Ultrasound assessment of the abdominal, diaphragm, and pelvic floor muscles during the respiratory and postural tasks in women with and without postpartum lumbopelvic pain: a case-control study.

INTRODUCTION AND HYPOTHESIS: Postpartum lumbopelvic pain (PLPP) is common among women. Abdominal, diaphragm, and pelvic floor muscles (PFMs) modulate intraabdominal pressure as a part of the force closure mechanism. These muscles are exposed to changes during pregnancy that compromise the force closure mechanism. It was hypothesized that abdominal and PFMs activity, the direction of bladder base displacement, diaphragm thickness, and excursion might differ between women with and without PLPP during respiratory and postural tasks. METHODS: Thirty women with and 30 women without PLPP participated in this case-control study. Ultrasound imaging was used to assess the abdominal, diaphragm, and PFMs during rest, active straight leg raising (ASLR) with and without a pelvic belt, and deep respiration. RESULTS: The bladder base descent was significantly greater in the PLPP group than in the controls during deep respiration and ASLR without a belt (p = 0.026; Chi-squared = 6.40). No significant differences were observed between the groups in the abdominal muscles activity and diaphragm muscle thickness. There was a significant interaction effect of the group and the task for diaphragm excursion (F (2, 116) = 6.08; p = 0.00) and PFM activity (F (2, 116) = 5.22; p = 0.00). In the PLPP group, wearing a belt compromised altered PFM activation and direction of bladder base displacement. CONCLUSION: The PFM activity, direction of bladder base displacement, and diaphragm excursion differed between groups during postural and respiratory tasks. Therefore, it is recommended to involve retraining of the PFMs and diaphragm muscle in the rehabilitation of women with PLPP.

Supervised versus unsupervised pelvic floor muscle training in the treatment of women with urinary incontinence - a systematic review and meta-analysis.

INTRODUCTION AND HYPOTHESIS: This study synthesized the effects of supervised and unsupervised pelvic floor muscle training (PFMT) programs on outcomes relevant to women's urinary incontinence (UI). METHODS: Five databases were searched from inception to December 2021, and the search was updated until June 28, 2022. Randomized and non-randomized control trials (RCTs and NRCTs) comparing supervised and unsupervised PFMT in women with UI and reported urinary symptoms, quality of life (QoL), pelvic floor muscles (PFM) function/ strength, the severity of UI, and patient satisfaction outcomes were included. Risk of bias assessment of eligible studies was performed by two authors through Cochrane risk of bias assessment tools. The meta-analysis was conducted using a random effects model with the mean difference or standardized mean difference. RESULTS: Six RCTs and one NRCT study were included. All RCTs were assessed as "high risk of bias", and the NRCT study was rated as "serious risk of bias" for almost all domains. The results showed that supervised PFMT is better than unsupervised for QoL and PFM function of women with UI. There was no difference between supervised and unsupervised PFMT for urinary symptoms and improvement of the severity of UI. Results of patient satisfaction were inconclusive due to the sparse literature. However, supervised and unsupervised PFMT with thorough education and regular reassessment showed better results than those for unsupervised PFMT without educating patients about correct PFM contractions. CONCLUSIONS: Supervised and unsupervised PFMT programs can both be effective in treating women's UI if training sessions and regular reassessments are provided.

Comparison of the Dynamic Postural Control During Lifting and Lowering an External Load in Low Back Pain: A Cross-Sectional Study.

