUISITION: The search strategy included the PubMed, SCOPUS, CINAHL, Physiotherapy Evidence Database, SciELO, and ScienceDirect up to the date of February 25, 2024. Randomized clinical trials that assessed pain caused by tendinosis using the Visual Analog Scale and Numeric Rating Scale were included. The studies were evaluated for quality using the Cochrane Risk of Bias 2, and the evidence strength was assessed by the GRADEpro GDT. EVIDENCE SYNTHESIS: Out of the 534 studies found, 8 were included in the review. A random-effects meta-analysis and standardized mean differences (SMD) were conducted. The ultrasound-guided percutaneous needle electrolysis proved to be effective in reducing pain caused by tendinosis in the overall outcome (SMD = -0.97; 95% CI, -1.26 to -0.68; I2 = 58%; low certainty of evidence) and in the short-term (SMD = -0.83, 95% CI, -1.29 to -0.38; I2 = 65%; low certainty of evidence), midterm (SMD = -1.28; 95% CI, -1.65 to -0.91; I2 = 0%; moderate certainty of evidence), and long-term (SMD = -0.94; 95% CI, -1.62 to -0.26; I2 = 71%; low certainty of evidence) subgroups. CONCLUSION(S): The application of the ultrasound-guided percutaneous needle electrolysis technique for reducing pain caused by tendinosis appears to be effective. However, due to the heterogeneity found (partially explained), more studies are needed to define the appropriate dosimetry, specific populations that may benefit more from the technique, and possible adverse events.

Ultrasound-Guided Percutaneous Needle Electrolysis Combined With Therapeutic Exercise May Add Benefit in the Management of Soleus Injury in Female Soccer Players: A Pilot Study.

CONTEXT: The performance of sprints during male soccer matches usually is slow medium paced, where the soleus and gastrocnemius (ankle plantar flexors) play a very important role. As in male soccer, soleus injuries should be considered in female soccer; but the scientific evidence is very limited in this case. DESIGN: Pilot clinical trial study. OBJECTIVE: To determine whether adding an ultrasound-guided percutaneous needle electrolysis (US-guided PNE) technique to a specific exercise program improved perceived pain at stretching and at palpation, ankle dorsiflexion range of motion, muscle fatigue, and sport performance in women soccer players with soleus injury. METHODS: This pilot study recruited 20 female players with chronic soleus injury (type 1, characterized by hypoechoic image) who were assigned to one of 2 groups: an experimental group (exercise program + US-guided PNE; n = 10) or a control group (exercise program + sham stimulation; n = 10). Pain intensity, dorsiflexion range of motion, knee-flexion heel raise test, curve sprint test, and the global rating of change scale were analyzed at baseline and after treatment (4 wk) and there was no further follow-up. RESULTS: Pain intensity at palpation and at stretching, dorsiflexion range of motion, and heel raise test values showed significant improvements (P < .05) between pretreatment and posttreatment for both groups, however, no significant differences were observed between groups. Curve sprint tests did not show significant differences between pretreatment and posttreatment for either group or between groups. However, the percentage of changes always revealed better values in favor of the PNE group. Both groups showed good player satisfaction with the therapies. CONCLUSION: The application of the US-guided PNE combined with a specific exercise program may cause clinical benefits in the treatment of female soccer players with soleus injury.

Kinematic Effect on the Navicular Bone with the Use of Rearfoot Varus Wedge.

