Acupuncture and dry needling for physical therapy of scar: a systematic review.

BACKGROUND: There is a continuing interest in finding effective methods for scar treatment. Dry needling is gaining popularity in physiotherapy and is defined by Western medicine as a type of acupuncture. The terms acupuncture and dry needling have been used interchangeably so we have focused on the efficacy of dry needling or acupuncture in scar treatment. OBJECTIVE: The aim of this systematic review was to determine the usefulness of dry needling or local acupuncture for scar treatment. In our search process, we used the terms 'acupuncture,' 'needling,' or 'dry needling' to identify all relevant scientific papers. We have focused on the practical aspects of local management of different scar types with dry needling or acupuncture. SEARCH STRATEGY: The search strategy included different combinations of the following keywords: 'scar', 'keloid', 'dry needling', 'needling', 'acupuncture', 'treatment', 'physical therapy'. This systematic review was conducted in accordance with PRISMA guidelines. MEDLINE (PubMed, EBSCOHost and Ovid), EMBASE (Elsevier), and Web of Science databases were searched for relevant publications from inception through October 2023. INCLUSION CRITERIA: The studies that investigated the effectiveness of dry needling or acupuncture for scar treatment were included. DATA EXTRACTION AND ANALYSIS: The main extraction data items were: the needling technique; needle: diameter, length; needling locations; manual needling manipulation; number of sessions; settings; outcomes and results. RESULTS: As a result of a comprehensive search, 11 manuscripts were included in the systematic review, of which eight were case reports, two were randomized trials and one study concerned case series. Two case reports scored 2-4 out of 8 points on the JBI checklist, five studies scored 5-7, and one study scored 8 points. The methodological quality of the two clinical trials was rated as good or fair on the PEDro scale. The case series study scored 7 of 10 points on the JBI checklist. A meta-analysis was not possible as only two randomized trials, eight case reports, and one case series were eligible for review; also, scar assessment scales and pain severity scales were highly heterogeneous. CONCLUSIONS: The studies differed regarding the delivery of dry needling or local acupuncture for scar treatment. Differences included treatment frequency, duration, number of treatments, selection of needle insertion sites, number of needles used, angle of needle placement, and use of manual needling manipulation. SYSTEMATIC REVIEW REGISTRATION: INPLASY no. 202310058.

Does the Self-Myofascial Release Affect the Activity of Selected Lower Limb Muscles of Soccer Players?

Myofascial therapy has already become one of the basic forms of treatment of the locomotor system. One form of the therapy is Self-Myofascial Release, in which external force is applied to the body with the help of special rollers (foam rolling, FR). The aim of the study was to investigate the direct effect of Self-Myofascial Release of hamstring muscles using a foam roller on the bioelectric activity of selected muscles (biceps femoris and gluteus maximus) during squats. The study involved 40 male soccer players, who were randomly divided into two groups: experimental and control. The tests used did not show significant differences in the analyzed variables before the experiment (baseline measurement p > 0.05), while significant intergroup differences appeared for subsequent measurements, both for reference MVC values (p < 0.01 - for % gluteus maximus MVC, p < 0.001 - for % biceps femoris MVC) and for raw EMG values (p < 0.01 gluteus maximus and p < 0.001 - for % 0.0001 for biceps femoris). The use of self-myofascial release within the hamstring muscles leads to changes in the electrical potential of the muscles of the lower limb.

Fascial Manipulation Method Is Effective in the Treatment of Myofascial Pain, but the Treatment Protocol Matters: A Randomised Control Trial-Preliminary Report.

Background: There are many therapeutic methods targeting fascia. However, the only method whose basic assumption is to eliminate the densification of fascia is Fascial Manipulation. Objective: To evaluate the effectiveness of various Fascial Manipulation (FM) protocols in reducing myofascial pain. Design: Randomized control trial. Subjects: A total of 54 individuals, aged 18-29 years, with musculoskeletal pain for at least 1 week. Methods: The patients were divided into four groups subjected to different treatment protocols: group 1-underwent the standard FM treatment protocol (STP), group 2-modified protocol (MTP), group 3-modified protocol 2 (MTP2), and the control group (CG)-did not undergo any therapy. Each protocol involved three treatments at intervals of 7-10 days and a follow-up examination after 30 days. The outcome was pain level measured using the VAS. Results: In the STP, all the measurements showed a significant decrease in pain level-the mean difference was 2.077 after the first treatment, 3.462 after the third treatment and 3.385 in the follow-up. In the MTP, a significant mean difference was noted after the third treatment, 3, and in the follow up, 2.4. In the MTP2, it was noted after the third session, 2, and in the follow up, 2.25. Only the CG group did not display significant changes. Conclusions: FM-based therapy results in pain relief. However, there are differences in the dynamics and durability of the results depending on the chosen protocol.

