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.

Reliability of inter-recti distance measurement on ultrasound images captured by novice examiners.

BACKGROUND: With the increased interest in inter-recti distance measurement using ultrasound imaging in physiotherapy, there is a question of measurement reliability, and the importance of the examiner's experience. PURPOSE: The study aimed to investigate the reliability of inter-recti distance measurement in a DICOM viewer software by an experienced radiologist. For the measurement, the radiologist used linea alba images captured by two physiotherapists who were novice examiners. METHODS: Ultrasound images were acquired by two novice examiners on repeated occasions 7 days apart (sessions A and B) in 28 nulliparous women at supraumbilical, umbilical, and infraumbilical locations along linea alba. RESULTS: Excellent intra-examiner reliability of inter-recti distance measurements was shown at the supraumbilical and umbilical levels (ICC2,k = 0.941-0.983) with minimal detectable change (MDC95) ranging from 1.31 mm to 2.29 mm. Infraumbilical measurements had good to excellent reliability (ICC2,k = 0.894-0.972) with MDC95 ranging from 0.33 mm to 0.72 mm. Session A inter-examiner reliability was excellent for the mean measurements of two, three, four, and five images taken at each location (ICC2,k = 0.913-0.954) with MDC95 ranging from 0.47 mm to 2.96 mm. Session B inter-examiner reliability was excellent for the mean measurements of two, three, four, and five images taken at the supraumbilical and umbilical (ICC2,k = 0.94-0.98), MDC95 ranging from 1.38 mm to 2.58 mm and good (ICC2,k ≥ 0.81) with MDC95 ranging from 0.72 mm to 0.80 mm at the infraumbilical locations. CONCLUSION: Novice examiners were able to capture good-quality ultrasound images of the linea alba that allowed for good to excellent intra- and inter-examiner reliability.

Technical aspects of inter-recti distance measurement with ultrasonographic imaging for physiotherapy purposes: the scoping review.

BACKGROUND: Inter-recti distance (IRD) measurement using musculoskeletal USI has been used in physiotherapy research, in particular, to investigate pregnancy-related diastasis recti abdominis (DRA) and to seek its effective treatment methods. Severe and untreated diastasis may result in the formation of umbilical or epigastric hernias. OBJECTIVE: This study aimed to systematically map physiotherapy-related research articles that included descriptions of IRD measurement procedures using USI to present their similarities and differences, and formulate recommendations on the procedure. DESIGN: A scoping review was conducted according to PRISMA-ScR guidelines, including 49 of 511 publications from three major databases. Publications were selected and screened by two independent reviewers whose decisions were consulted with a third reviewer. The main synthesized data items were: the examinees' body position, breathing phase, measurement sites, and DRA screening methods. The final conclusions and recommendations were the result of a consensus between seven reviewers from four research centers. RESULTS: Studies used 1-5 measurement sites that were differently determined. IRD was measured at the umbilicus (n = 3), at its superior (n = 16) and/or inferior border (n = 9), and at different levels: between 2 and 12 cm above the umbilicus, or a third of the distance and halfway between the umbilicus and xiphoid (n = 37); between 2 and 4.5 cm below the umbilicus or halfway between the umbilicus and pubis (n = 27). Different approaches were used to screen subjects for DRA. CONCLUSIONS: The discrepancies between the measurement procedures prevent between-study comparisons. The DRA screening method should be standardized. IRD measurement protocol standardization has been proposed. CRITICAL RELEVANCE STATEMENT: This scoping review indicates that the inter-recti distance measurement procedures using ultrasound imaging differ between studies, preventing between-study comparisons. Based on the results synthesis, the measurement protocol standardization has been proposed. KEY POINTS: The inter-recti distance measurement procedures using USI differ between studies. Proposed standardization concerns body position, breathing phase, measurements number per location. Determination of measurement locations considering individual linea alba length is suggested. Recommended locations: umbilical top, ½ of umbilical top-xiphoid, » of umbilical top-xiphoid/pubis distances. Diastasis recti abdominis diagnostic criteria are needed for proposed measurement locations.

Comparison of First Childbirth Characteristics between Elite Judo Athletes and Non-Athletes: The Preliminary Retrospective Case-Control Study.