BACKGROUND: The rearfoot varus wedge (RVW) is a common treatment for foot pain and valgus deformity. There is research on its effects in the calcaneus, but there is little research on the navicular. More research is needed with the use of RVW due to the relationship that exists between the position of the navicular and the risk of suffering an injury. OBJECTIVES: this study sought to understand how RVW can influence the kinematics of the navicular bone, measuring their movement with the 6 SpaceFastrak system. METHODS: a total of 60 subjects participated in the study. Two sensors were used to measure the movement of the calcaneus and navicular using RVWs as compared in the barefoot position in a static way. RESULTS: there were statistically significant differences, the use of RVWs caused changes in the navicular bone, with subjects reaching the maximum varus movement with the use of RVW 7 mm of 1.35 ± 2.41° (p < 0.001), the maximum plantar movement flexion with the use of RVW 10 mm of 3.93 ± 4.44° (p < 0.001). CONCLUSIONS: when RVWs were placed under the calcaneus bone, the navicular bone response was in varus movement too; thus, the use of rearfoot varus wedge can influence the movement of the navicular bone.

Correct Sciatic Nerve Management to Apply Ultrasound-Guided Percutaneous Neuromodulation in Patients With Chronic Low Back Pain: A Pilot Study.

BACKGROUND: The objectives of this study were to evaluate the effects of an ultrasound (US)-guided percutaneous neuromodulation (PNM) intervention on the sciatic nerve, regarding pain, hip range of motion (ROM), balance, and functionality in patients with chronic low back pain (LBP); and to determine the optimal anatomical location of sciatic nerve stimulation to obtain therapeutic benefits in such patients. MATERIALS AND METHODS: Thirty patients with chronic LBP were recruited and divided randomly into three groups. All patients received a single percutaneous electrical stimulation intervention on the sciatic nerve, with a different anatomical application location for each group (proximal, middle, and distal). Level of pain, hip passive ROM, dynamic balance, and Oswestry disability index were analyzed. All variables were calculated before the intervention, immediately postintervention, 48 hours and one week after the intervention, except the LBP questionnaire (before, and 48 hours and one week after the intervention). RESULTS: All interventions decreased the level of pain and increased the ROM, balance, and functionality. Besides, these therapeutic effects were maintained during one week, regardless of the anatomical location of application. CONCLUSIONS: The choice of an anatomical location of application of the US-guided PNM on the sciatic nerve by the physiotherapist does not influence the improvement of pain, ROM, balance, and function in patients with chronic LBP.

Effects of Novel Inverted Rocker Orthoses for First Metatarsophalangeal Joint on Gastrocnemius Muscle Electromyographic Activity during Running: A Cross-Sectional Pilot Study.

BACKGROUND: The mobility of the first metatarsophalangeal joint (I MPTJ) has been related to the proper windlass mechanism and the triceps surae during the heel-off phase of running gait; the orthopedic treatment of the I MPTJ restriction has been made with typical Morton extension orthoses (TMEO). Nowadays it is unclear what effects TMEO or the novel inverted rocker orthoses (NIRO) have on the EMG activity of triceps surae during running. OBJECTIVE: To compare the TMEO effects versus NIRO on EMG triceps surae on medialis and lateralis gastrocnemius activity during running. STUDY DESIGN: A cross-sectional pilot study. METHODS: 21 healthy, recreational runners were enrolled in the present research (mean age 31.41 ± 4.33) to run on a treadmill at 9 km/h using aleatory NIRO of 6 mm, NIRO of 8 mm, TMEO of 6 mm, TMEO of 8 mm, and sports shoes only (SO), while the muscular EMG of medial and lateral gastrocnemius activity during 30 s was recorded. Statistical intraclass correlation coefficient (ICC) to test reliability was calculated and the Wilcoxon test of all five different situations were tested. RESULTS: The reliability of values was almost perfect. Data showed that the gastrocnemius lateralis increased its EMG activity between SO vs. NIRO-8 mm (22.27 ± 2.51 vs. 25.96 ± 4.68 mV, p < 0.05) and SO vs. TMEO-6mm (22.27 ± 2.51 vs. 24.72 ± 5.08 mV, p < 0.05). Regarding gastrocnemius medialis, values showed an EMG notable increase in activity between SO vs. NIRO-6mm (22.93 ± 2.1 vs. 26.44 ± 3.63, p < 0.001), vs. NIRO-8mm (28.89 ± 3.6, p < 0.001), and vs. TMEO-6mm (25.12 ± 3.51, p < 0.05). CONCLUSIONS: Both TMEO and NIRO have shown an increased EMG of the lateralis and medialis gastrocnemius muscles activity during a full running cycle gait. Clinicians should take into account the present evidence when they want to treat I MTPJ restriction with orthoses, and consider the inherent triceps surae muscular cost relative to running economy.