Analysis of Posture Parameters in Patients with Idiopathic Scoliosis with the Use of 3D Ultrasound Diagnostics-Preliminary Results.

(1) Background: Idiopathic scoliosis occurs in 2 to 4% of children between 10 and 16 years of age. Due to the harmfulness of radiological examination, non-invasive devices, including the 3D ultrasound technology and Scolioscan apparatus, are more and more frequently used for postural diagnostics. The aim of the study was to analyze the parameters of posture in patients with idiopathic scoliosis with the use of 3D ultrasound diagnostics. (2) Methods: The study included 20 girls, aged 10 to 16 years, with double-curve idiopathic scoliosis (the value of primary curve ranged from 25-50°), types I and II according to King-Moe classification. On the basis of X-ray scan, the Cobb angle of primary and secondary curves was assessed, the skeletal maturity was evaluated with the Risser test, and the type of scoliosis was determined. The girls participated in a 3-week rehabilitation program. The examinations were performed before and after therapy. A scoliometer was used for measurements. Each of the participants underwent individual therapy. The three-plane approach to asymmetric exercises was based largely on positions that included primary curve correction with hypercorrection of the secondary curve. (3) Results: After the therapy, values of trunk rotation angles and the angle of scoliotic curvature of secondary curve were significantly lower than before the therapy, except for the value of the primary curve angle. The parameters measured by X-ray were significantly and positively related to the results obtained with the scoliometer and the scolioscan. (4) Conclusions: The application of therapy that takes into account summing parameters may prevent the deterioration of the secondary curve when treating patients with idiopathic scoliosis. The observed correlations between the parameters of the radiological examination, the scoliometer, and the scolioscan prove the possibility of their interchangeable application in the assessment of effects of the therapy. Three-dimensional ultrasound diagnostics may become an alternative to radiological examination in assessing the treatment effects of patients with idiopathic scoliosis.

A Randomised-Controlled Clinical Study Examining the Effect of High-Intensity Laser Therapy (HILT) on the Management of Painful Calcaneal Spur with Plantar Fasciitis.

Calcaneal spur and plantar fasciitis are the most common causes of plantar heel pain. There are many effective physical modalities for treating this musculoskeletal disorder. So far, the are no clear recommendations confirming the clinical utility of high-intensity laser therapy (HILT) in the management of painful calcaneal spur with plantar fasciitis. This study aimed to evaluate the effectiveness of HILT in pain management in patients with calcaneal spur and plantar fasciitis. A group of 65 patients was assessed for eligibility based on the CONSORT guidelines. This study was prospectively registered in the Australian New Zealand Clinical Trial Registry platform (registration number ACTRN12618000744257, 3 May 2018). The main eligibility criteria were: cancer, pregnancy, electronic and metal implants, acute infections, impaired blood coagulation, cardiac arrhythmias, taking analgesic or anti-inflammatory medications, non-experience of heel pain, or presence of other painful foot conditions. Finally, 60 patients were randomly assigned into two groups: study group (n = 30, mean age 59.9 ± 10.1), treated with HILT (7 W, 149.9 J/cm2, 1064 nm, 4496 J, 12 min), and placebo-controlled group (n = 30, mean age 60.4 ± 11.9), treated with sham HILT therapy. Both groups received ultrasound treatments (0.8 W/cm2, 1 MHz frequency, 100% load factor, 5 min). Treatment procedures were performed once a day, five times per week for three weeks (total of 15 treatment sessions). Study outcomes focused on pain intensity and were assessed before (M1) and after (M2) the treatment as well as after 4 (M3) and 12 (M4) weeks using the Visual Analogue Scale (VAS) and the Laitinen Pain Scale (LPS). According to VAS, a statistically significant decrease in the study group was observed between M1 and M2 by 3.5 pts, M1 and M3 by 3.7 pts, and M1 and M4 by 3.2 pts (p < 0.001). On the other hand, the control group showed a statistically significant decrease (p < 0.001) between M1 and M2 by 3.0 pts, M1 and M3 by 3.4 pts, and M1 and M4 by 3.2 pts. According to LPS, a statistically significant decrease in the study group was observed between M1 and M2 by 3.9 pts, M1 and M3 by 4.2 pts, and M1 and M4 by 4.0 pts (p < 0.001). On the other hand, the control group showed a statistically significant decrease between M1 and M2 by 3.2 pts (p = 0.002), M1 and M3 by 4.0 pts (p < 0.001), and M1 and M4 by 3.9 pts (p < 0.001). However, there were no statistically significant differences between the groups in VAS and LPS (p > 0.05). In conclusion, the HILT does not appear to be more effective in pain management of patients with calcaneal spurs and plantar fasciitis than the conservative standard physiotherapeutic procedures.