It has been speculated that elite athletes are more likely to have obstetric interventions during labor and delivery. So far, the impact of many years of competitive sports participation on childbirth characteristics has not been well-established. This preliminary retrospective case-control study aimed to determine whether the first labors of elite judo competitors required obstetric interventions more frequently and were longer than those of non-athletes. The study comprised 32 parous women: 16 elite judo athletes and 16 non-athletes. Women were included if they had access to the following obstetric data (from their first childbirth hospital discharge reports and/or first child's health record books): induction and augmentation of labor, mode of delivery, the duration of labor and its second stage, episiotomy, perineal tear, and the neonate's Apgar score. Electronic surveys were completed concerning childbirth characteristics, level of "eliteness" (judo athletes), and recreational physical activity (non-athletes). The statistical analysis showed no significant between-group differences in any of the first childbirth outcomes under analysis. The preliminary results indicate elite judo practice before first pregnancy had no negative impact on the rates of labor induction and augmentation, delivery mode, duration of labor, the rates of episiotomy and perineal tear, and the neonate's Apgar score. Due to the small sample size, the conclusions should be considered with caution.

The effect of body mass reduction on functional stability in young obese women.

Functional stability is necessary for everyday activities. The studies have indicated the deterioration of functional stability during standing in the obese adults. This study aimed to determine whether the 3-month weight-loss program that resulted in body mass reduction equal to or greater than 5% of the initial body mass would improve functional stability in young obese women. For the purpose of this study, the data of 30 females were included. Their mean age was 35.8 ± 9.2. The women performed the anterior limit of stability test on the force platform twice: before and after weight-loss program. Their BMI at two sessions was 36.1 ± 5.1 and 32.3 ± 5, respectively. After the weight loss program, the COP velocities were increased in both phases of the anterior limit of stability test: the dynamic transition from standing to maximal forward-leaning and the maintenance of maximal forward-leaning position (p < 0.05). No significant changes in the values of the COP parameters were found in the eyes-closed trial (p > 0.05). The results suggest that body mass reduction in young obese women led to improved mobility and postural control when visual cuing was available. The longer-lasting weight-loss program might be necessary to observe this effect under visual deprivation conditions. Body mass should be reduced in obese patients to improve their mobility and functional stability; it may prevent unexpected falls.

Characteristics of Functional Stability in Young Adolescent Female Artistic Gymnasts.

The aim of this study was to determine whether young adolescent female artistic gymnasts demonstrate better functional stability than age- and sex-matched non-athletes. Different characteristics of the gymnasts' postural control were expected to be observed. Twenty-two 10- to 13-year-old healthy females (ten national-level artistic gymnasts and twelve non-athletes) participated in the study. To assess their forward functional stability, the 30-s limit of stability test was performed on a force plate. The test consisted of three phases: quiet standing, transition to maximal forward leaning, and standing in the maximal forward leaning position. Between-group comparisons of the directional subcomponents of the root mean squares and mean velocities of the center of pressure and rambling-trembling displacements in two phases (quiet standing and standing in maximal leaning) were conducted. Moreover, anterior stability limits were compared. During standing in maximal forward leaning, there were no differences in the center of pressure and rambling measures between gymnasts and non-athletes (p > 0.05). The values of trembling measures in both anterior-posterior and medial-lateral directions were significantly lower in gymnasts (p < 0.05). Both groups presented similar values for anterior stability limits (p > 0.05). The comparisons of rambling components may suggest a similar supraspinal control of standing in the maximal leaning position between gymnasts and healthy non-athletes. However, decreased trembling in gymnasts may indicate reduced noise in their postural control system possibly due to superior control processes at the spinal level. The anterior stability limit was not influenced by gymnastics training in female adolescents.

Reliability of pelvic floor muscle surface electromyography (sEMG) recordings during synchronous whole body vibration.