OBJECTIVE: This study aimed to compare dynamic postural control between individuals with and without chronic low back pain (LBP) through load lifting and lowering. METHODS: This cross-sectional study included 52 male patients with chronic LBP (age: 33.37 ± 9.23 years) and 20 healthy male individuals (age: 31.75 ± 7.43 years). The postural control parameters were measured using a force plate system. The participants were instructed to stand barefoot (hip-width apart) on the force plate and lift a box (10% of the weight of the participants) from the waist height to overhead and then lower it from overhead to waist height. The interaction between the groups and tasks was determined using a 2-way repeated-measures analysis of variance. RESULTS: There was no significant interaction between the groups and tasks. Regardless of the groups, postural control parameters including amplitude (P = .001) and velocity (P < .001) in anterior-posterior (AP) direction, phase plane in medial-lateral (ML) direction (P = .001), phase plane in AP-ML direction (P = .001), and the mean total velocity (P < .001) were lesser during the lowering compared with lifting. The results indicated that, regardless of the tasks, the postural control parameters including velocity (P = .004) and phase plane in AP direction (P = .004), velocity in ML direction (P < .001), phase plane (AP-ML) (P = .028), and mean total velocity (P = .001) in LBP were lesser compared with the normal group. CONCLUSION: Different tasks affected postural control differently in patients with LBP and healthy individuals. Moreover, postural control was more challenged during the load-lowering than the load-lifting task. This may have been a result of a stiffening strategy. It may be that the load-lowering task might be considered as a more influential factor for the postural control strategy. These results may provide a novel understanding of selecting the rehabilitation programs for postural control disorders in patients.

The Analysis of Spontaneous Electroencephalogram (EEG) in Chronic Low Back Pain Patients Compared with Healthy Subjects.

Background: Quantitative electroencephalography (EEG) power spectra analysis was applied to assess brain activation during chronic pain. Although many studies have shown that there are some common characteristics among individuals suffering from various pain syndromes, the data remains inconclusive. The present study aimed to assess chronic low back pain (CLBP) based on functional brain changes with EEG in CLBP patients compared with healthy controls. Methods: Multichannel electroencephalogram data were recorded from 30 subjects with CLBP and 30 healthy controls under eye-open resting state conditions and active lumbar forward flexion, and their cortical oscillations were compared using electrode-level analysis. Data were analyzed using a pair t-test. Results: A total of 30 patients (19 men and 11 women in the case group (mean [SD] age, 35.23 [5.93] years) with 30 age and sex-match healthy controls participated in the study. A paired t-test was applied to identify whether there was any difference in the absolute and relative power of frequency spectra between CLBP patients and healthy controls. The results showed a significant increase in alpha relative power in CLBP patients compared with healthy controls in an open-eye resting state ( P < 0.050) and active lumbar forward flexion ( P < 0.050). Conclusion: The enhanced alpha relative power in CLBP patients could be relevant to attenuating sensory information gating and excessive integration of pain-related information. Increased power at the EEG seems to be one of the clinical characteristics of individuals with CLBP. EEG can be a simple and objective tool for studying the mechanisms involved in chronic pain and identifying specific characteristics of CLBP patients.

Pressure Pain Threshold in Subjects With Piriformis Syndrome: Test-Retest, Intrarater, and Interrater Reliability, and Minimal Detectible Changes.

OBJECTIVE: This study aimed to assess the test-retest, intrarater, and interrater reliability of using the pressure pain threshold (PPT) in healthy and affected piriformis muscles and to estimate its absolute reliability. As a secondary objective, the degree of tenderness of the affected piriformis muscles was compared with healthy piriformis muscles. STUDY DESIGN: This study used a comparative and reliability-based design. SETTING: Rehabilitation clinic. PARTICIPANTS: Patients (N=30) with unilateral piriformis muscle syndrome (30 affected and 30 healthy piriformis muscles) were recruited, and the PPT of both the healthy and affected piriformis muscles was recorded using digital algometry. Measurements of PPT were done by 2 raters (rater 1 and 2), which were selected at random order. Rater 1 repeated the PPT measurements 24-72 hours after initial assessment. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: PPT. RESULTS: Excellent intrarater intraclass correlation coefficient (ICC) values were observed for the PPT of the affected piriformis (ICC: 0.86-0.96) and the healthy piriformis (ICC: 0.88-0.96) in the same session. The PPT measurements using digital algometry showed good-to-excellent interrater reliability (ICC: 0.64-0.92) and test-retest reliability (ICC: 0.72-0.95) in both the healthy and affected piriformis muscles. The findings revealed a significant decrease in the PPT of the affected piriformis muscle in comparison to the healthy piriformis muscle (mean difference 12.76; 95% confidence interval, 15.69-9.82; P<.001). CONCLUSIONS: Digital algometry is a reliable tool for measuring piriformis PPT, regardless of the testing session and the rater. Patients with unilateral piriformis muscle syndrome have increased tenderness and decreased PPT in the affected piriformis muscle in comparison to the healthy piriformis muscle.

