Effects of static stretching as compared to autogenic inhibition and reciprocal inhibition muscle energy techniques in the management of mechanical neck pain: a randomized controlled trial.

OBJECTIVE: To compare the effects of static stretching with autogenic inhibition and reciprocal inhibition muscle energy techniques on pain, disability and range of motion in patients with mechanical neck pain. METHODS: A parallel design randomised controlled trial was conducted at Fauji Foundation Hospital and Railway-General Hospital, Rawalpindi, Pakistan, from April to November, 2017, and comprised of patients aged 18-70 years with neck pain of moderate intensity scoring 4-8 on numeric pain rating scale with limited or painful range of motion. The patients were randomly allocated via lottery method into static stretching group, autogenic inhibition muscle energy technique group and reciprocal inhibition muscle energy technique group. All the subjects received five consecutive treatments sessions. Outcome measurements included numeric pain rating scale score, neck disability index score and goniometry for cervical range of motion. Data was collected at baseline and after first and fifth sessions, and was analysed using SPSS 21. RESULTS: Of the 78 subjects, there were 26(33.3%) in each of the three groups. Of them 7 were lost to follow-up and the study was completed by 71(91%) subjects. The overall mean age was 41.55±11.89 years (p>0.05). There was no significant difference between the groups at baseline (p>0.05). However, at first and second follow-up, there was a significant difference (p<0.05) between the groups in terms of immediate and short-term relief, except for immediate effects related to range of motion (p=0.056). CONCLUSIONS: Significant difference existed among static stretching, autogenic inhibition and reciprocal inhibition groups in terms of pain, disability and range of motion in patients with mechanical neck pain.

Effectiveness of Faradic and Russian currents on plantar flexor muscle spasticity, ankle motor recovery, and functional gait in stroke patients.

BACKGROUND AND PURPOSE: Spasticity is a major disabling symptom in patients post stroke. Though studies have demonstrated that electrical stimulation (ES) can reduce spasticity and improve passive ankle range of motion (ROM), not many studies have evaluated the effectiveness of ES on active ankle ROM. The purpose of this study was to determine the effectiveness of Faradic and Russian currents in the reduction of ankle plantar-flexor spasticity and improving motor recovery in patients post stroke. METHODS: Eighty-three patients (29 females and 54 males; mean age of 57.12 years) were randomly assigned to Group 1 (task-oriented exercises), Group 2 (Faradic current for 10 min and task-oriented exercises), and Group 3 (Russian current for 10 min and task-oriented exercises) for a period of 5 sessions per week for 6 weeks. All patients were assessed for soleus and gastrocnemius muscles spasticity measured by modified modified Ashworth scale; active and passive range ROM measured by goniometer; and functional ambulation measured by modified Emory Functional Ambulation Profile at the time of recruitment to study and after 6 weeks. RESULTS: Both the types of stimulation and exercises were not associated with improvements in modified Emory Functional Ambulation Profile (p > 0.05). The results showed that all the groups are effective in improving passive ankle ROM (p < 0.05) and reducing soleus and gastrocnemius muscles spasticity (p < 0.05). Though all the groups were effective in improving active ankle ROM, no group was found to be superior to another after treatment CONCLUSION: Adding ES to exercises are associated with low to medium effect sizes (<0.5) in reducing spasticity and improving ankle ROM.

The Reliability of Standing Sagittal Measurements of Spinal Curvature and Range of Motion in Older Women With and Without Hyperkyphosis Using a Skin-Surface Device.

OBJECTIVE: The purpose of this study was to investigate the intrarater reliability of a skin-surface instrument (Spinal Mouse, Idiag, Voletswil, Switzerland) in measuring standing sagittal curvature and global mobility of the spine in older women with and without hyperkyphosis. METHODS: Measurements were made in 19 women with hyperkyphosis (thoracic kyphosis angle ≥50°), mean age 67 ± 5 years, and 14 women without hyperkyphosis (thoracic kyphosis angle <50°), mean age 63 ± 6 years. Sagittal thoracic and lumbar curvature and mobility of the spine were assessed with the Spinal Mouse during neutral standing, full spinal flexion, and full spinal extension. Tests were performed by the same examiner on 2 days with a 72-hour interval. The intrarater reliability of the measurements was analyzed using the intraclass correlation coefficient, standard error of measurement and minimal detectable change. RESULTS: Intraclass correlation coefficients ranged from 0.89 to 0.99 in both groups. The standard errors of measurement ranged from 1.02° to 2.06° in the hyperkyphosis group and from 1.15° to 2.22° in the normal group. The minimal detectable change ranged from 2.85° to 5.73° in the hyperkyphosis group and from 3.20° to 6.17° in the normal group. CONCLUSIONS: Our results indicated that the Spinal Mouse has excellent intrarater reliability for the measurement of sagittal thoracic and lumbar curvature and mobility of the spine in older women.