Comparative Effects of One-Shot Electrical Stimulation on Performance of the Flexor Hallucis Longus Muscle in Professional Dancers: Percutaneous Versus Transcutaneous?

OBJECTIVE: High demand of flexor hallucis longus (FHL) in the positions of extreme flexion of the ankle and toes is required in the dance. The aim was to investigate the effects of single-shot of ultrasound-guided percutaneous neuromodulation (PNM) vs. single-shot of transcutaneous electrical nerve stimulation (TENS) in performance of the FHL muscle in professional dancers. MATERIALS AND METHODS: Thirty-two female healthy dancers were divided into two groups: TENS group and PNM group. The stimulation interventions consisted in the application of a square wave biphasic electrical current for a total of 1.5 mins. Range of motion (ROM) of first metatarsophalangeal joint, balance test, and unilateral heel raise fatigue test were performed in dominance limb. RESULTS: There were no differences between both groups in the baseline measurements. Compared to their baseline values, the TENS group statistically improved balance (p < 0.01, d = 0.6), ROM (p < 0.001, d = 0.3), and endurance (p = 0.04, d = 0.5). The PNM group only statistically improved balance and endurance (p < 0.001), with a large effect size for both test (d = 0.8 and d = 2.24, respectively). After interventions, there were no significant differences between TENS and PNM groups for all variables. However, PNM was qualitatively more effective because the percentage change in mean was greater and effect size was large for the balance test and endurance test. CONCLUSIONS: Simple single-shot procedure with percutaneous or TENS provided immediate performance improvement of FHL muscle in dancers, being PNM the more effective intervention.

Effectiveness of a 12-Week Physical Exercise Program on Lower-Limb Malalignment in School-age Rugby: A Randomized Clinical Trial.

OBJECTIVE: We sought to assess the effectiveness of 12 weeks of a physical exercise program (PEP) in child rugby players with lower-limb overpronation during gait. METHODS: This was a randomized clinical trial. A total of 123 young athletes (mean ± standard deviation age, 10.35 ± 1.22 years) were evaluated, 20 of whom had lower-limb overpronation (n = 40 extremities). Participants were randomly assigned to 2 groups: the experimental group, who performed their normal training and a PEP for 12 weeks, and the control group, who continued with their normal training for the same time. The PEP was focused on stretching the hypertonic muscle and potentiating the weakened muscles of the lower body. All participants underwent biomechanical analysis including the Helbing angle, the femorotibial angle, and the Fick angle in both limbs. RESULTS: All participants (n = 20) completed the study. Baseline measurements showed no significant differences between groups in any of the variables tested. After 12 weeks, there were significant differences between groups (P < .001 for all angles). No improvement was found in the control group; however, meaningful improvement was found in all variables in the experimental group: Helbing angle (175°, P < .001, effect size [ES] = 1.94), femorotibial angle (173°, P < .001, ES = 1.77), Fick angle (12°, P < .001, ES = 1.55). The number needed to treat was 2 for femorotibial angle and Helbing angle, and 3 for Fick angle. CONCLUSION: A 12-week PEP produced significant improvements in these 3 biomechanical variables. We also conclude that young athletes with a pathological gait pattern reached a normal gait pattern.

Acute Effects of a Single Football Training or Match on Passive Hip Rotation Range of Motion in Semi-Professional Football Players: A Pilot Study.