Effect of Chronic Low Back Pain on Lumbar Spine Lordosis During Sit-to-Stand and Stand-to-Sit.

OBJECTIVE: This study aimed to evaluate lumbar lordosis during sit-to-stand (STS) and stand-to-sit (SIT) in individuals with and without chronic nonspecific low back pain (CNLBP). The second objective was to investigate sex-related differences in lumbar lordosis. METHODS: Twenty-six patients with CNLBP and 26 controls were recruited. Controls were matched with cases using a frequency matching method. Reflective markers were placed over the spinous process of T12, L3, S2, and the anterior and posterior superior iliac spines. The participants were instructed to stand up at a self-selected pace and maintain their normal upright standing posture for 3 seconds, and then sit down. Kinematic data were recorded at a sampling frequency of 100 Hz using a motion capture system. Lumbar lordosis angle was calculated from the intersection between the line joining T12 and L3, and the line joining L3 to S2. RESULTS: Lumbar lordosis was decreased in patients with CNLBP during STS and SIT compared with the asymptomatic group (mean difference = 2.68°-9.32°; P ≤ .005). Furthermore, no differences were seen in lumbar lordosis at starting position between CNLBP and asymptomatic groups during STS and SIT (mean difference = 2.68°-3.75°; P ≥ .099). Interestingly, the magnitude of the effect size suggested that the difference in lumbar lordosis values between female and male participants was relatively large (Cohen's d = -1.81 to 0.20). CONCLUSION: Decreased lumbar lordosis in patients with CNLBP during STS and SIT could be considered as an important point during rehabilitation. Moreover, the present study showed that there is a sex-related difference among women and men in lumbar lordosis during STS and SIT tasks.

Intrarater reliability of musculoskeletal ultrasound imaging of psoas major muscle in patients with subacute low back pain and healthy controls.

Background: Psoas major (PM) is a challenging muscle from the functional and anatomical point of view. The dysfunction of this muscle can result in low back pain (LBP). This study aimed to assess the intrarater reliability of ultrasound imaging (USI) of PM muscle thickness in subacute LBP patients and healthy participants without LBP in rest and during muscle contraction conditions. Methods: PM thickness was measured in all lumbar segments (L1-L5) using a USI device in 10 healthy and 10 subacute LBP participants. The intrarater data were assessed on the same day with 1- hour interval and after 7 days. Intraclass correlation coefficients (ICC), standard error of measurement (SEM), minimal detectable change (MDC), and independent t test were used for analyses. Significant level was set at 0.05. Results: PM thickness in all lumbar levels had excellent reliability (ICC range 80-98) for both groups and conditions. SEM (0.42- 2.29) and MDC (1.16-6.34) were low, and PM thickness was greater than rest in contraction condition. There were no significant differences between the 2 groups in PM thickness. Conclusion: The USI demonstrated good intrarater reliability for assessing PM thickness in patients with subacute LBP. The thickness of PM in patients with subacute LBP was similar with that in healthy participants.

Ultrasound-guided dry needling decreases pain in patients with piriformis syndrome.

INTRODUCTION: Piriformis muscle syndrome (PMS) is a disorder that can lead to symptoms of buttock pain and limited hip-joint mobility, and may have an impact on quality of life. METHODS: Thirty-two patients with PMS were randomized to the treatment group, which included three sessions of ultrasound-guided dry needling (DN) of the piriformis muscle (n = 16), or a waitlist control group (n = 16). The primary outcome was pain intensity measured on the visual analog scale recorded at baseline and then at 72 hours and 1 week after treatment. RESULTS: At 1-week follow-up, pain intensity was significantly less in the DN group than in the waitlist control group (-2.16 [-1.01 to -3.32], P = .007) by an amount consistent with clinically meaningful improvement. DISCUSSION: The findings suggest that DN resulted in clinically meaningful short-term improvement in pain intensity of patients with PMS.