Ankle-Angle Estimation from Blind Source Separated Afferent Activity in the Sciatic Nerve for Closed-Loop Functional Neuromuscular Stimulation System.

Cuff electrode recording has been proposed as a solution to obtain robust feedback signals for closed-loop controlled functional neuromuscular stimulation (FNS) systems. However, single-channel cuff electrode recording requires several electrodes to obtain the feedback signal related to each muscle. In this study, we propose an ankle-angle estimation method in which recording is conducted from the proximal nerve trunk with a multichannel cuff electrode to minimize cuff electrode usage. In experiments, muscle afferent signals were recorded from a rabbit's proximal sciatic nerve trunk using a multichannel cuff electrode, and blind source separation and ankle-angle estimation were performed using fast independent component analysis (PP/FastICA) combined with dynamically driven recurrent neural network (DDRNN). The experimental results indicate that the proposed method has high ankle-angle estimation accuracy for both situations when the ankle motion is generated by position servo system or neuromuscular stimulation. Furthermore, the results confirm that the proposed method is applicable to closed-loop FNS systems to control limb motion.

Validation of a method to assess range of motion of the cervical spine using a tape measure.

OBJECTIVE: The purposes of this study were to validate a tape measure method for measuring cervical spine range of motion compared with a universal goniometer in all planes of motion and to derive equations to convert a linear measurement to an angular distance. METHODS: Participants were healthy volunteers. Measurements of flexion/extension, rotation, and lateral flexion were made with the universal goniometer and tape measure, in the neutral position, extreme of motion, and 2 positions between. Measurements from the 2 techniques were compared with Pearson correlation coefficient and simple linear regression to determine R(2), the regression coefficient and the regression equation. Reliability was assessed using the intraclass correlation coefficient. RESULTS: There were 40 participants with a mean age of 30.5 (SD, 9.1) years. Goniometer measurements had good to excellent correlation with both absolute and percentage change in tape measurement (correlation coefficients, 0.74-0.94 and 0.75-0.91, respectively). Correlation was highest for flexion and extension, lowest for rotation and lateral flexion. The amount of variability in the data explained by the linear regression models (R(2)) varied from 55% to 89%. Intraclass correlation coefficient ranged from 0.44 to 0.69 and 0.38 to 0.59 for intrarater and interrater reliability, respectively. Reliability was greatest for flexion and extension, lowest for rotation and lateral flexion. CONCLUSION: This study demonstrated that tape measurements correlated well with a universal goniometer. The tape measure may be useful for measuring cervical spine range of motion where availability, simplicity, and low cost are important considerations such as with conduct of research or patient management.

Validity and reliability of skin markers for measurement of intersegmental mobility at L2-3 and L3-4 during lateral bending in healthy individuals: a fluoroscopy study.

It is clinically important to assess kinematic parameters of lumbar spine movement to increase our understanding of lumbar mobility impairments in patients with low back pain. This is the first step for restoration of motor function. The use of non-invasive surface markers has currently attracted the interests of many researchers but scientific utilization of this technique for clinical research requires validity and reliability studies. The aim of the present study was to examine whether skin markers can be used to measure lumbar motions during lateral bending. Twelve healthy individuals were lying in prone position on the video fluoroscopy table and skin markers were attached over their spinous processes. Fluoroscopy images were taken in two positions of neutral and right lateral bending (RLB). The correlation of the L2-3 and L3-4 angles and lumbar curvature between markers and vertebrae measurements in the neutral and RLB positions was determined by Pearson Correlation Coefficient. The Intraclass correlation coefficient (ICC) was used to measure inter-examiner reliability of measurement in five participants. The results showed high reliability (ranging from 0.94 to 0.99) for angular measurements at L2-3 and L3-4 and lumbar curvature and also significant correlation between angular measurement derived from markers and vertebrae at L2-3 (r = 0.7, p = 0.015), L3-4 and lumbar curvature (r = 0.91 p = 0.001). The results showed that motions of skin markers follow the motions of the assigned underlying lumbar vertebrae. Therefore, skin markers can be confidently used for estimation of lumbar movements during lateral bending.