The influence of rotational movement exercise on the abdominal muscle thickness and trunk mobility - Randomized control trial.

BACKGROUND: Trunk rotations are important functional movements which form the foundations of human motion pattern, especially in the functions of walking and running. They prevent the functional impairments and structural lesions resulting from axial overloading in static positions such as sitting. OBJECTIVES: The aim of the study was to assess the influence of rotational movement training exercises on the abdominal muscle thickness and spinal mobility range. STUDY DESIGN: Randomized controlled trial. METHODS: The study involved 73 individuals aged 18-45. The subjects were randomly divided into two groups. The study group (TG) comprised 40 people who performed rotational movement exercises over the period of 4 weeks (16 training sessions). In the control group (CG) the training was not applied. Changes in the thickness of selected abdominal muscles on ultrasound imaging were evaluated, as well as trunk mobility, based on the trunk lateral flexion test. RESULTS: The analysis of the obtained data has demonstrated a statistically significant increase in the thickness of the abdominal internal (IO) (p < 0.05) and external oblique muscles (EO) (p < 0.001) in the study group (TG) between measurements I and II, and measurements I and III. A similar increase in the thickness was found in the summation measurement of TrA + IO + EO. Bilateral increase in the trunk lateral flexion range in the frontal plane has also been noted. CONCLUSIONS: Rotational movement training of the trunk leads to an increase in the thickness of the abdominal oblique muscles. Rotational movement exercise training increases trunk mobility in the frontal plane.

Effectiveness of the FED Method in the Treatment of Idiopathic Scoliosis of Girls Aged 11-15 Years.

(1) Background: The unknown etiology of idiopathic scoliosis and its three-dimensional nature make the cause-and-effect therapeutic management difficult. A tendency to progression of scoliosis and the failure of many methods of conservative treatment have prompted the search for new methods that would stop and correct deformations. One of them is the FED method, used in the conservative treatment of idiopathic scolioses, in which all scoliotic curves are corrected. The aim of this study was a comparative analysis of the effectiveness of idiopathic scoliosis treatment with the FED and FITS methods. (2) Methods: The study included 60 randomly selected girls, aged 11 to 15 years, treated with the FED and FITS methods. They were diagnosed with idiopathic scoliosis grade II according to Cobb and double-curve scoliosis type I and II according to King-Moe classification. The results of the therapy were assessed with the use of the Bunnell scoliometer. The examinations were performed before the start of the therapy-on the first day of the child's stay-and 3 weeks after the therapy. The angle of trunk rotation and the sum of two rotations were assessed using a scoliometer. (3) Results: The performed statistical analysis demonstrated significant changes in the examined parameters in both therapeutic groups. (4) Conclusions: 1. The obtained results indicate that the FED therapy may prove to be an effective method of treating idiopathic scoliosis; however, it requires further research in a larger group of patients; 2. both methods significantly improved trunk rotation in primary and secondary scoliosis, but after using summing parameters (SDR parameter), the FED method appeared to be statistically more effective.

Assessment of the influence of global and local exercises on core stabilization mechanisms: randomized controlled trial.

