Comparison of Single and Combined Treatment with Exercise Therapy and Collagen Supplementation on Early Knee Arthritis among Athletes-A Quasi-Randomized Trial.

Athletic injuries are commonly implicated in the development of early osteoarthritic (EOA) changes in the knee. These changes have a significant impact on athletic performance, and therefore the early detection of EOA is paramount. The objective of the study is to assess the impact of different interventions on individuals with EOA, particularly focusing on recreational athletes. The study aims to evaluate the effectiveness of three treatment groups in improving various aspects related to knee EOA, including pain, range of motion, strength, and function. A study was undertaken with 48 recreational athletes with EOA who were assigned to one of three groups by the referring orthopedic surgeon: collagen (Col), exercise (Ex), or collagen and exercise (ColEx) groups. All the participants received their respective group-based intervention for 12 weeks. Visual analog scale (VAS), knee flexion range of motion (ROM) knee flexors and extensors strength, and KOOS were assessed at baseline, and after 4 weeks, 8 weeks, and 12 weeks of intervention. VAS for activity improved in all treatment groups, with no difference between groups. The between-group analysis for knee ROM revealed a significant difference (p = 0.022) in the Col vs. Ex group at 12 weeks. The knee flexor and extensor strength and the KOOS scores improved considerably in the Ex and the ColEx group (p < 0.05) at 12 weeks. Exercise therapy improved pain, strength and function in subjects with EOA, whereas the association of collagen seems to have accentuated the effects of exercise in bringing about clinical improvements.

Upper-crossed syndrome and disability in shoulder adhesive capsulitis.

STUDY DESIGN: Cross-sectional analytical study. INTRODUCTION: Adhesive capsulitis (AC) is a long-standing condition with varying extents of disability seen among patients. The role of postural manifestations and contractile tissue involvement in this condition is poorly understood and yet to be explored. PURPOSE: This study aimed to analyze if individuals with adhesive capsulitis demonstrated the characteristics of an upper crossed syndrome (UCS) postural manifestation and whether or not its presence affected the extent of disability experienced by this population. METHODS: Sixty-five individuals with AC were assessed for the presence of UCS. Scapular muscle strength and length alterations, forward head posture (FHP), and disability were assessed and compared between those with and without UCS. Paired T test and an independent T test were utilized to compare means within and between these groups, respectively, while non-parametric measures were utilized for their skewed counterparts. Phi coefficient (φ) was used to determine the strength of association between the descriptive patient characteristics. The correlation between symptom duration and degree of postural involvement was analyzed using Pearson's correlation coefficient. RESULTS: 43.1% of the study population demonstrated UCS and 80% FHP with a significant negative correlation between Cranio Vertebral Angle and chronicity of AC (r = -0.27). Individuals with AC demonstrated significantly decreased scapular muscle strength (p = <.001) and pectoralis minor length on the affected side (p = .03). No differences were seen between groups with and without UCS. The mean SPADI scores between groups demonstrated a more significant level of perceived pain and disability in individuals with UCS (p = .049). CONCLUSIONS: As seen in UCS, individuals with AC demonstrated alterations in movement patterns and posture. UCS was seen to contribute towards the existing disability in AC. This study suggests a careful evaluation and intervention based on these findings to document its effect on pain and dysfunction in AC.

A systematic review of the effectiveness of wrist manipulative therapy in patients with lateral epicondylitis.

STUDY DESIGN: Systematic review. INTRODUCTION: Several treatment methods treat lateral epicondylitis, but there is no consensus regarding the most effective method. Research has suggested that joint mobilizations may help recover patients with lateral epicondylitis. PURPOSE OF THE STUDY: To determine if wrist joint manipulations effectively improve pain, grip strength, ROM, and functional outcome in adults with lateral epicondylitis. METHODS: Searches were performed in 6 databases to identify relevant clinical trials. Three reviewers independently extracted data and assessed the methodological quality using the PEDro scale. Standard data were extracted and summarized. RESULTS: A total of 4 studies met the inclusion criteria. A best-evidence synthesis was used to summarize the results. The included studies found effectiveness in favor of wrist manipulations given for at least 3 weeks to reduce pain in lateral epicondylitis against comparison groups comprising ultrasound, laser, friction massage, and exercises. Functional outcomes varied considerably among studies. Grip strength showed varied results, and no effect was seen on wrist ROM. CONCLUSION: The evidence is convincing that wrist joint manipulations positively affect pain in the short term, compared to comparison groups in the management of lateral epicondylitis. Future high-quality studies are recommended.

Myofascial release versus Mulligan sustained natural apophyseal glides' immediate and short-term effects on pain, function, and mobility in non-specific low back pain.