BACKGROUND AND OBJECTIVES: The repetitive loading forces generated during football activities may induce alterations in the hip rotation range of motion (ROM) in players. The objective of this study was to evaluate the acute effects of a training and a match on bilateral passive hip rotation ROM in both lower limbs in soccer. MATERIAL AND METHODS: Twenty-eight male players were divided into two groups: 14 players (28 limbs) with normal bilateral hip rotation ROM (NH group) and 14 players (28 limbs) with restricted bilateral hip ROM (RH group). Passive bilateral hip rotation ROM was measured, by goniometer, before and after training or a match. Internal-rotation ROM (ROMIR), external-rotation ROM (ROMER), total ROM (ROMTOT) and relative internal rotation (ROMREL) were calculated. RESULTS: The NH group did not show substantial changes in hip ROM after a training nor a match. After a training session, only the RH group exhibited a substantial increase in ROMIR, ROMER and ROMTOT. After a match, only the RH group exhibited a substantial increase in ROMER and ROMTOT and exhibited a substantial decrease in ROMREL. Comparing both groups, there were significant differences within ROM changes for ROMER and ROMTOT after training and for ROMER and ROMREL after a match. CONCLUSIONS: Despite the small sample size of the present study, the findings indicate that a single football activity leads to significant changes in hip rotation ROM in players with restricted bilateral hip external-rotation ROM. However, these changes did not reach reference cut-off scores.

Does Function Determine the Structure? Changes in Flexor Hallucis Longus Muscle and the Associated Performance Related to Dance Modality: A Cross-Sectional Study.

Background and Objectives: Flexor hallucis longus pathology is one of the most common conditions of the ankle and foot in dancers, due to the high demand of dance movements performed in an extreme plantar flexion and dorsiflexion range of motion. The objectives of this study were to determine the bilateral differences between the thickness and cross-sectional area of the flexor hallucis longus muscle in dancers, to establish possible differences between dance modalities, and to analyze whether there is a correlation between ultrasonographic parameters or performance variables and the dance modality. Material and Methods: A sample of 50 (29 classical and 21 contemporary) full-time pre-professional female dancers were included in the study. The thickness and cross-sectional area of the flexor hallucis longus muscle were evaluated for both limbs using ultrasound imaging. The range of movement of the first metatarsophalangeal joint was measured using functional extension with maximal ankle plantarflexion, balance was measured in a unilateral stance with the heel raised, endurance was evaluated through a modified heel rise fatigue test, and a counter movement jump to assess the vertical jump performance was measured bilaterally. Results: There were no significant differences recorded between the dominant and non-dominant limbs for each variable, within both groups. Contemporary dancers showed a greater thickness and cross-sectional area of the flexor hallucis longus muscle than classical dancers. However, classical dancers showed an increase of balance, endurance, range of movement of the first metatarsophalangeal joint, and counter movement jump with respect to contemporary dancers. Conclusion: Bilateral symmetry was identified in all variables for both groups. The size and performance of the flexor hallucis longus muscle may be influenced by the specific nature of dance modality.

Strength-Duration Curves of Radial Nerve in Patients With Lateral Elbow Pain.