BACKGROUND: Over the last few years, various concepts of applying core stabilization mechanisms in the formation of human motor function have come to existence. The objective of the research was to assess the influence of two types of core stability training on deep abdominal muscle thickness and on global trunk mobility. METHODS: The study involved 108 individuals divided into 3 groups: LT (local training), performing the stability training based on locally isolated work of the transversus abdominis muscle; GT (global training), performing the training based on global movement patterns; and CG (control group), who did not undergo the training. The workout programs comprised 4 weeks of the exercise, 4 times a week. The measurement of the observed muscle thickness was carried out by means of ultrasound imaging. Trunk mobility was evaluated based on the toe-touch test, as well as the measurement of lateral flexion ranges. All the measurements were performed before the workout programs, right after finishing and 2 weeks after the end of the training cycle. RESULTS: Both training concepts have an impact on deep abdominal muscle thickness; however, in the LT group, significant improvement was noted with regard to the transversus abdominis, whereas in the GT group the improvement concerned the external oblique muscle. Both training methods also improved trunk mobility in the sagittal and frontal plane. CONCLUSIONS: The results we have obtained imply that both concepts of core stability training affect the human body at a structural as well as functional level. The application of the described training methods may not only provide measurable benefits in the field of clinical physiotherapy, for instance in the treatment of spine-related back pain, but also in motor training designed to improve athletes' performance and to minimize the risk of injury.

Ground reaction force analysis for assessing the efficacy of focused and radial shockwaves in the treatment of symptomatic plantar heel spur.

BACKGROUND: Extracorporeal shock wave therapy is among the conservative treatments for symptomatic heel spur. OBJECTIVE: The purpose of this trial is to evaluate and compare the therapeutic effects of radial shock wave (RSWT) and focused shock wave (FSWT) applied in the treatment of symptomatic heel spur. METHODS: Fifty-five participants were randomly divided into two comparative groups that were administered FSWT and RSWT, respectively. The severity of dysfunction (Foot Function Index, FFI), ground reaction forces (GRF) and walking temporal parameters were measured in all patients at baseline and at weeks 1, 3, 6, 12 and 24 after treatment. RESULTS: In both groups, a gradual decrease in the FFI values occurred after treatment. The percentage reduction in the FFI was comparable for both groups. Statistically significant changes were only noted between some measurements of GRF and walking temporal parameters. The percentage changes in the values of the force and temporal parameters were similar between the groups. CONCLUSIONS: Both FSWT and RSWT are efficacious in the treatment of symptomatic heel spur and their therapeutic effects are comparable. Objective data registered by force platforms during walking are not useful for tracing the progress of treatment applied to patients with symptomatic heel spur between consecutive procedures.

The Effectiveness Of Radial Extracorporeal Shock Wave Therapy In Patients With Chronic Low Back Pain: A Prospective, Randomized, Single-Blinded Pilot Study.

PURPOSE: This prospective, randomized and single-blinded study assesses the influence of radial extracorporeal shock wave therapy (rESWT) in patients with low back pain (LBP). METHODS: A total of 52 patients with LBP were enrolled in the study, out of which a homogeneous group of 40 patients with mean age of 53.45±4.9 years was included. Patients were randomized into group A (n=20) treated with rESWT (2000 pulses; 2.5 bars; 5 Hz, 7 mins) performed twice a week for five weeks (10 sessions) and stabilization training, as well as group B (n=20) treated with sham rESWT and stabilization training. To analyze the therapeutic progress, the following tests were performed (before and after therapy; 1 and 3 months follow-up) to assess pain and functional efficiency: (1) Visual Analog Scale (VAS), (2) Laitinen Pain Scale (LPS), and (3) Oswestry Disability Index (ODI). RESULTS: The control group had a statistically significant advantage over the rESWT group (4.4 vs. 3.1 points on the VAS; p=0.039). However, in long-term observations, group A gradually experienced more pain relief than group B (2.7 vs. 3.5 points, p>0.05, at one month and 2.0 vs. 4.4 points at three months after treatment; p<0.0001). Similar findings can be seen in the analysis of changes in pain sensations measured with the LPS. The functional state (ODI) was better in rESWT group, especially in follow-up observation (9.3 vs. 14.6 points, p=0.033, at one month and 9.3 vs. 17.8 points, p=0.004, at three months after treatment). CONCLUSION: The rESWT combined with stabilization training is particularly effective in the long-term and achieves a stable beneficial effect for patients with LBP. The use of rESWT has a significant long-term influence on the reduction of pain and the improvement of the general functional state in relation to the conventional motor improvement program.