Concentración de la hidroxiprolina en la orina de jóvenes tras un programa de estiramientos estáticos y facilitación neuromuscular proprioceptiva / Concentration of hydroxyproline in urine of the young undergoing a static stretching program and proprioceptive neuromuscular facilitation

Introducción. La flexibilidad está en los debates sobre la actividad física y su prescripción. Es necesario identificar la forma de entrenamiento que aumente el catabolismo del colágeno locomotor generando la adaptación en los tejidos, llegando a la fase plástica del estiramiento. Objetivo. Comparar el nivel de hidroxiprolina (HP) entre jóvenes sedentarios sometidos a 2 tipos de estiramientos: a) estáticos pasivos (EP); y b) facilitación neuromuscular propioceptiva (FNP). Material y método. La muestra es de 30 sujetos distribuidos de forma aleatoria en: grupo FNP (GF, n = 15; edad: 22 ± 3 años; IMC: 24,12 ± 3,69), grupo EP (GA, n = 15; edad: 23 ± 4 años; IMC: 25 ± 4,33) y grupo control (GC, n = 15; edad: 24 ± 4 años; IMC: 23, 91 ± 3,09). El estiramiento (EP) se realizó con mantenimiento durante 6 segundos, mientras que el estiramiento por FNP se realizó por el método mantener y relajar. La intensidad de cada intervención fue controlada mediante la Escala de estrés percibido en la flexibilidad (PERFLEX). Resultados. Respecto al intra-grupo en GF (Δ = 3,55mg/24 horas; p = 0,0001) y GA (Δ = 3,47mg/24 horas; p = 0,002) y entre los grupos, entre GF y GC (Δ = 2,43mg/24 horas; p = 0,018) y entre GA y GC (Δ = 2,83mg/24 horas; p = 0,005), favorable a los dos grupos de entrenamiento. Podría estar relacionado que ambas metodologías obtuvieran resultados similares, aumentando el nivel de HP, lo que hace posible concluir que los resultados de este estudio no nos permiten afirmar cuál de los dos métodos es el más adecuado por tener menor riesgo de lesiones en lo que respecta a su prescripción(AU)

Introduction. Flexibility has been increasingly incorporated into discussions about physical activity and its prescription, creating the need for identifying the form of flexibility training that will increase catabolism of collagen in the locomotor system, thus forcing the conjunctive tissue to adapt and achieve the plastic phase of stretching. Objective. This study has aimed to compare hydroxyproline (HP) levels among sedentary young people submitted to two types of stretchings: static stretching (SS) and proprioceptive neuromuscular facilitation (PNF). Material and methods. The sample was randomly divided into PNF group (PG; n=15; age=22±3 years; BMI=24, 12±3.69); static stretching group (SG; n=15; age=23±4 years; BMI= 25±4.33) and control group (CG; n=15; age: 24±4 years; BMI: 23.91±3.09). Static stretching was done by passive straining during six seconds and PNF was done according to the hold-relax method. The intensity of each intervention was controlled with the Scale of Perceived Exertion in the Flexibility – PERFLEX. Results. The study found satisfactory results: intra-group, in PG (Δ = 3.55mg/24h; p = 0.0001) and in SG (Δ= 3.47mg/24h; p=0.002) and inter-groups, between PG and CG (Δ = 2.43mg/24h; p = 0.018) and between SG and CG (Δ = 2.83mg/24h; p = 0.005), both favorable to the training groups. It was possible to infer that both forms of training obtained satisfactory results, increasing the level of HP, which leads to the conclusion that the results of this study do not allow us to state that one of these forms of training is more adequate than the other in regards to the prescription of which one would entail the lowest risk of injuries(AU)

Interés del tratamiento osteopático en la enfermedad de De Quervain. A propósito de un caso / Interest of the osteopathic treatment in ''De Quervain'' disease. '' A case report

Diseño: estudio de casos. Objetivos: describir la aplicación de técnicas osteopáticas en el tratamiento fisioterápico en un caso de enfermedad de De Quervain. Paciente y método: mujer de 29 años que presenta enfermedad de De Quervain bilateral de 8 meses de evolución. La paciente refería dolor constante de intensidad 7/10 en escala visual analógica (EVA). La movilidad estaba conservada. El balance muscular era doloroso para la extensión y abducción del pulgar y la prueba Filkenstein positiva bilateral. Los tests osteopáticos mostraron lesión de la cabeza radial en anterioridad en el codo derecho y en posterioridad en el izquierdo. El tratamiento consistió en iontoforesis con diclofenaco, ejercicios activos y tratamiento manual de elastificación de los músculos afectados. A partir de la quinta sesión se incluyeron técnicas osteopáticas de ambos codos, que consistieron en bombeos, técnicas articulatorias y manipulación. Resultados: tras 8 sesiones de tratamiento se alcanzó una importante reducción del dolor (2/10 en EVA) y normalización de la exploración. Conclusiones: la aplicación de un tratamiento fisioterapéutico consistente en iontoforesis, tratamiento manual, ejercicios de flexibilización durante 4 sesiones, seguido de 4 sesiones en las que se realiza además tratamiento con técnicas osteopáticas consistentes en bombeos, técnicas articulatorias y manipulación, ha demostrado, en este caso clínico, ser de gran utilidad en la resolución de los síntomas de la paciente. Dados los escasos efectos secundarios de este tratamiento, pensamos que podría plantearse como una opción terapéutica previa al tratamiento quirúrgico(AU)