The primary aim of the study was to assess intraday and interday reliability of surface electromyography (sEMG) reflex activity of the pelvic floor muscles during synchronous whole-body vibration (S-WBV) of two intensities (30Hz/2mm; 40Hz/4mm) using band-stop filter and high-pass filter signal processing. The secondary aim of the study was to assess intraday and interday (test-retest) reliability of sEMG obtained from maximal voluntary contraction (MVC) test. We evaluated the intraday reliability of sEMG recordings obtained during sessions 1 and 2 performed on the same day. The sessions consisting of maximal voluntary pelvic floor muscle contraction and synchronous vibration sets with 1-hour rest in-between sessions 1 and 2 in healthy nulliparous women. The next intraday reliability was evaluated between the results of sessions 3 and 4 performed on the same day but followed at an interval of 4 weeks. to include the entire menstrual cycle. The interday reliability was determined based on the results of sessions 1 and 3 using the intraclass correlation coefficient (ICC 3,3). The intraday ICCs for band-stop filtered mean and median sEMG frequency and mean normalized sEMGRMS amplitude of the 30Hz/2mm (ICC = 0.89-0.99) and 40Hz/4mm vibration (ICC = 0.95-0.99) indicated substantial reproducibility. The intraday reliability of high-pass filter at 100-450Hz for these parameters was also substantial (30Hz/2mm ICC of 0.92 to 0.98; 40Hz/4mm ICC of 0.88 to 0.98). The interday reliability (session 1 vs. session 3) of the mean normalized sEMGRMS amplitude for band-stop filtered means of 40 Hz/4mm and 30Hz/2mm vibration recordings was substantial (ICC = 0.82 and 0.93). However, ICCs of the mean and median frequency were indicative of fair reliability (ICC of 0.43 to 0.59). The interday reliability of mean normalized sEMGRMS amplitude for high-pass filter at 100-450Hz was substantial (30Hz/2mm ICC of 0.90; 40Hz/4mm ICC of 0.73) for the 30Hz/2mm S-WBV and moderate (ICC = 0.73) for the 40/4mm S-WBV. The ICCs for mean and median sEMG frequency ICCs indicated slight to fair reproducibility (ICC of 0.16 to 0.56). The intraday reliability of the strongest MVC contraction and average MVC turned out substantial (ICC = 0.91-0.98). The interday reliability coefficients of the strongest MVC contraction and average MVCs were 0.91 and 0.82, respectively. Concluded, the intraday reliability proved satisfactory for all variables; however, the interday comparison showed sufficient ICC levels only for the mean amplitude. We therefore recommend this parameter should be used when analyzing PFM sEMG recorded during vibration. ICCs of the mean and median frequency for both signal processing methods were indicative of insufficient reliability and did not reach the threshold for usefulness. Our study showed similar reliability of PFM sEMG during S-WBV in case of the two filtering methods used.

Postural sway in young female artistic and acrobatic gymnasts according to training experience and anthropometric characteristics.

BACKGROUND: Gymnastics training enhances the development of postural control in children and adolescents. In competitive gymnastics, the training regimen is specific to the given gymnastic discipline and is usually followed from the early years of practicing. This study aimed to determine whether postural steadiness differed between young gymnasts practicing two distinct disciplines, and whether it was related to the duration of their training experience, age, and their anthropometric characteristics. METHODS: Thirty 10-13-year-old females ̶ ten artistic gymnasts, ten acrobatic gymnasts (training as "tops"), and ten non-athletes ̶ were examined during 60-s quiet standing trials on a force platform with the eyes open and closed. Their postural sway was represented by directional components of centre of foot pressure mean velocity. Mann-Whitney U, Wilcoxon and Spearman's ρ tests were used for analyses. RESULTS: Anterior-posterior and medial-lateral centre of foot pressure mean velocities were not different between the artistic and acrobatic gymnasts (p > 0.05). In the artistic gymnasts, the duration of training experience, age, body height, body mass, and maturity offset were negatively correlated with the anterior-posterior centre of foot pressure mean velocity under eyes-open conditions. The acrobatic gymnasts' body mass and BMI percentiles were negatively correlated with their anterior-posterior and medial-lateral centre of foot pressure mean velocities under both visual conditions (r ranged from - 0.64 to - 0.93; p < 0.05). The non-athletes' centre of foot pressure mean velocities were non-significantly correlated with their age and anthropometric measures under both visual conditions (p > 0.05). CONCLUSIONS: The artistic gymnasts' longer training experience, greater age, body height, body mass, and biological maturity were associated with better anterior-posterior postural steadiness when vision was available; the acrobatic gymnasts' greater body mass and BMI percentiles were associated with better overall postural steadiness regardless of visual conditions. Relationships were observed between postural steadiness and discipline-specific training experience and anthropometric characteristics; however, causes and effects were not proven.