Passive stiffness of the hamstrings and the rectus femoris in persons after an ACL reconstruction.

OBJECTIVES: The aim of the article is to investigate the passive stiffness (PS) of rectus femoris and hamstring muscles working for the knee joint in persons after anterior cruciate ligament (ACL) reconstruction surgery. METHODS: Thirty subjects (8 women and 22 men) aged 19-46 (x = 28.2 ± 7) participated in the investigation; an experimental group comprised 15 persons (4 women and 11 men) who underwent ACL reconstruction surgery. The other persons had no knee injury and described themselves as healthy. All the subjects underwent an investigation of the PS of the hamstrings and the rectus femoris on the injured as well as on the healthy leg. RESULTS: The data shows vital difference in the PS of the hamstring muscles between the healthy and injured limb (p < 0.05), a significant difference in the PS of the rectus femoris (p < 0.001) was noted. Furthermore, the PS level of the hamstring muscles of the operated limb in the experimental group is significantly different to the both legs in control group (p < 0.001). CONCLUSIONS: Injury of the ACL results in a considerable increase in passive stiffness of the hamstring and rectus femoris muscles in both the injured leg and the healthy leg.

The impact of core muscles training on the range of anterior pelvic tilt in subjects with increased stiffness of the hamstrings.

The aim of this study is to verify the hypotheses that muscular coordination training of the core region in subjects showing increased hamstring stiffness results in an increase in anterior pelvic tilt and that there is a correlation between hamstring stiffness and anterior pelvic tilt. The two-group, non-blinded experimental controlled trial with three repeated measurements of the dependent variables. The experimental group received muscular coordination training during a period of two weeks, control group - no training. Thirty generally healthy subjects (9 women) were randomly assigned to the two equal groups. Passive knee extension test (hamstring stiffness); the range of anterior pelvic tilt (as measured in neutral standing position and during forward bending of the trunk). A significant decrease in the level of hamstring stiffness was recorded in the experimental group accompanied by an increase in anterior pelvic tilt. No significant changes were observed in the control group. There was a significant, negative, and moderate correlation between hamstring stiffness and anterior pelvic tilt with forward bending of the trunk).

Ultrasound Assessment of the Abdominal Muscles at Rest and During the ASLR Test Among Adolescents With Scoliosis.

STUDY DESIGN: Observational study. OBJECTIVE: Are there deviations in the thickness of abdominal muscles at rest in individuals with adolescent idiopathic scoliosis (AIS)? Are there deviations in abdominal muscular activity in people with AIS during the active straight leg raise (ASLR) test? SUMMARY OF BACKGROUND DATA: Ultrasound imaging can be used to assess the lateral abdominal muscle. Some authors suggest that scoliosis develops through a weakness or improper functioning of the abdominal muscles that cannot provide adequate support to the spinal segments. However, the literature lacks studies on the functioning of the abdominal muscles in individuals with spinal deviations. This study focuses on the evaluation of the thickness of the external oblique (EO), internal oblique (IO), and transversus abdominalis (TrA) muscles of individuals with AIS. MATERIALS AND METHODS: Seventy-one healthy adolescents and 71 patients with AIS, all aged 10-16 years, were studied. The thickness of the muscles at rest was measured at the end of normal exhalation in millimeters. Muscular activity during the ASLR test was measured in the final position, and the standards were normalized with the thickness produced at rest. Muscular activity during the ASLR test was represented as a percentage change in the muscle thickness. RESULTS: The AIS group demonstrated a smaller resting thickness of all tested muscles of both sides (P<0.01). All the muscles on the right side of the body showed higher activity in the AIS group during the ASLR test (P<0.01). CONCLUSIONS: Patients with AIS had thinner EO, IO, and TrA at rest in the supine position. During the ASLR test, the AIS patients displayed higher activity of the EO, IO, and TrA muscles on the right side.

Influence of passive stiffness of hamstrings on postural stability.

