The Application of Creatine Supplementation in Medical Rehabilitation.

Numerous health conditions affecting the musculoskeletal, cardiopulmonary, and nervous systems can result in physical dysfunction, impaired performance, muscle weakness, and disuse-induced atrophy. Due to its well-documented anabolic potential, creatine monohydrate has been investigated as a supplemental agent to mitigate the loss of muscle mass and function in a variety of acute and chronic conditions. A review of the literature was conducted to assess the current state of knowledge regarding the effects of creatine supplementation on rehabilitation from immobilization and injury, neurodegenerative diseases, cardiopulmonary disease, and other muscular disorders. Several of the findings are encouraging, showcasing creatine's potential efficacy as a supplemental agent via preservation of muscle mass, strength, and physical function; however, the results are not consistent. For multiple diseases, only a few creatine studies with small sample sizes have been published, making it difficult to draw definitive conclusions. Rationale for discordant findings is further complicated by differences in disease pathologies, intervention protocols, creatine dosing and duration, and patient population. While creatine supplementation demonstrates promise as a therapeutic aid, more research is needed to fill gaps in knowledge within medical rehabilitation.

Clinical trial readiness study of distal myopathy and dysphagia in nephropathic cystinosis.

BACKGROUND: Nephropathic cystinosis is a lysosomal storage disorder with late-onset systemic complications, such as myopathy and dysphagia. Currently employed outcome measures lack sensitivity and responsiveness for dysphagia and myopathy, a limitation to clinical trial readiness. METHODS: We evaluated 20 patients with nephropathic cystinosis in two visits over the course of a year to identify outcomes sensitive to detect changes over time. Patients also underwent an expiratory muscle strength training program to assess any effects on aspiration and dysphagia. RESULTS: There were significant differences in the Timed Up and Go Test (TUG) and Timed 25-Foot Walk (25-FW) between baseline and 1-y follow-up (P < .05). Maximum expiratory pressure (MEP) and peak cough flow (PCF) significantly improved following respiratory training (P < .05). CONCLUSIONS: Improved respiratory outcomes may enhance patients ability to expel aspirated material from the airway, stave off pulmonary sequelae associated with chronic aspiration, and yield an overall improvement in physical health and well-being.

Adapted physical activity and therapeutic exercise in late-onset Pompe disease (LOPD): a two-step rehabilitative approach.

Aerobic exercise, training to sustain motor ability, and respiratory rehabilitation may improve general functioning and quality of life (QoL) in neuromuscular disorders. Patients with late-onset Pompe disease (LOPD) typically show progressive muscle weakness, respiratory dysfunction and minor cardiac involvement. Characteristics and modalities of motor and respiratory rehabilitation in LOPD are not well defined and specific guidelines are lacking. Therefore, we evaluated the role of physical activity, therapeutic exercise, and pulmonary rehabilitation programs in order to promote an appropriate management of motor and respiratory dysfunctions and improve QoL in patients with LOPD. We propose two operational protocols: one for an adapted physical activity (APA) plan and the other for an individual rehabilitation plan, particularly focused on therapeutic exercise (TE) and respiratory rehabilitation.

The Torsional Upper Crossed Syndrome: A multi-planar update to Janda's model, with a case series introduction of the mid-pectoral fascial lesion as an associated etiological factor.

The Upper Crossed Syndrome (UCS) was presented by Janda to introduce neuromotor aspects of upper body muscle imbalances, describing sagittal plane postural asymmetries as barriers to recovery from chronic locomotor system pain syndromes. The UCS describes muscle imbalances of key antagonists causing forward postures of the head and shoulders and associated changes in the spinal curves -particularly an increased thoracic kyphosis - as well as changed function in the shoulder girdle. The role of fascial tissue has gained remarkable interest over the past decade, previously emphasizing its anatomic compartmental and binding role, while more recently emphasizing load transfer, sensory and kinetic chain function. The authors introduce the Mid-Pectoral Fascial Lesion (MPFL) as a myofascial disorder, describing 11 ipsilateral chest wall cases. While managing these cases, the authors encountered and subsequently designated the Torsional Upper Crossed Syndrome (TUCS) as a multi-planar addition to Janda's classic sagittal plane model. This article integrates published updates regarding the role of posture and fascia with the effects of chest wall trauma and a newly described associated postural syndrome as illustrated with this case series. An effective therapeutic approach to release the MPFL is then briefly described.