Kinematics of the Spine During Sit-to-Stand Movement Using Motion Analysis Systems: A Systematic Review of Literature.

CONTEXT: Clinical evaluation of the spine is commonplace in musculoskeletal therapies, such as physiotherapy, physical medicine/rehabilitation, osteopathic, and chiropractic clinics. Sit-to-stand (STS) is one of the most mechanically demanding daily activities and crucial to independence. Difficulty or inability to perform STS is common in individuals with a variety of motor disabilities, such as low back pain (LBP). OBJECTIVE: The purpose of this systematic review was to evaluate available evidence in literature to determine 2-dimensional and 3-dimensional kinematics of the spine during STS in patients with LBP and healthy young adult participants using motion analysis systems (electromagnetic and marker based). METHODS: Electronic databases (PubMed/MEDLINE [National Library of Medicine], Scopus, ScienceDirect, and Google Scholar) were searched between January 2002 and February 2017. Additionally, the reference lists of the articles that met the inclusion criteria were also searched. Prospective studies published in peer-reviewed journals, with full text available in English, investigating the kinematics of the spine during STS in healthy subjects (mean age between 18 and 50 y) or in patients with LBP using motion analysis systems, were included. Sixteen studies fulfilled the eligibility criteria. All information relating to methodology and kinematic modeling of the spine segments along with the outcome measures was extracted from the studies identified for synthesis. RESULTS: The results indicated that the kinematics of the spine are greatly changed in patients with LBP. In order to develop a better understanding of spine kinematics, studies recommended that the trunk should be analyzed as a multisegment. It has been shown that there is no difference between the kinematics of patients with LBP and healthy population when the spine is analyzed as a single segment. Furthermore, between-gender differences are present during STS movement. CONCLUSION: This review provided a valuable summary of the research to date examining the kinematics of the spine during STS.

Effect of Elastic Therapeutic Taping on Abdominal Muscle Endurance in Patients With Chronic Nonspecific Low Back Pain: A Randomized, Controlled, Single-Blind, Crossover Trial.

OBJECTIVE: The purpose of this study was to determine the immediate effect of elastic therapeutic taping and sham taping of the abdominal musculature on maximum hold time of endurance tests in patients with chronic nonspecific low back pain (CNLBP). METHODS: Twenty-six people with CNLBP and 26 asymptomatic individuals were included in this study. The CNLBP participants were allocated to an elastic therapeutic tape group or a sham tape group. Standard adhesive elastic therapeutic tape was utilized for facilitatory application in the elastic therapeutic tape group. The elastic therapeutic tape group received real elastic therapeutic taping on the transversus abdominis and internal obliques, and the sham tape group received sham elastic therapeutic taping application. For the sham group, the elastic therapeutic tape was positioned horizontally above the navel and applied without tension. After a wash-out period, each CNLBP participant was switched to the other group. Outcome measures included maximum hold time of supine isometric chest raise, supine double straight-leg raise, and abdominal drawing in maneuver. RESULTS: The CNLBP participants had lower maximum hold time compared to the asymptomatic individuals (P ≤ .01). Following taping, both groups showed an increase in the maximum hold time (mean difference = 4.43 - 50.69 seconds; P ≤ .02). Although there was no difference between the results of both groups (P ≥ .12), effect sizes were large for the elastic therapeutic tape group (Cohen's d = -1.93 to -1.00). CONCLUSIONS: The results suggest that the maximum hold time of endurance tests was decreased in CNLBP patients compared to healthy participants. The application of both elastic therapeutic tape and sham tape to the transversus abdominis and internal obliques produced short-term improvement in abdominal endurance. There was no statistically significant difference between the results of elastic therapeutic tape and sham tape.

Reliability and concurrent validity of a new iPhone® goniometric application for measuring active wrist range of motion: a cross-sectional study in asymptomatic subjects.