BACKGROUND: Myofascial release (MFR) and Mulligan Sustained Natural Apophyseal Glides (SNAGs) are manual therapy techniques routinely practiced in the management of non-specific low back pain (NSLBP). As a solo intervention or along with other therapies, both methods have reported positive results for individuals with NSLBP. However, which technique improves NSLBP-related pain, restricted range of motion (ROM) and disability, warrants further research. OBJECTIVE: To study the comparative effects of MFR and SNAGs on pain, disability, functional ability, and lumbar ROM in NSLBP. METHOD: A parallel-group study was conducted at tertiary care hospitals. Sixty-five Sub-acute or chronic NSLBP patients were allocated to receive strengthening exercises along with either MFR (n = 33) or SNAGs (n = 32) for six treatment sessions over one week. An independent assessor evaluated outcome measures such as the Visual Analog Scale (VAS), Patient-Specific Function Scale (PSFS), and ROM at baseline, immediate (after 1st treatment), and short-term (post-sixth day of the intervention). The Modified Oswestry disability index (MODI) was assessed at baseline and short-term. RESULTS: Within-group analysis found clinically and statistically significant (p < 0.05) changes for VAS and PSFS at immediate and short-term for both the groups. The lumbar extension also showed improvement immediately and in the short-term. Improvement in Lumbar flexion was seen only in the SNAGs group over the short-term. A statistically significant improvement was seen for MODI in both the groups but was not clinically significant in the MFR group. The analysis observed no statistically significant difference (p < 0.05) between the groups at both the immediate and short-term. CONCLUSIONS: Pain and restricted function associated with NSLBP can be improved using SNAGs or MFR, along with strengthening exercises. For limited lumbar flexion ROM, Mulligan SNAGs have a better outcome than MFR over the short-term. Hence, both manual therapy techniques can be incorporated along with exercises for immediate and short-term management of sub-acute to chronic NSLBP.Clinical Trial Registration. CTRI/2018/12/016787 (http://ctri.nic.in/Clinicaltrials/).

Association of thoraco-lumbar fascia length in individuals with non-specific low back pain - an observational study.

OBJECTIVE: The purpose of the study was to assess the length of TLF and to evaluate the strength of muscles attached to it in subjects with and without nonspecific low back pain (NSLBP). METHODS: 31 patients with NSLBP and 31 healthy individuals were included in the study. In each subject the TLF length was assessed by quantifying lumbar rotation using Back range of motion (BROM-II) instrument. The endurance of transverses abdominis was assessed using the pressure biofeedback unit while the strength of Latissimus dorsi, internal and external oblique's were assessed using MMT. Outcome measure such as Range of Motion (ROM) was compared across the group using independent sample T-test. While the muscle strength of Latissimus dorsi and oblique's were compared across the group using Man-whitney U- test. Transverse abdominis endurance was tested using chi-square test. RESULTS: There was statistically significant difference in the length of TLF of subjects with NSLBP when compared with subjects without NSLBP. When the strength of Latissimus dorsi muscle, transverses abdominis muscle and internal and external oblique's muscle was assessed no significant (p value > 0.05) difference was found in either group. CONCLUSIONS: There was statistically significant reduction in length of TLF but there was no difference in the strength of Latissimus dorsi, internal and external oblique's or endurance of transverses abdominus attached to the TLF in individuals with NSLBP and without low back pain. This study will help in determining the inclusion of TLF and the associated structures in evaluation and management of subjects with NSLBP.

Clinical and Ultrasonic Evaluation of the Thumb: Comparison of Young Adults With and Without Thumb Pain With Text Messaging.

OBJECTIVE: The aim of this study was to compare clinical and ultrasound findings of thumb joints in young adults with and without thumb pain associated with text messaging. METHODS: In this case-control study, 117 students with thumb pain associated with text messaging were evaluated clinically and with ultrasound analysis of the thumb. Age- and sex-matched controls received ultrasound evaluation to note any subclinical changes. RESULTS: Clinical examination in the cases identified tenderness most commonly in the metacarpophalangeal joints, followed by the carpometacarpal joints, and then the interphalangeal joints. Tenderness was noted in the web space and the anatomic snuff box. Hypermobility on the Beighton scale was recorded as 2. Grind tests were positive in 21% of participants. Grip strength did not differ, but lateral and tip pinch strength were significantly reduced in the cases compared with controls. Fluid was detected in the metacarpal joints by ultrasound but not in the carpometacarpal or interphalangeal joints. No changes were detected in the controls. CONCLUSION: Clinical examination indicated involvement of all joints of the thumb, but ultrasound evaluation could identify changes only in metacarpal joints, indicating signs of possible subclinical changes taking place in the thumb in these participants as a result of repetitive use.