Mind the gap: diastasis of the rectus abdominis muscles in pregnant and postnatal women.

This article looks at the abdominal physiology of pregnant and postnatal women, the incidence of diastasis recti abdominis and the possible risk factors for this condition. The longer-term implications of this condition, the effects of exercise, indicators for referral and future pregnancies are discussed. Key practice points and resources for midwives and women are offered.

The immediate effect of kinesiology taping on muscular imbalance in the lateral flexors of the neck in infants: a randomized masked study.

OBJECTIVE: To investigate the immediate effect of kinesiology taping (KT) on muscular imbalance in the lateral flexors of the neck. DESIGN: Randomized controlled trial. PARTICIPANTS: Twenty-nine infants with congenital muscular torticollis and muscular imbalance in the lateral flexors of the neck were chosen consecutively. In addition, 5 healthy infants with no signs of muscular imbalance in the neck were tested. METHOD: The infants were randomly allocated to either an intervention group or a control group. The intervention group had kinesiology taping applied on the affected side using the muscle-relaxing technique. The healthy infants were tested both with and without kinesiology taping. The evaluator was blinded to whether the infants were or were not taped. RESULTS: There was a significant difference in the change of Muscle Function Scale (MFS) scores between the groups (P < .0001). In the intervention group, there were significantly lower scores on the affected side that had been taped (P < .0001) and also significantly higher scores on the unaffected side (P = .01). There were no significant differences in the control group. For the healthy infants, with no imbalance in the lateral flexors of the neck, there were no changes to the MFS scores regardless of whether the kinesiology tape was applied. CONCLUSIONS: For infants with congenital muscular torticollis, kinesiology taping applied on the affected side had an immediate effect on the MFS scores for the muscular imbalance in the lateral flexors of the neck.

[Comprehensive rehabilitation of the subjects presenting with occupational muscular-skeletal abnormalities].

The methodological approach to the rehabilitative treatment of the subjects presenting with occupational muscular-skeletal abnormalities in the upper limb girdle associated with their occupational activities implies the combined application of a pulsed magnetic field, therapeutic peloids and ultrasound therapy to the neuromuscular apparatus and tendinous-capsular structures of the rotator cuff undergoing dystrophic degeneration. This therapeutic modality makes it possible to improve the biomechanical conditions of the patients by broadening the range of active painless movements in the affected shoulder joint by 42% (p < 0.05), normalizing tonal and load-bearing characteristics of the muscles (increase of the initially reduced muscular tone at rest by 27% (p < 0.05) at a maximum voluntary tension (16%, p > 0.05), changing trophicity of periarticular tissues (elevation of the pain sensitivity threshold of tendons and painful indurations in the functionally active muscles of the thoracic girdle of the upper extremity by 76% (p < 0.05). It is concluded that these changes contribute to the improvement of professional activities of the patients.

Contrast water therapy and exercise induced muscle damage: a systematic review and meta-analysis.