CONTEXT: Lateral epicondylalgia (LE) refers to a painful condition at or around the lateral epicondyle of the humerus. LE is one of the most common injuries of the elbow; however, the cause of the pathology is not clear. Patients often experience symptoms consistent with a radial nerve injury; however, data on the involvement of the radial nerve are needed. OBJECTIVE: To analyze the relationship between electrophysiologic excitability and morphology of the radial nerve in patients with unilateral chronic LE. DESIGN: Cross-sectional study. SETTING: Department of Physiotherapy, University of Seville. PATIENTS: A total of 56 elbows (28 right, 28 left) in 28 patients (12 females, 16 males; age 49 [7.37] y) were recruited by convenience sampling. MAIN OUTCOME MEASURES: Strength-duration curves (chronaxia and accommodation index) and cross-sectional area (CSA) of the radial nerve were made in all participants. All parameters were compared between both limbs. Also, pain with palpation in the lateral epicondyle and functional pain of involved extremities was assessed using visual analog scale and the Patient-Rated Tennis Elbow Evaluation, respectively. RESULTS: Symptomatic limb showed higher CSA values of the radial nerve when compared with the asymptomatic limb (P < .001). On the symptomatic limb, duration of symptoms was positively correlated with CSA values. Chronaxia values were all normal and similar between both limbs (P = .35). Regarding accommodation index, 14 (54%) patients showed accommodation indices that suggested pathological radial nerve on the right limb, 4 (14%) on the left limb, 5 (18%) on both limbs, and 4 (14%) had none of the affected nerves. Eight-six percent of patients showed accommodation indices that suggested pathological radial nerve, independently of symptomatic limb. In these cases, affected nerves had higher CSA than the unaffected nerve (P = .01). On the affected nerves, duration of symptoms was positively correlated with accommodation indices. CONCLUSIONS: These findings suggest that patients with unilateral chronic LE show a decreased excitability in any radial nerve, independently of the symptomatic limb, and that pathological nerves have higher CSA than the nonpathological nerves.

Ultrasonography Features of the Plantar Fascia Complex in Patients with Chronic Non-Insertional Achilles Tendinopathy: A Case-Control Study.

PURPOSE: The goal of the present study was to assess, by ultrasound imaging (USI), the thickness of the plantar fascia (PF) at the insertion of the calcaneus, mid and forefoot fascial locations, and the calcaneal fat pad (CFP) in patients with Achilles tendinopathy (AT). METHODS: An observational case-control study. A total sample of 143 individuals from 18 to 55 years was evaluated by USI in the study. The sample was divided into two groups: A group composed of the chronic non-insertional AT (n = 71) and B group comprised by healthy subjects (n = 72). The PF thicknesses at insertion on the calcaneus, midfoot, rearfoot and CFP were evaluated by USI. RESULTS: the CFP and PF at the calcaneus thickness showed statistically significant differences (P < 0.01) with a decrease for the tendinopathy group with respect to the control group. For the PF midfoot and forefoot thickness, no significant differences (P > 0.05) were observed between groups. CONCLUSION: The thickness of the PF at the insertion and the CPF is reduced in patients with AT measured by USI.

Efficacy of monopolar dielectric transmission radio frequency in panniculus adiposus and cellulite reduction.

INTRODUCTION: Despite high incidence rate of cellulite, there are few studies regarding its treatment. Most of them present non-validated evaluation tools. Radio frequency is a focused treatment very used in aesthetics to reduce it. OBJECTIVES: To know the efficacy of Monopolar Dielectric Radio frequency (MDR) treatment in dynamic applications to reduce cellulite, panniculus adiposus and gluteal and posterior thigh regions. METHODS: Experimental study consisting of inferior members of nine women. They received 10 sessions based on dynamic applications of MDR. Variables included the following: Cellulite Severity Scale (CSS), appearance of the cutaneous area, flaccidity and ultrasound measurement of the panniculus adiposus. RESULTS: The final CSS score of the leg treated reflects statistically significative differences (p = 0.023) when compared with control leg (p = 0.622). Significant reductions of body perimeters at the level of the great trochanter (p = 0.02), the gluteal region (p = 0.03) and the midpoint of the posterior thigh (p = 0.01) are found. The reduction of the panniculus adiposus measured using ultrasound techniques shows significant changes in the midpoint of the posterior thigh (p = 0.028) as well as in the gluteal region (p = 0.03). CONCLUSIONS: The dynamic application of MDR seems to be effective in order to reduce not only the thickness of panniculus adiposus but also gluteal and posterior thigh perimeters.

Effect of Ultrasound-Guided Percutaneous Neuromodulation of Sciatic Nerve on Hip Muscle Strength in Chronic Low Back Pain Sufferers: A Pilot Study.