A prospective longitudinal comparison of the sacral inclination angle in women between their early and advanced pregnancy and 6-month postpartum follow-up.

PURPOSE: The impact of pregnancy on the anterior-posterior sacral orientation and its relation to lumbopelvic pain and weight gain has not been fully recognized. This longitudinal study aimed to compare the sacral inclination angle in women between their early and advanced pregnancy and at 6 months postpartum. The authors also searched for a correlation between the sacral inclination and lumbopelvic pain, BMI and change in body mass. METHODS: Thirteen healthy women participated in the study. Data were collected at 8-16 and 35-38 weeks of gestation, and at 27-31.5 postpartum weeks. At each session, the women's sacral inclination angles were measured using the Saunders digital inclinometer. Data were also collected on lumbopelvic pain, BMI and body mass gain/loss. RESULTS: There was no effect of the evaluation period on the sacral inclination (p > 0.05); however, various individual values of the sacral inclination in pregnancy and postpartum were noted. In advanced pregnancy, 61.5% of the women had recurrent pain in the lumbopelvic region. The sacral inclination did not correlate with the lumbopelvic pain, BMI and body mass change (p > 0.05) in the pregnancy and postpartum periods. CONCLUSIONS: Advanced pregnancy did not influence sacral inclination. However, individuals varied in their responses. Therefore, we suggest that an individually-based physical therapy approach concerning proper posture during and after pregnancy should be emphasized. The sacral inclination had no impact on the occurrence of recurrent lumbopelvic pain. BMI and changes in body mass did not influence the sacral inclination in advanced pregnancy and at 6 months postpartum.

Quiet standing postural sway of 10- to 13-year-old, national-level, female acrobatic gymnasts.

PURPOSE: The aim of the study was to determine whether 10- to 13-year-old, national-level, female acrobatic gymnasts present a different quiet standing postural control (with and without visual cues) than untrained female peers. METHODS: The mean velocity of the center of pressure (in anterior-posterior and medial-lateral directions) was computed from 60-s long quiet-standing trials on a stationary force plate in fifteen 10- to 13-year-old female acrobatic gymnasts and thirteen sex- and age-matched non-athletes. A two-way repeated measures ANOVA (acrobatic gymnasts vs. non-athletes and eyes open vs. eyes closed) was used for the anterior-posterior and mediallateral COP mean velocity. The relation between subjects' body mass and COP mean velocity was tested with the used Spearman's Rank Correlation Coefficient. RESULTS: Postural sway (represented by COP mean velocity) was not significantly different between the acrobatic gymnasts and the non-athletes ( p > 0.05), except for the faster medial-lateral sway in eyes-open conditions in the acrobatic gymnasts ( p < 0.05). The gymnasts' body mass negatively correlated with their anterior-posterior sway velocity in both visual conditions (eyes open: r = -0.7; eyes closed: r = -0.6) and with medial-lateral sway velocity during eyes-closed trials (r = -0.5; p < 0.05). CONCLUSIONS: Results of the study indicate that in quiet standing postural control 10- to 13-year-old acrobatic gymnasts did not make use of their trained abilities. Heavier gymnasts might have been more stable than lighter ones during quiet standing.

Trunk forward flexion mobility in reference to postural sway in women after delivery: A prospective longitudinal comparison between early pregnancy and 2- and 6-month postpartum follow-ups.