The aim of this systematic review was to examine the effect of Contrast Water Therapy (CWT) on recovery following exercise induced muscle damage. Controlled trials were identified from computerized literature searching and citation tracking performed up to February 2013. Eighteen trials met the inclusion criteria; all had a high risk of bias. Pooled data from 13 studies showed that CWT resulted in significantly greater improvements in muscle soreness at the five follow-up time points (<6, 24, 48, 72 and 96 hours) in comparison to passive recovery. Pooled data also showed that CWT significantly reduced muscle strength loss at each follow-up time (<6, 24, 48, 72 and 96 hours) in comparison to passive recovery. Despite comparing CWT to a large number of other recovery interventions, including cold water immersion, warm water immersion, compression, active recovery and stretching, there was little evidence for a superior treatment intervention. The current evidence base shows that CWT is superior to using passive recovery or rest after exercise; the magnitudes of these effects may be most relevant to an elite sporting population. There seems to be little difference in recovery outcome between CWT and other popular recovery interventions.

Does electrical stimulation enhance post-exercise performance recovery?

Elite sport requires high-volume and high-intensity training that inevitably induces neuromuscular fatigue detrimental for physical performance. Improving recovery processes is, therefore, fundamental and to this, a wide variety of recovery modalities could be proposed. Among them, neuromuscular electrical stimulation is largely adopted particularly by endurance-type and team sport athletes. This type of solicitation, when used with low stimulation frequencies, induces contractions of short duration and low intensity comparable to active recovery. This might be of interest to favour muscle blood flow and therefore metabolites washout to accelerate recovery kinetics during and after fatiguing exercises, training sessions or competition. However, although electrical stimulation is often used for recovery, limited evidence exists regarding its effects for an improvement of most physiological variables or reduced subjective rating of muscle soreness. Therefore, the main aim of this brief review is to present recent results from the literature to clarify the effectiveness of electrical stimulation as a recovery modality.

Measurement properties of the pressure biofeedback unit in the evaluation of transversus abdominis muscle activity: a systematic review.

BACKGROUND: Measurements from pressure biofeedback units (PBUs) can be used to evaluate the activity of the transversus abdominis (TrA) muscle indirectly. These measurements can classify patients or monitor the progress of treatment programmes for people with low back pain. OBJECTIVE: To systematically review studies on the measurement properties of PBUs for the assessment of TrA activity. DATA SOURCES: Eligible studies were identified through searches of PUBMED, CINAHL and BIREME (1990 to 2009). In addition, hand searches of journals and citation tracking were performed. STUDY SELECTION: Full-text studies involving any type of clinimetric tests of PBU measurement for the assessment of TrA activity were selected. DATA EXTRACTION: Two independent reviewers selected the studies, extracted the data and assessed methodological quality. DATA SYNTHESIS: Due to the heterogeneity of study designs and statistical analysis, it was not possible to pool the data for a meta-analysis. RESULTS: Six studies met the inclusion criteria. These studies were typically of low quality and recruited healthy subjects rather than patients with low back pain. The studies found moderate to good reproducibility (intra-class correlation coefficients from 0.47 to 0.82) and acceptable construct validity (intra-class correlation coefficients from 0.48 to 0.90). CONCLUSIONS: The current evidence about the measurement properties of PBUs for the assessment of TrA activity is mainly based on studies with suboptimal designs, and the findings from these studies are likely to be overly optimistic. The most important clinical questions about the measurement properties of PBUs for the assessment of TrA activity are yet to be answered.

Oxidative stress, inflammation and recovery of muscle function after damaging exercise: effect of 6-week mixed antioxidant supplementation.