Background: Limited hip internal rotation range of motion (IR-ROM) and hip abductor weakness are recognized in low back pain (LBP) sufferers. The main aim was to investigate the effect of a ultrasound (US)-guided percutaneous neuromodulation (PNM) technique on hip strength in people with LBP. A second purpose was to discover whether the location along the sciatic nerve, where percutaneous neuromodulation was applied, could influence the change of strength response in these patients. Methods: Sixty LBP sufferers were recruited and divided randomly into three groups. All participants received an isolated percutaneous electrical stimulation at one of three different locations of the sciatic nerve pathway (proximal, middle, and distal), depending on the assigned group. Pain intensity, hip passive IR-ROM, hip muscle strength, and the Oswestry disability index (ODI) were analyzed. All variables were calculated before the intervention and one week after the intervention. Results: All interventions significantly decreased pain intensity and improved the IR-ROMs, strength, and functionality after one week (p = 0.001). However, between-group (treatment x time) differences were reported for flexion strength in the non-intervention limb (p = 0.029) and ODI (p = 0.021), although the effect size was small (Eta2 = 0.1) in both cases. Conclusions: The application of an isolated intervention of the US-guided PNM technique may be a useful therapeutic tool to increase the hip muscle strength in patients with chronic LBP.

Muscle Quality Assessment by Ultrasound Imaging of the Intrinsic Foot Muscles in Individuals with and without Plantar Fasciitis: A Case-Control Study.

Objective: The primary aim of the present study was to compare the echo intensity (EI) and echovariation (EV) of the intrinsic foot muscles (IFMs) between individuals with and without plantar fasciitis (PF), using ultrasound imaging. The secondary objective was to study the intra-rater reliability of the echotexture variables. Methods: A case−control study was conducted with 64 participants, who were divided into the following two groups: A, the PF group (n = 32); B, the healthy group (n = 32). Results: The comparison between the two groups did not identify significant differences (p > 0.05) between the flexor hallucis brevis (FHB), flexor digitorum brevis (FDB), quadratus plantae (QP) and abductor hallucis brevis (AHB) variables for the EI and EV. Moreover, excellent intra-rater reliability was reported for the following ultrasound imaging EI variables: ABH (ICC = 0.951), FHB (ICC = 0.949), FDB (ICC = 0.981) and QP (ICC = 0.984). Conclusions: The muscle quality assessment using the EI and EV variables did not identify differences in the FHB, FDB, AHB and QP muscles between individuals with and without PF through USI evaluation. The reliability of all the IFM measurements was reported to be excellent.

Features of Extrinsic Plantar Muscles in Patients with Plantar Fasciitis by Ultrasound Imaging: A Retrospective Case Control Research.

The present study aimed to compare by ultrasound imaging (USI) the tibial posterior (TP), medial gastrocnemius (MG) and soleus muscle in patients with and without plantar fasciitis (PF). A sample of 42 individuals was recruited and divided into two groups: PF and a healthy group. The thickness, cross-sectional area (CSA), echointensity and echovariation were assessed in both groups by USI. TP, soleus and MG variables did not report differences (p > 0.05) for thickness and CSA. For the echotexture parameters significant differences were found for MG echointensity (p = 0.002), MG echovariation (p = 0.002) and soleus echointensity (p = 0.012). Non-significant differences (p > 0.05) were reported for soleus echovariation, TP echointensity and TP echovariation variables. The thickness and CSA of the TP, GM and soleus muscle did not show significant differences between individuals with and without PF measured by USI. Muscle quality assessment reported an increase of the MG echointensity and echovariation, as well as a decrease of echointensity of the soleus muscle in the PF group with respect to the healthy group. Therefore, the evaluation of the structure and muscle quality of the extrinsic foot muscles may be beneficial for the diagnosis and monitoring the physical therapy interventions.

Innovative Medial Cushioning Orthoses Affect Peroneus Longus Electromyographic Activity during Running.