BACKGROUND: It has been documented that pregnancy-related increased connective tissue laxity may persist postpartum; however, it is still unclear for how long. This longitudinal study aimed to compare total trunk forward flexion mobility in women between their first trimester of pregnancy and at 2- and 6-month postpartum follow-ups. We also searched for a correlation between women's trunk flexibility and their postural stability in the sagittal plane. METHODS: Seventeen healthy women participated in the study. Data were collected at their 7-12 weeks gestation appointments and at 6-10 and 25-28 weeks postpartum. At each session, the women performed a finger floor distance test, and data were collected on their waist circumference and BMI. The women's center of foot pressure mean velocity in the anterior-posterior direction was computed from 30-s long quiet-standing trials on a stationary force plate. FINDINGS: Total trunk forward flexion mobility was significantly higher at 2 and 6 months postpartum compared to that in early pregnancy (P < 0.05). At 6 months postpartum, a moderate negative correlation between finger floor distance test values and their anterior-posterior center of foot pressure mean velocity was observed (r = -0.6, P < 0.05). INTERPRETATION: Increased total trunk flexibility may be present in women 6 months postpartum. During that period, women with higher trunk flexibility may be more likely to present higher anterior-posterior postural sway velocity in quiet standing.

Adaptive changes in spatiotemporal gait characteristics in women during pregnancy.

Spatiotemporal gait cycle characteristics were assessed at early (P1), and late (P2) pregnancy, as well as at 2 months (PP1) and 6 months (PP2) postpartum. A substantial decrease in walking speed was observed throughout the pregnancy, with the slowest speed (1±0.2m/s) being during the third trimester. Walking at slower velocity resulted in complex adaptive adjustments to their spatiotemporal gait pattern, including a shorter step length and an increased duration of both their stance and double-support phases. Duration of the swing phase remained the least susceptible to changes. Habitual walking velocity (1.13±0.2m/s) and the optimal gait pattern were fully recovered 6 months after childbirth. Documented here adaptive changes in the preferred gait pattern seem to result mainly from the altered body anthropometry leading to temporary balance impairments. All the observed changes within stride cycle aimed to improve gait safety by focusing on its dynamic stability. The pregnant women preferred to walk at a slower velocity which allowed them to spend more time in double-support compared with their habitual pattern. Such changes provided pregnant women with a safer and more tentative ambulation that reduced the single-support period and, hence, the possibility of instability. As pregnancy progressed a significant increase in stance width and a decrease in step length was observed. Both factors allow also for gait stability improvement.

Static Postural Stability in Women during and after Pregnancy: A Prospective Longitudinal Study.

This longitudinal study aimed to compare static postural stability in women between early pregnancy, advanced pregnancy, and at 2 and 6 months postpartum. Forty-five pregnant women were enrolled and 31 completed the protocol. Data were collected at 7-16 and 34-39 weeks gestation, and at 6-10 and 26-30 weeks postpartum. For each subject, the center of foot pressure path length and mean velocity (with directional subcomponents) were computed from 30-s long quiet-standing trials on a stationary force plate with eyes open or closed. The body mass, stance width, and sleep duration within 24 h before testing were also recorded. Static postural stability was not different between pregnancy and postpartum, except for the anterior posterior sway tested in the eyes-closed condition, which was significantly increased in late pregnancy compared to that at 2 and 6 months postpartum. Pregnant/postpartum women's body mass weakly positively correlated with anterior-posterior sway in the eyes-closed condition and their stance width weakly positively correlated with the anterior-posterior sway in the eyes-open condition. No effect of sleep duration on postural sway was found. Our findings indicate that under visual deprivation conditions women in advanced pregnancy may have decreased static stability compared to their non-pregnant state.

Comparison of static postural stability in exercising and non-exercising women during the perinatal period.

BACKGROUND: The purpose of the study was to determine whether women who exercised during and after pregnancy had better static postural stability compared to those who did not exercise. MATERIAL AND METHODS: Posturographic tests were performed in 31 women at 34-39 weeks gestation, and again at 6-10 weeks postpartum. The center of pressure mean velocity (with directional subcomponents) and sway area were computed from 30-s quiet standing trials on a stationary force plate with eyes open or closed. The women were surveyed about their lifestyle and physical activity in the perinatal period. Based on the survey, 12 of the women were assigned as regular exercisers and 19 as non-exercisers. A Mann-Whitney U test was used to compare data of the exercisers and the non-exercisers in their advanced pregnancy and again at 2 months postpartum. RESULTS: Postural sway measures were not significantly different between the exercisers and the non-exercisers in advanced pregnancy and at 2 months postpartum (p>0.05). CONCLUSIONS: Individually performed physical activity during the perinatal period did not affect pregnant/postpartum women's postural stability characteristics of quiet standing.