There is no consensus regarding the effects of mixed antioxidant vitamin C and/or vitamin E supplementation on oxidative stress responses to exercise and restoration of muscle function. Thirty-eight men were randomly assigned to receive either placebo group (n = 18) or mixed antioxidant (primarily vitamin C & E) supplements (n = 20) in a double-blind manner. After 6 weeks, participants performed 90 min of intermittent shuttle-running. Peak isometric torque of the knee flexors/extensors and range of motion at this joint were determined before and after exercise, with recovery of these variables tracked for up to 168 h post-exercise. Antioxidant supplementation elevated pre-exercise plasma vitamin C (93 ± 8 µmol l(-1)) and vitamin E (11 ± 3 µmol l(-1)) concentrations relative to baseline (P < 0.001) and the placebo group (P ≤ 0.02). Exercise reduced peak isometric torque (i.e. 9-19% relative to baseline; P ≤ 0.001), which persisted for the first 48 h of recovery with no difference between treatment groups. In contrast, changes in the urine concentration of F(2)-isoprostanes responded differently to each treatment (P = 0.04), with a tendency for higher concentrations after 48 h of recovery in the supplemented group (6.2 ± 6.1 vs. 3.7 ± 3.4 ng ml(-1)). Vitamin C & E supplementation also affected serum cortisol concentrations, with an attenuated increase from baseline to the peak values reached after 1 h of recovery compared with the placebo group (P = 0.02) and serum interleukin-6 concentrations were higher after 1 h of recovery in the antioxidant group (11.3 ± 3.4 pg ml(-1)) than the placebo group (6.2 ± 3.8 pg ml(-1); P = 0.05). Combined vitamin C & E supplementation neither reduced markers of oxidative stress or inflammation nor did it facilitate recovery of muscle function after exercise-induced muscle damage.

Evidence-based review of manual therapy efficacy in treatment of chronic musculoskeletal pain.

Chronic musculoskeletal pain contributes greatly to the community's disability and morbidity. Although many interventions are employed for treating chronic musculoskeletal pain, few have been proven in randomized controlled trials. Manual therapy is a widely used method for managing such conditions, but to date, its efficacy has not been established. This evidence-based review aims to assess the efficacy of manual therapy interventions for chronic musculoskeletal pain. MEDLINE, CINAHL, EBM Reviews (Cochrane DSR, ACP Journal Club, DARE, and CCTR), Ovid Healthstar, and PsycINFO databases were searched from 1961 to March 2009 using keywords of interest. Potential studies for inclusion were reviewed independently by two reviewers. Methodological quality was assessed based on the Physiotherapy Evidence Database scale. Trials were quantitatively categorized according to the Modified Oxford Centre for Evidence-based Medicine Levels of Evidence. Meta-analysis was not possible due to heterogeneity of outcome measures. Evidence supports some manual therapy techniques in chronic low back and knee pain.

How to treat the stiff total knee arthroplasty?: a systematic review.

BACKGROUND: Multiple modalities have been used to treat the stiff TKA, including manipulation under anesthesia (MUA), arthroscopy, and open arthrolysis. QUESTIONS/PURPOSES: We reviewed the literature to address three questions: (1) How many degrees of ROM will a stiff TKA gain after MUA, arthroscopy, and open arthrolysis? (2) Does the timing of each procedure influence this gain in ROM? (3) What is the number of clinically important complications for each procedure? METHODS: We performed a PubMed search of English language articles from 1966 to 2008 and identified 20 articles, mostly Level IV studies. RESULTS: For patients who have arthrofibrosis after TKA, the gains in ROM after MUA and arthroscopy (with or without MUA) are similar. Open arthrolysis seems to have inferior gains in ROM. MUA is more successful in increasing ROM when performed early but still may be effective when performed late. Arthroscopy combined with MUA still is useful 1 year after the index TKA. The numbers of clinically important complications after MUA and arthroscopy (with or without MUA) are similar. CONCLUSIONS: Stiffness after TKA is a common problem that can be improved with MUA and/or arthroscopic lysis of adhesions with few complications. The low quality of available literature makes it difficult to develop treatment protocols. LEVEL OF EVIDENCE: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

The use of EMG biofeedback for learning of selective activation of intra-muscular parts within the serratus anterior muscle: a novel approach for rehabilitation of scapular muscle imbalance.