The aim of the study was to explore whether passive stiffness of the hamstrings influences the strategy of maintaining postural stability. A sample of 50 subjects was selected; the final analyses were based on data of 41 individuals (33 men, 8 women) aged 21 to 29 (mean = 23.3, SD = 1.1) years. A quasi- experimental ex post facto design with repeated measures was used. Categories of independent variables were obtained directly prior to the measurement of the dependent variables. In stage one of the study, passive knee extension was measured in the supine position to assess hamstring stiffness. In stage two, the magnitude of postural sway in antero-posterior direction was measured, while varying the body position on a stabilometric platform, both with and without visual control. The margin of safety was used as a measure of postural control. The magnitude of the margin of safety increased significantly between the open-eye and closed-eye trials. However, although we registered a visible tendency for a larger increase of the margin of safety associated with lower levels of passive hamstrings stiffness, no significant differences were found. Therefore, this study demonstrated that hamstring stiffness did not influence the strategy used to maintain postural stability.

Assessment of the cervical spine range of motion after the use of the saunders traction device in different positioning of the upper extremities.

BACKGROUND: Among the procedures used in the therapy of spinal pain syndromes one of the most frequently recommended is the cervical traction. The methods of performing the traction are varied. OBJECTIVES: It was decided to examine in the research whether the abduction and external rotation of the brachium, causing relaxation of the pectoral girdle muscles as well as the cervical spine, affects the quality and efficiency of traction in the patient's subjective assessment and the changes in the cervical spine range of motion. MATERIAL AND METHODS: Fifty subjects aged 20 to 42 were involved in the study, including 26 women and 24 men. The criterion of inclusion into the research project was the age between 20 and 40 years and the result of questionnaire containing the NDI scale for evaluation of the degree of dysfunction of the cervical spine, ranging in value between 5 and 14 points. The admitted group of 50 subjects was randomly divided into two experimental groups. The traction of the cervical spine was performed twice in both groups by means of the Saunders device. In the first group used the traditional positing, with the upper extremities placed along the torso, was adapted as first whereas in the second group the modified position was applied, in which the upper extremities were in the external rotation in abduction and with flexion in the cubital articulation, in other words the patients placed their hands next to head. In both cases the patient was in the supine position on a therapeutic table with a support roll under the knees. RESULTS: The evaluation of the cervical spine range of motion pointed, that in both position all the obtained differences proved statistical significance. The subjects taking part in the research claimed that the procedure performed by means of the traditional method was more pleasant. CONCLUSIONS: No significant difference was discovered in the effectiveness of the suggested positioning of the arms during performing the traction procedure of the cervical spine. The modified position caused greater sensation of discomfort than position with traditional arrangement of the arms.

Assessment of transverse abdominal muscle symmetry by ultrasonography.

BACKGROUND: One of the methods of assessing the transverse abdominal muscle is ultrasonography, which visualizes its thickness and location. We set out to answer the question if the transverse abdominal muscle can always be treated as located symmetrically among the trunk structures. MATERIAL AND METHODS: A group of 113 volunteers took part in the study. The volunteers did not experience any severe pain of musculoskeletal structures as determined by the VAS and ODI scales. The location of the transverse abdominal muscle (TRA) was determined with a Honda NS 2100 ultrasound system. Basing on original methodology, the distance between the place where the transverse abdominal muscle tendon becomes the muscle belly and the linea alba was measured. The next stage was the assessment of correlation of pain. RESULTS: The results in the study group show a statistically significant difference in the distance between the place where the transverse abdominal muscle tendon becomes the muscle belly and the linea alba between left and right. No correlation was found between the asymmetry and pain intensity. CONCLUSIONS: 1. Differences in the distance between the transverse abdominal muscle and the linea alba on left and right side of the body were discovered in the study group. 2. No correlations were found between the presence of an asymmetry and lumbar pain in the study group.

Development of low postural tone compensatory patterns in children - theoretical basis.

Neurological literature indicates the existence of children with low postural tone without association with central nervous system damage. This fact induces to think about mechanisms, which allow these children to maintain upright posture. There is a suspicion that compensatory mechanism included in this process, enables to achieve upright posture, but at expense of body posture quality. Observations of children's developmental stages caused determination of some postural tone area, which comprise both children with normotonia and with low postural tone without characteristics of central nervous system (CNS) damage. Set of specific qualities allows determination of two types of low postural tone: spastoidal and atetoidal type. Spastoidal type is characterized by deep trunk muscles (local) low postural tone compensated by excessive tension of superficial muscles (global). Atetoidal type includes children with low postural tone in both deep and superficial muscles. At inefficient active subsystem, verticalization proceeds at excessive use of passive subsystem qualities, that is meniscus, ligament, bone shape, and muscles passive features. From neurodevelopmental point of view compensatory mechanisms can be used in children with low postural tone in order to achieve upright posture, but at expense of body posture quality.