Measurement of wrist range of motion (ROM) is often considered to be an essential component of wrist physical examination. The measurement can be carried out through various instruments such as goniometers and inclinometers. Recent smartphones have been equipped with accelerometers and magnetometers, which, through specific software applications (apps) can be used for goniometric functions. This study, for the first time, aimed to evaluate the reliability and concurrent validity of a new smartphone goniometric app (Goniometer Pro©) for measuring active wrist ROM. In all, 120 wrists of 70 asymptomatic adults (38 men and 32 women; aged 18-40 years) were assessed in a physiotherapy clinic located at the School of Rehabilitation Sciences, Iran University of Medical Science and Health Services, Tehran, Iran. Following the recruitment process, active wrist ROM was measured using a universal goniometer and iPhone® 5 app. Two blinded examiners each utilized the universal goniometer and iPhone® to measure active wrist ROM using a volar/dorsal alignment technique in the following sequences: flexion, extension, radial deviation, and ulnar deviation. The second (2 h later) and third (48 h later) sessions were carried out in the same manner as the first session. All the measurements were conducted three times and the mean value of three repetitions for each measurement was used for analysis. Intraclass correlation coefficient (ICC) models (3, k) and (2, k) were used to determine the intra-rater and inter-rater reliability, respectively. The Pearson correlation coefficients were used to establish concurrent validity of the iPhone® app. Good to excellent intra-rater and inter-rater reliability was demonstrated for the goniometer with ICC values of ≥ 0.82 and ≥ 0.73 and the iPhone® app with ICC values of ≥ 0.83 and ≥ 0.79, respectively. Minimum detectable change at the 95% confidence level (MDC95 ) was computed as 1.96 × standard error of measurement × âˆš2. The MDC95 ranged from 1.66° to 5.35° for the intra-rater analysis and from 1.97° to 6.15° for the inter-rater analysis. The concurrent validity between the two instruments was high, with r values of ≥ 0.80. From the results of this cross-sectional study, it can be concluded that the iPhone® app possesses good to excellent intra-rater and inter-rater reliability and concurrent validity. It seems that this app can be used for the measurement of wrist ROM. However, further research is needed to evaluate symptomatic subjects using this app.

Role of the Internal Superior Laryngeal Nerve in the Motor Responses of Vocal Cords and the Related Voice Acoustic Changes.

BACKGROUND: Repeated efforts by researchers to impose voice changes by laryngeal surface electrical stimulation (SES) have come to no avail. This present pre-experimental study employed a novel method for SES application so as to evoke the motor potential of the internal superior laryngeal nerve (ISLN) and create voice changes. METHODS: Thirty-two normal individuals (22 females and 10 males) participated in this study. The subjects were selected from the students of Iran University of Medical Sciences in 2014. Two monopolar active electrodes were placed on the thyrohyoid space at the location of the ISLN entrance to the larynx and 1 dispersive electrode was positioned on the back of the neck. A current with special programmed parameters was applied to stimulate the ISLN via the active electrodes and simultaneously the resultant acoustic changes were evaluated. All the means of the acoustic parameters during SES and rest periods were compared using the paired t-test. RESULTS: The findings indicated significant changes (P=0.00) in most of the acoustic parameters during SES presentation compared to them at rest. The mean of fundamental frequency standard deviation (SD F0) at rest was 1.54 (SD=0.55) versus 4.15 (SD=3.00) for the SES period. The other investigated parameters comprised fundamental frequency (F0), minimum F0, jitter, shimmer, harmonic-to-noise ratio (HNR), mean intensity, and minimum intensity. CONCLUSION: These findings demonstrated significant changes in most of the important acoustic features, suggesting that the stimulation of the ISLN via SES could induce motor changes in the vocal folds. The clinical applicability of the method utilized in the current study in patients with vocal fold paralysis requires further research.

Changes in postural and trunk muscles responses in patients with chronic nonspecific low back pain during sudden upper limb loading.