Motor control and learning possibilities of scapular muscles are of clinical interest for restoring scapular muscle balance in patients with neck and shoulder disorders. The aim of the study was to investigate whether selective voluntary activation of intra-muscular parts within the serratus anterior can be learned with electromyographical (EMG) biofeedback, and whether the lower serratus anterior and the lower trapezius muscle comprise the lower scapula rotation force couple by synergistic activation. Nine healthy males practiced selective activation of intra-muscular parts within the serratus anterior with visual EMG biofeedback, while the activity of four parts of the serratus anterior and four parts of the trapezius muscle was recorded. One subject was able to selectively activate both the upper and the lower serratus anterior respectively. Moreover, three subjects managed to selectively activate the lower serratus anterior, and two subjects learned to selectively activate the upper serratus anterior. During selective activation of the lower serratus anterior, the activity of this muscle part was 14.4+/-10.3 times higher than the upper serratus anterior activity (P<0.05). The corresponding ratio for selective upper serratus vs. lower serratus anterior activity was 6.4+/-1.7 (P<0.05). Moreover, selective activation of the lower parts of the serratus anterior evoked 7.7+/-8.5 times higher synergistic activity of the lower trapezius compared with the upper trapezius (P<0.05). The learning of complete selective activation of both the lower and the upper serratus anterior of one subject, and selective activation of either the upper or lower serratus anterior by five subjects designates the promising clinical application of EMG biofeedback for restoring scapular muscle balance. The synergistic activation between the lower serratus anterior and the lower trapezius muscle was observed in only a few subjects, and future studies including more subjects are required before conclusions of a lower scapula rotation couple can be drawn.

The immediate effect of musculoskeletal physiotherapy techniques and massage on pain and ease of breathing in adults with cystic fibrosis.

The optimal treatment approach to musculoskeletal pain in cystic fibrosis remains unclear. This study aimed to examine the effect of a combination of musculoskeletal physiotherapy techniques and massage therapy on musculoskeletal pain and ease of breathing. A single treatment session was associated with reduction in pain and improvement in ease of breathing in adults with cystic fibrosis.

The prevention and treatment of exercise-induced muscle damage.

Exercise-induced muscle damage (EIMD) can be caused by novel or unaccustomed exercise and results in a temporary decrease in muscle force production, a rise in passive tension, increased muscle soreness and swelling, and an increase in intramuscular proteins in blood. Consequently, EIMD can have a profound effect on the ability to perform subsequent bouts of exercise and therefore adhere to an exercise training programme. A variety of interventions have been used prophylactically and/or therapeutically in an attempt to reduce the negative effects associated with EIMD. This article focuses on some of the most commonly used strategies, including nutritional and pharmacological strategies, electrical and manual therapies and exercise. Long-term supplementation with antioxidants or beta-hydroxy-beta-methylbutyrate appears to provide a prophylactic effect in reducing EIMD, as does the ingestion of protein before and following exercise. Although the administration of high-dose NSAIDs may reduce EIMD and muscle soreness, it also attenuates the adaptive processes and should therefore not be prescribed for long-term treatment of EIMD. Whilst there is some evidence that stretching and massage may reduce muscle soreness, there is little evidence indicating any performance benefits. Electrical therapies and cryotherapy offer limited effect in the treatment of EIMD; however, inconsistencies in the dose and frequency of these and other interventions may account for the lack of consensus regarding their efficacy. Both as a cause and a consequence of this, there are very few evidence-based guidelines for the application of many of these interventions. Conversely, there is unequivocal evidence that prior bouts of eccentric exercise provide a protective effect against subsequent bouts of potentially damaging exercise. Further research is warranted to elucidate the most appropriate dose and frequency of interventions to attenuate EIMD and if these interventions attenuate the adaptation process. This will both clarify the efficacy of such strategies and provide guidelines for evidence-based practice.