Background: Over-supination processes of the foot and ankle involving peroneus longus (PL) damage during running sports have been treated conservatively with passive control tools, such as tapes, braces, or external ankle supports, but the effect of orthoses with typical lateral wedging orthoses (TLWO) on the muscular activity of PL during running remains unclear. Here we investigate the effects of innovative medial cushioning orthoses (IMCO) on PL activity during the full running gait cycle. In addition, we wished to ascertain the effects of innovative medial cushioning orthoses (IMCO) on PL activity during running. Methods: Thirty-one healthy recreational runners (mean age 34.5 ± 3.33) with neutral foot posture index scores, were selected to participate in the present study. They ran on a treadmill at 9 km/h wearing seven different orthoses (NRS, IMCO 3 mm, IMCO 6 mm, IMCO 9 mm, TLWO 3 mm, TLWO 6 mm and TLWO 9 mm), randomly performed on the same day while electromyographic activity of the PL muscle was recorded. Statistical intraclass correlation coefficient (ICC) to test reliability was carried out and the Wilcoxon test with Bonferroni's correction was developed to analyze the differences between the conditions. Results: the reliability of all assessments showed data higher than 0.81, that is, "almost perfect reliability"; all EMG PL values wearing either TLWO or IMCO showed a statistically significant reduction versus NRS during the fully analyzed running gait cycle; the highest difference was set on NRS 23.08 ± 6.67 to TLWO 9 mm 17.77 ± 4.794 (p < 0.001). Conclusions: Muscular EMG activity of the PL during the full running gait cycle decreases when wearing either TLWO or IMCO relative to NRS; therefore, these orthoses could be prescribed to treat the strain and overload pathologies of PL. In addition, IMCO­as it less thick, compared with TLWO­can be used when aiming to achieve better running economy.

Muscular Echovariation as a New Biomarker for the Classification of Soleus Muscle Pathology: A Cross-Sectional Study.

BACKGROUND: Soleus injury is one of the most common soft tissue tears during sport activities. Current classifications of muscle tears are based on symptoms and tear size and they do not contribute suitable evidence-based treatment protocols. The objective of this study was to analyze the most frequent echotexture findings of patients with soleus muscle injury, located in the central intramuscular tendon (IMT), and healthy people to determine whether they behave differently and to propose an ultrasound (US)-based classification. METHODS: eighty-four athletes, who played in sport activities comprising lower limbs. Echotexture characteristics of soleus muscle were reviewed for 84 subjects. They were divided based on the muscle echogenicity in three groups (Injury Type 1 group, Injury type 2 group and healthy group). Echointensity (EI) and Echovariation (EV) were taken in all groups like quantitative US variable. RESULTS: The Injury Type 1 group was identified by a hypoechoic area and characterized by a higher EV; and Injury Type 2 group was identified by a fibrotic area and characterized by a lower EV. The echogenic pattern of healthy people obtained an intermediate value of EV between both injured soleus types. CONCLUSIONS: EV may be useful to classify different types of soleus muscle pathology according to the echogenicity pattern. An innovative proposed US-based classification system for soleus tears may be used to guide treatment decisions for patients with central tendon injury of soleus muscle.

Cross-cultural adaptation of the Victorian institute of sports assessment - Hamstrings (VISA-H) questionnaire for Spanish speaking athletes with proximal hamstring tendinopathy.