Objectives: Describe the application of osteopathic techniques in the physiotherapytreatment of a case of De Quervain Disease.Patient and method: A 29-year old woman who had bilateral De Quervain Disease of 8month’s evolution. The patient reported constant pain, scoring 7/10 intensity on the VisualAnalogue Scale (VAS). Mobility was conserved. Muscular balance was painful for extensionand abduction of the thumb and Filkenstein test was positive for bilateral involvement.The osteopathic tests showed a lesion in the anterior position in the right elbow and posterior one in the left elbow. The treatment consisted of iontophoresis with dichlofenac,active exercises and manual treatment of elasticity of the muscles affected. After the 5th sessions, osteopathic techniques for both elbows were included. These consisted inpumping, articulation and manipulation techniques.Results: There was a significant reduction in pain after 8 treatment sessions (2/10 onVAS), normalization being found in the examination.Conclusions: Application of a physiotherapy treatment, that consisted in iontophoresis,manual treatment, flexibility exercises for 4 sessions, followed by 4 sessions in which treatment was performed with osteopathic techniques, that consisted in pumping, articulation and manipulation techniques, has been demonstrated to be of great use in this clinical case to resolve the patient’s symptoms. Given the scarce side effects of thistreatment, we consider that it should be proposed as a therapeutic option prior to surgical treatment(AU)

Reliability of spinal range of motion in healthy boys using a skin-surface device.

OBJECTIVE: The purpose of this study was to examine the interrater and intrarater reliability of spinal extension and flexion measurements using a skin-surface (Spinal Mouse; Idiag, Voletswil, Switzerland) instrument. METHODS: Spinal curvature was measured during standing, full flexion, and full extension in 81 healthy children (10.6 +/- 1.7 years) by 3 raters on 2 separate occasions. Intraclass correlation coefficients (ICCs) and standard errors of measurement were used to examine between-day and interrater reliability for thoracic, lumbar, and hip range of motion. RESULTS: The intrarater ICCs ranged from 0.61 to 0.96, and the interrater ICCs ranged from 0.70 to 0.93. The standard error of measurement ranged from 0.61 degrees to 13.18 degrees . CONCLUSION: Evaluation of spinal range of motion measures in children using the Spinal Mouse demonstrates fair to high reliability.

Differences in range of motion between dominant and nondominant sides of upper and lower extremities.

OBJECTIVE: The objective of this study was to compare ranges of motion (ROM) between dominant and nondominant sides for the joints of the upper and lower extremities. METHODS: Ninety healthy white women from 18 to 59 years of age were measured in this study. Active and passive ROM were measured for the ankle, knee, hip, shoulder, elbow, and wrist using a standard goniometer. The order of the joints, motion, sides, and active or passive motion testing was randomly selected. A paired t test was used for the comparison between sides. RESULTS: The results of this study showed a statistically significant difference between dominant and nondominant sides for 34 of the 60 ROM measured. The maximum mean difference between sides for all ROM measured was 7.5 degrees . CONCLUSION: The results of this show that some ROM are different between body sides and that when these differences exist they are minimal and may not be clinically insignificant. These results support the practice of using the opposite side of the body as an indicator of preinjury or normal extremity ROM.

Development of a computerized intervertebral motion analysis of the cervical spine for clinical application.

OBJECTIVE: The objective of this study was to develop a measurement method that could be implemented in chiropractic for the evaluation of angular and translational intervertebral motion of the cervical spine. METHODS: Flexion-extension radiographs were digitized with a scanner at a ratio of 1:1 and imported into a software, allowing segmental motion measurements. The measurements were obtained by selecting the most anteroinferior point and the most posteroinferior point of a vertebral body (anterior and posterior arch, respectively, for C1), with the origin of the reference frame set at the most posteroinferior point of the vertebral body below. The same procedure was performed for both the flexion and extension radiographs, and the coordinates of the 2 points were used to calculate the angular movement and the translation between the 2 vertebrae. RESULTS: This method provides a measure of intervertebral angular and translational movement. It uses a different reference frame for each joint instead of the same reference frame for all joints and thus provides a measure of motion in the plane of each articulation. The calculated values obtained are comparable to other studies on intervertebral motion and support further development to validate the method. CONCLUSION: The present study proposes a computerized procedure to evaluate intervertebral motion of the cervical spine. This procedure needs to be validated with a reliability study but could provide a valuable tool for doctors of chiropractic and further spinal research.