BACKGROUND: Alterations in the neuromuscular control of the spine were found in patients with chronic low back pain (CLBP). Sudden loading of the spine is assumed to be the cause of approximately 12% of lower back injuries. However, some aspects of this problem, such as alterations in the sensory-motor control of the spine, remain questionable. This study investigated postural and neuro- motor changes in trunk muscles during sudden upper limb loading in patients with CLBP. METHODS: Electromyography of the erector spinae (ES) and transverses abdominis/internal oblique (TrA/IO) and external oblique (EOA) muscles were recorded in 20 patients with CLBP and 20 asymptomatic individuals with eyes open (EO) and eyes closed (EC) conditions. Moreover, measurements of the center of pressure (COP) and vertical ground reaction force (GRF) or Fz were recorded using a force plate. Data were analyzed using paired t-test and independent t-test at the significance level of 0.05. RESULTS: In patients with CLBP, decreased electrical activity of the ES muscle was observed under both the EO and EC conditions and that of the TrA/IO muscle was observed under the EO condition (p< 0.05). Other findings included a shorter peak latency of the ES muscle in the EO condition and a greater increase in the peak latency of the ES muscle following the EC condition (p< 0.05). No significant differences were observed in COP and GRF measurements between the groups. CONCLUSION: Electrical muscle activity may indicate less stiffening or preparatory muscle activity in the trunk muscle of patients with CLBP. Altered latency of the muscle may lead to microtrauma of lumbar structures and CLBP.

The effects of arm movement on reaction time in patients with latent and active upper trapezius myofascial trigger point.

BACKGROUND: Myofascial pain syndrome is a significant source of mechanical pain. The aim of this study was to investigate the effects of arm movement on reaction time in females with latent and active upper trapezius myofascial trigger point. METHODS: In this interventional study, a convenience sample of fifteen women with one active MTP, fifteen women with one latent MTP in the upper trapezius, and fifteen normal healthy women were participated. Participants were asked to stand for 10 seconds in an erect standing position. Muscle reaction times were recorded including anterior deltoid (AD), cervical paraspinal (CP) lumbar paraspinal (LP), both of upper trapezius (UT), sternocleidomastoid (SCM) and medial head of gastrocnemius (GcM). Participants were asked to flex their arms in response to a sound stimulus preceded by a warning sound stimulus. Data were analyzed using one-way ANOVA Test. RESULTS: There was significant differences in motor time and reaction time between active and control groups (p< 0.05) except for GcM. There was no significant difference in motor time between active and passive groups except for UT without MTP and SCM (p< 0.05). Also, there were no significant differences in motor times between latent MTP and control groups. Furthermore, there was no significant difference in premotor times between the three groups. CONCLUSION: The present study shows that patients with active MTP need more time to react to stimulus, but patients with latent MTP are similar to healthy subjects in the reaction time. Patients with active MTP had less compatibility with environmental stimulations, and they responded to a specific stimulation with variability in Surface Electromyography (SEMG).

The Effect of an Overhead External Load Lifting and Lowering on Dynamic Postural Control in Subgroups of Low Back Pain.

BACKGROUND: Understanding postural control in low back pain (LBP) subgroups can help develop targeted interventions to improve postural control. The studies on this topic are limited. Therefore, the primary purpose of this study was to compare the postural control of LBP subgroups with healthy individuals during overhead load lifting and lowering. METHODS: In this cross-sectional study, the participants were 52 with LBP and 20 healthy. The LBP patients were classified based on the O'Sullivan classification system into 21 flexion patterns and 31 active extension patterns. The participants lifted the box from their waists to their overheads and lowered it to their waists. Changes in postural control parameters were measured with a force plate system. RESULTS: The results of the analysis of variance showed that during load lifting, the mediolateral phase plane (p = .044) and the mean total velocity (p = .029) had significant differences between flexion patterns and healthy. Also, the load-lowering results showed that active extension patterns, compared with healthy, had significant differences in the anteroposterior-mediolateral phase plane (p = .042). The patients showed less postural sway than the healthy. CONCLUSIONS: The results in this work highlight the importance of identifying the homogenous subgroups in LBP and support the classification of heterogeneous LBP. Different subgroups exhibit different postural control behaviors. These behaviors can be due to the loading of various tissues during different tasks.