OBJECTIVE: To cross-culturally adapt and validate the Victorian Institute of Sports Assessment - Hamstrings (VISA-H) scale into Spanish. DESIGN: Clinical measurement study (psychometric analysis). SETTING: Sports clubs and physiotherapy clinics. PARTICIPANTS: The Spanish version of the VISA-H (VISA-H-Sp) scale was administered to 101 subjects: 50 healthy runners and 51 patients with a clinical diagnosis of PHT. MAIN MEASURES: The Victorian Institute of Sports Assessment - Hamstrings. RESULTS: Cronbach's alpha for the VISA-H-Sp was >0.8. The ICC 2,1 was 0.993 (95%CI 0.991-0.995). In the exploratory factor analysis, a one-factor solution explained 72.1% of the total variance. Athletes with PHT scored significantly lower in the VISA-H-Sp than healthy subjects (P < 0.001). The VISA-H-Sp score results in the PHT group showed significant correlations with SF-36 physical components (Spearman r'>0.6; P < 0.001), and low or non-significant association with psychological dimensions. The standard error of measurement was 1.45 whereas the minimal detectable change was 4.02 points. The responsiveness indicators included an effect size of 2.75, and a standardised response mean of 3.1 at discharge. CONCLUSION: The VISA-H-Sp shows adequate psychometric properties for assessing the severity of symptoms in Spanish-speaking athletes who suffer from PHT.

Crossover effects of ultrasound-guided percutaneous neuromodulation on contralateral hamstring flexibility.

BACKGROUND: Crossover effects refer to the responses of a non-exercised contralateral limb. There is evidence of this effect, as it relates to muscle fatigue, strength, and stretch, but not as it relates to neuromodulation. OBJECTIVES: To compare the crossover effects of percutaneous neuromodulation (PNM) on hip range of motion (ROM), observed in a straight leg raise (SLR) test, in asymptomatic participants with bilateral reduced hamstring flexibility, versus the neurodynamic sciatic sliding technique, hamstring stretching and mechanical stimulation of the sciatic nerve using a needle (without electrical stimulation). To evaluate the tensiomyographic changes between the two lower limbs after these interventions. METHODS: 80 participants with bilateral reduced hamstring flexibility were randomized into four groups: Stretching, Neurodynamic, PNM, and Needle groups. All interventions were performed on the right limb. Each participant's leg was subjected to SLR testing and tensiomyography before and after the interventions. RESULTS: Each group improved their SLR values in the non-intervention limb compared to baseline values, but the PNM and Needle groups obtained higher values for the SLR test in the non-intervention limb compared with the Neurodynamic and Stretching groups. There were statistically significant differences for mean SLR measures between limbs pre- and post-intervention for all groups except the PNM group, suggesting crossover effects for PNM but not the other techniques studied. There were no differences in tensiomyographic assessments between groups or between sides, at baseline or upon completion of the study. CONCLUSION: PNM produced benefits in the SLR test in the non-intervention limb and only 1.5 min was enough to obtain this effect. In addition, no technique interfered with muscle activation.

Ultrasound Imaging Evaluation of Textural Features in Athletes with Soleus Pathology-A Novel Case-Control Study.

BACKGROUND: the aim of this study was to compare the echotexture of patients with soleus muscle injury and age matched controls. METHODS: a sample of 62 athletes was recruited at the private clinic and was divided in two group: a healthy group (n = 31) and a soleus pathology group whose athletes had soleus muscle injury, located in the central tendon (n = 31). The muscle thickness (MTh), echointensity (EI) and echovariation (EV) were analyzed. An intra-rater reliability test (Intraclass Correlation Coefficient-ICC) was performed in order to analyze the reliability of the values of the measurements. RESULTS: Sociodemographic variables did not show statistically significant differences (p > 0.05). Ultrasound imaging measurements who reported statistically significant differences were EI (p = 0.001) and standard deviation (SD) (p = 0.001). MTh and EV variables did not show statistically significant differences (p = 0.381 and p = 0.364, respectively). Moreover, reliability values for the MTh (ICC = 0.911), EI (ICC = 0.982), SD (ICC = 0.955) and EV (ICC = 0.963). Based on these results the intra-rater reliability was considered excellent. CONCLUSION: Athletes with a central tendon injury of soleus muscle showed a lower EI when they were compared to healthy athletes. The echogenicity showed by the quantitative ultrasound imaging measurement may be a more objective parameter for the diagnosis and follow-up the soleus muscle injuries.