Tratamiento de la disfunción del suelo pélvico / Treatment of the dysfunction of the pelvic floor

El periné está formado por elementos músculos-aponeuróticos que se integran bajo el control del sistema nervioso. Su alteración es responsable de patologías uroginecológicas, coloproctológicas y sexuales. Para conseguir su tratamiento exitoso es obligado no olvidar el papel que juega el periné en las mismas. El tratamiento de la disfunción del suelo pélvico agrupa una serie de técnicas y procedimientos conservadores como cambios en hábitos de vida, terapia conductual, biofeedback, electroestimulación (neuromodulación y estimulación eléctrica periférica) y entrenamiento con ejercicios musculares del suelo pélvico (rehabilitación perineal). El objetivo de todas ellas es mejorar o conseguir la continencia urinaria, el fortalecimiento de su musculatura para conseguir equilibrar la estática pélvica, mejorar la vascularización local y la función ano-rectal además de conseguir una sexualidad satisfactoria

The perineum is formed by muscle-aponeurotic elements that are integrated under the control of the nervous system. Their alterations are responsible for urogynecological, coloproctologic and sexual pathologies. In order to obtain a successful treatment, it is obliged not to forget the role that plays the perineum in those pathologies. The treatment of the dysfunction of the pelvic floor groups conservative techniques and procedures like changes in life habits, behavioural therapy, biofeedback, electroestimulation (neuromodulation and peripheral electrical stimulation) and training with muscular exercises of the pelvic floor (perineal rehabilitation). The objective of all of them is to improve or to obtain the urinary continence, the strengthening of its musculature to be able to balance pelvic static, to improve the local vascularization and the anorrectal function besides securing a satisfactory sexuality

The control of parameters within the therapeutic range in neuromuscular electrical stimulation.

The purpose of this article was to investigate the pattern of differences among three parameters according to the increased level of the muscle force obtained in response to neuromuscular electrical stimulation (NMES). Ten healthy subjects were enrolled in this study, which involved applying NMES to the wrist extensor of the nondominant side. The threshold intensity that induced target motion was determined at first and NMES was then applied while changing three parameters. The muscle force was measured by means of a dynamometer for each parameter. Thus, the increased pattern of the muscle force was compared for each parameter. Compared with the duration or the frequency, the increase of the muscle force that accompanied the increase of intensity was more prominent. When the duration was doubled, the increase of muscle force was more evident at threshold intensity than at high intensity (p < .01). When the intensity was doubled, the increase of muscle force was more prominent at 0.2 than at 0.4 milliseconds duration (p < .01). However, there was no such interaction between the increase of the frequency and either the duration or the intensity. The data suggest that stimulus intensity may be the most effective parameter that can be used to enhance the strengthening of the muscle.

Effects of magnetic stimulation in the treatment of pelvic floor dysfunction.

OBJECTIVE: To correlate, in a pilot study, the clinical results of extracorporeal magnetic innervation therapy (ExMI) of the pelvic floor muscles with functional changes in the pelvic floor musculature, urodynamics and quality of life. PATIENTS AND METHODS: In all, 74 patients (65 women and nine men) with urge incontinence, urgency/frequency, stress incontinence, mixed incontinence and defecation problems were included in a prospective study of ExMI using a 'electromagnetic chair'. All patients were treated twice weekly for 8 weeks. Digital palpation and biofeedback with a vaginal or anal probe were used for registration of the pelvic floor musculature. A urodynamic evaluation, a voiding diary, a pad-test, the King's Health Questionnaire (KHQ) and a visual analogue scale (VAS) were completed by the patient at baseline and at the end of the study. RESULTS: In the group as a whole, there were no significant differences in the voiding diary, pad-test, quality of life, VAS score, biofeedback registration and urodynamics before and after treatment. Additional stratification was applied to the total patient group, related to the pretreatment rest tone of the pelvic floor, the basal amplitude registered on electromyography, to age and to previous treatments. However, there were no significant differences in the data before and after treatment within all subgroups (stress incontinence, urge incontinence, urgency/frequency, defecation problems, overactive pelvic floor, age, previous treatments), except for the KHQ domain of 'role limitations', where there was a significant improvement in all groups. CONCLUSION: ExMI did not change pelvic floor function in the present patients. The varying outcomes of several studies on ExMI stress the need for critical studies on the effect and the mode of action of electrostimulation and magnetic stimulation. In our opinion 'the chair' is suitable to train awareness of the location of the pelvic floor. However, active pelvic floor muscle exercises remain essential.