Could dry needling change the kinematics of gait in individuals with piriformis muscle syndromes? Secondary analysis of a randomized controlled trial.

INTRODUCTION: Piriformis muscle syndrome (PMS) is a condition that can lead to symptoms including gluteal pain, local tenderness, and limitation of hip joint motion in daily activities, and it may have a major impact on some daily functions such as gait. We proposed that dry needling (DN) can improve the gait of individuals with PMS. METHODS: Thirty-two individuals with PMS were assigned equally and randomly to the treatment group or the wait-list control group. Subjects in the treatment group received three sessions of DN of the piriformis muscle. All participants in both groups were educated to correct their lifestyles. The outcome measures were the gait-related parameters (walking speed, peak hip flexion, peak hip extension, time to peak internal and external hip rotation, and knee sagittal range of motion), which were evaluated at baseline and after treatment. To compare different outcomes, analysis of covariance (ANCOVA) was used, with baseline as the covariance and groups as a factor. RESULT: After DN sessions, peak hip extension during gait showed a statistically significant difference [adjusted MD 1.9 (3.7-0.08), p < 0.05, d = 0.56 (0.1-1.28)] in favor of the DN group. Peak hip flexion, on the other hand, exhibited a marginal statistically significant difference [adjusted MD -3.2 (-6.51 to 0.01), p = 0.053, d = 0.44 (1.16 to -0.02)] compared to the control group. CONCLUSION: The findings suggest that participants in DN showed significantly greater peak extension angle of the hip during walking in individuals with PMS than in the control group.

Additional effect of neuromuscular electrical stimulation in a conservative intervention on morphology and strength of abductor hallucis muscle and correction of hallux valgus deformity: a randomized controlled trial.

BACKGROUND: In hallux valgus, morphological changes and functional weakness of intrinsic foot muscles occur, especially in the abductor hallucis muscle. OBJECTIVES: This study aimed to investigate how a conservative treatment with the addition of neuromuscular electrical stimulation affects the volume and strength of the muscle, the correction of deformity, passive range of motion, pain, and disability. METHODS: Twenty-eight female participants (48 feet) were randomly assigned to two groups. The interventions included orthoses and exercise (Ortho) in both groups. One group received additional neuromuscular electrical stimulation of abductor hallucis muscle to activate it. Each group received the treatments for one month and was assessed two times, at baseline before starting and after one month of treatment. Mixed within-between ANOVA, analysis of covariance, and nonparametric tests were used for data analysis. RESULTS: The muscle volume, abduction strength, goniometric angle, and passive hallux dorsi/plantar flexion showed significant changes in both groups (p < .001). Subscales of the foot and ankle ability questionnaire, significantly changed (p ≤ .05). Pain decreased significantly in the two groups (p < .001 and p = .02). Intermetatarsal angle did not significantly differ between the two groups (p = .86, partial eta effect size = 0.001). But, the hallux valgus angle mean (on MRI) in the Ortho group was less than that of the orthoNMES group (p = .007, partial eta effect size = 0.15). CONCLUSION: Both groups showed nearly identical treatment effects in the primary volume and hallux valgus correction outcome measures. In this study, adding neuromuscular electrical stimulation did not have an additional effect compared to conservative in the treatment of hallux valgus. TRIAL REGISTRATION NUMBER: The RCT Code is IRCT20200915048725N1.

The Effects of Stabilization and Mckenzie Exercises on Transverse Abdominis and Multifidus Muscle Thickness, Pain, and Disability: A Randomized Controlled Trial in NonSpecific Chronic Low Back Pain.