Development of low postural tone compensatory patterns - predicted dysfunction patterns in upper part of the body.

Lower postural tone is not always associated with central nervous system structures damage. There is a such kind of tone that stays within the broadly defined normal range, but is characterized by distinct decrease of tone of the deep muscles responsible for stabilization. External syndromes are features of active or passive compensation observed in the postural and motor patterns. Active compensation of the lower muscle tone is associated with excessive use of the superficial muscles for stabilization that leads to limitation of motion in the joints and to functional shortening of some muscles. Active compensation mechanisms in the upper part of the body cause translation of the head before the line of the shoulders, high alignment of the shoulder girdle and increase of the thoracic kyphosis (spastoidal type). Passive compensation is initiated in case of decreased tone of both deep and superficial muscles. Stabilization is kept with considerable participation of the spatial shape of bones, ligaments, meniscus and passive properties of the muscles. Tendency to hypermobility of the periarthritis elements is observed, which is manifested by the increase of the physiological range of motion in the joints. As a result in the upper part of the body postural faults develop, which are characterized by decreased thoracic kyphosis and sunken chest (atetoidal type). These observations indicate that lower tone of the muscles responsible for stabilization triggers off the sequence of compensatory mechanisms that ultimately lead to specific postural faults.

Development of low postural tone compensatory patterns - predicted dysfunction patterns in lower part of the body.

Lower postural tone is not always associated with central nervous system structural damage. There is such kind of tone that stays within the broadly defined normal range, but is characterized by distinct decrease of tone of the deep muscles responsible for stabilization. External syndromes are features of active or passive compensation observed in the postural and motor patterns. Active compensation of the lower muscle tone is associated with excessive use of the superficial muscles for stabilization that leads to limitation of motion in the joints and to functional shortening of some muscles. Active compensation mechanisms in the lower part of the body cause decreased anterior pelvic tilt, functional shortening of the hamstring muscles and pes cavus (spastoidal type). Passive compensation is initiated in case of decreased tone of both deep and superficial muscles. Stabilization is kept with considerable participation of the spatial shape of bones, ligaments, meniscus and passive properties of the muscles. Tendency to hypermobility of the periarthritis elements is observed, which is manifested by increase of the physiological range of motion in the joints. As a result in the lower part of the body postural faults develop, which are characterized by increased lumbar lordosis, anterior pelvic tilt, valgus knee and feet (atetoidal type). Observations indicate that lower tone of the muscles responsible for stabilization triggers off the sequence of compensatory mechanisms that ultimately lead to specific postural faults.

The effect of Saunders traction and transcutaneous electrical nerve stimulation on the cervical spine range of motion in patients reporting neck pain - pilot study.

INTRODUCTION: It is estimated that about 80% of the general population occasionally experience spinal pain, with as many as 50% reporting pain in the cervical spine. The aim of this study was to determine the effectiveness of treatment of cervical spine pain with the Saunders traction device and transcutaneous electrical nerve stimulation (TENS) by assessing their impact on the cervical spine range of motion in the sagittal, coronal and horizontal planes. MATERIAL AND METHODS: A total of 39 patients aged 26 to 62 years took part in the study. All patients reported chronic cervical spine pain caused by overload and postural insufficiency. The participants were randomly divided into three experimental groups. The first group was treated with Saunders traction where the traction force was administered so that the patient would experience noticeable but painless traction. The second group received traction as well as classic transcutaneous electrical nerve stimulation, whereas the third group received only TENS. Each patient attended 10 treatment sessions not more than three days apart. Measurements of the range of motion were performed with the CROM instrument before and after the first session, after the fifth and tenth session and about three weeks after completion of rehabilitation. RESULTS: The study revealed the greatest ROM improvement in the coronal and horizontal planes and for the extension motion. CONCLUSIONS: The best therapeutic effect was obtained by combining traction with transcutaneous electrical nerve stimulation.