Tai Chi, caídas y osteoporosis / Tai Chi, falls and osteoporosis

Objetivo. Revisar la evidencia científica del Tai Chi como ejercicio o intervención terapéutica útil para mejorar factores intrínsecos relacionados con las caídas, prevenir las caídas en el anciano y prevenir la osteoporosis. Estrategia de búsqueda. Se han planteado las siguientes preguntas: ¿Cuáles son los efectos del Tai Chi sobre los factores de riesgo intrínseco de sufrir caídas (fuerza muscular y equilibrio)? ¿Previene el Tai Chi las caídas en el anciano? ¿El Tai Chi tiene efecto sobre la masa ósea y la osteoporosis? Para responderlas, se ha realizado una búsqueda en 7 bases de datos en inglés, con las siguientes palabras clave "Tai Chi" y "falls", "accidental falls", "elderly", "balance", "posture", "strength", "flexibility", "stance", "gait", "daily living activities", "SF-36", "SF-12", "osteoporosis", "exercise", "osteoporotic fracture", "bone mineral density", "postmenopausal". Selección de estudios. Se ha utilizado una lista Delphi para valorar la calidad de los ensayos clínicos y un checklist de valoración crítica (http://www.le.ac.uk/li/lgh/library/CRDappraisal %20checklists.doc) para los casos y controles. Finalmente se ha utilizado la Metodología Basada en la Evidencia de Oxford (Centre for Evidence-Based Medicine) para establecer el nivel de evidencia y el grado de recomendación. En todos estos trabajos se ha estudiado al menos las características del diseño, muestra, intervenciones, estado de salud, estilo de Tai Chi utilizado, y finalmente las medidas de resultados. Síntesis de resultados. Se han analizado 12 ensayos clínicos aleatorizados, 10 ensayos clínicos no aleatorizados y 9 casos controles. Conclusiones. Se han descrito efectos beneficiosos sobre las medidas de fuerza muscular, equilibrio, caídas y osteoporosis. Sin embargo, se han detectado limitaciones importantes en los estudios analizados por lo que es difícil generalizar estas conclusiones

Objective. Review the scientific evidence of Tai Chi as a useful therapeutic intervention or exercise to improve intrinsic factors related with falls, prevents falls in the elderly and prevent osteoporosis. Search strategy. The following questions have been asked: What are the effects of Tai Chi on the intrinsic risk factors of suffering falls (muscle force and balance)? Does Tai Chi prevent falls in the elderly? Does Tai Chi have an effect on bone mass and osteoporosis? A search in 7 databases in English was made to answer them. The following key words were used "Tai Chi" and "falls," "accidental falls," "elderly," "balance," "posture," "strength," "flexibility," "stance," "gait," "daily living activities," "SF-36," "SF-12," "osteoporosis," "exercise," "osteoporotic fracture," "bone mineral density," "postmenopausal." Study selection. A Delphi list to assess clinical trial quality and critical assessment checklist for the cases and controls (http://www.le.ac.uk/li/lgh/library/CRDappraisal %20checklists.doc) were used for the cases and controls. Finally, the Oxford Evidence Based Method (Centre for Evidence-Based Medicine) was used to establish the level of evidence and recommendation grade. In all these studies, at least the characteristics of design, sample, intervention, health condition, Tai Chi style used, and finally the measurements of results have been studied. Synthesis of results. Twelve randomized clinical trials, 10 non-randomized clinical trials and 9 control cases were analyzed. Conclusions. Benefits on the measurements of muscle force, balance, falls and osteoporosis have been described. However, important limitations have been detected in studies analyzed, so it is difficult to generalize these conclusions