[Purpose] This study compared the effectiveness of stabilization and McKenzie exercises on pain, disability, and thickness of the transverse abdominis and multifidus muscles in patients with nonspecific chronic low back pain. [Subjects] Thirty patients were randomly assigned into two groups: the McKenzie and stabilization exercise groups. [Methods] Before and after intervention, pain, disability, and thickness of the transverse abdominis and multifidus muscles were evaluated by visual analogue scale, functional rating index, and sonography, respectively. The training program was 18 scheduled sessions of individual training for both groups. [Results] After interventions, the pain score decreased in both groups. The disability score decreased only in the stabilization group. The thickness of the left multifidus was significantly increased during resting and contracting states in the stabilization group. The thickness of the right transverse abdominis during the abdominal draw-in maneuver, and thickness of the left transverse abdominis during the active straight leg raising maneuver were significantly increased in the stabilization group. The intensity of pain, disability score, thickness of the right transverse abdominis during the abdominal draw-in manouver, and thickness of the left transverse abdominis during active straight leg raising in the stabilization group were greater than those on the Mackenzie. [Conclusion] Stabilization exercises are more effective than McKenzie exercises in improving the intensity of pain and function score and in increasing the thickness of the transverse abdominis muscle.

Effect of progressive muscle relaxation as an add-on to pulmonary telerehabilitation in discharged patients with COVID-19: A randomised controlled trial.

BACKGROUND: and purpose: Most patients with coronavirus disease 2019 (COVID-19) experience persistent physical and psychological symptoms. This study aimed to investigate the effects of pulmonary telerehabilitation (PTR) combined with progressive muscle relaxation (PMR) on the physical and psychological outcomes of discharged patients with COVID-19. MATERIALS AND METHODS: This randomised, assessor-blinded, parallel-group study was conducted in hospitals affiliated with Qom University of Medical Sciences between May and October 2021. Discharged COVID-19 patients aged 18-65 years were randomly assigned to two groups of 26 patients each. The experimental group underwent PTR and PMR for six weeks, while the comparison group received PTR alone. Primary (functional capacity) and secondary (dyspnoea, anxiety, depression, fatigue, sleep quality, and quality of life) outcomes were evaluated at baseline and after six weeks. RESULTS: The experimental group showed significantly higher sleep quality (P = 0.001, 95% confidence interval [CI]: 1.20-4.09) and significantly lower fatigue (P = 0.041, 95% CI: 4.79-5.25) and anxiety (P = 0.001, 95% CI: 1.21-4.47) than the comparison group. No between-group differences were observed in terms of other outcomes (P > 0.05). CONCLUSION: PTR coupled with PMR was more effective for promoting sleep quality and alleviating anxiety and fatigue than PTR alone.

Reliability of Ultrasound Findings in Patients with Lumbar Multifidus Myofascial Pain Syndrome.

Background: Lumbar multifidus muscle provides stability to the spine. The present study aimed to evaluate the reliability of ultrasound findings in patients with lumbar multifidus myofascial pain syndrome (MPS). Methods: A total of 24 cases (7 females, 17 males, mean age: 40.13± 5.69, BMI: 26.48±4.96) with multifidus MPS were assessed. The variables were muscle thickness in rest and contraction, thickness changes, and cross-sectional area (CSA) in rest and contraction. Two examiners performed the test and retest sessions. Results: The active trigger points of lumbar multifidus on the right and left side of the cases were 45.8 % and 54.2%, respectively. The intraclass correlation coefficient (ICC) values for muscle thickness and thickness changes showed moderate to very high reliability for both within and between intra-examiner measurements. (ICC, 1st examiner: 0.78-0.96; ICC, 2nd examiner: 0.86-0.95). In addition, the ICC values of within and between-session intra-examiner for CSA were high. (ICC, 1st examiner: 0.83-0.88; ICC, 2nd examiner: 0.84-0.89). The ICC and standard error of measurement (SEM) of inter-examiner reliability ranged between 0.75 to 0.93 and 0.19 to 0.88 for multifidus muscle thickness and thickness changes. The ICC and SEM of inter-examiner reliability ranged between 0.78 to 0.88 and 0.33 to 0.90 for CSA of the multifidus muscle. Conclusion: The within and between-session reliability of multifidus thickness, thickness changes, and CSA was moderate to very high in patients with lumbar MPS when taken by two examiners. Furthermore, the inter-examiner reliability of these sonographic findings was high.