Effect of open vs. closed kinetic chain exercises in ACL rehabilitation on knee joint pain, laxity, extensor muscles strength, and function: a systematic review with meta-analysis.

Anterior cruciate ligament (ACL) injuries are common among physically active individuals, often requiring ACL reconstruction (ACLR) for recovery. Rehabilitating these injuries involves determining the appropriate timing for initiating open kinetic chain (OKC) exercises. Although OKC exercises are effective post-ACLR, their use in rehabilitation remains a subject of debate. Therefore, this study aims to conduct a systematic review to determine whether OKC or closed kinetic chain (CKC) exercises result in differences in laxity, strength of the knee extensor muscle group, function, and functional performance in ACL rehabilitation. Five electronic databases were searched for randomized controlled between-group trials (RCTs). Two reviewers independently evaluated the risk of bias using the PEDro scale. We performed a meta-analysis using a random-effects model or calculated mean differences (fixed-effect) where appropriate. Certainty of evidence was judged using the GRADE approach. The systematic literature search yielded 480 articles, of which 9 met the inclusion criteria. The evidence for all outcomes ranged from very low to low certainty. Across all comparisons, inconsistent results were found in outcome measures related to knee function between OKC and CKC exercises post-ACLR. A significant increase in quadriceps isokinetic strength was found in post-ACLR and ACL-deficient knees in favor of OKC exercises at 3 (p = 0.03) and 4 (p = 0.008) months, respectively. A significant decrease in knee laxity was observed in ACL-deficient knees in favor of OKC at 10 weeks (p = 0.01), although inconsistency was noted at 4 months. Finally, a significant decrease in pain was found in favor of early OKC compared to late OKC (p < 0.003). Additionally, in ACL-deficient knees, low load resistance training (LLRT) OKC showed no significant laxity difference compared to controls (p > 0.05). In contrast, high load resistance training (HLRT) OKC had less laxity than controls at 6 weeks (p = 0.02) but not at 12 weeks (p > 0.05). OKC exercises appear to be superior to CKC for improving quadriceps strength 3-4 months post-injury, whether as a part of conservative or post-surgery rehabilitation. On the other hand, OKC exercises seem to be either superior or equally effective to CKC for improving knee laxity, thus presenting their importance in being included in a rehabilitation protocol from the initial phase. Systematic Review Registration: PROSPERO [CRD42023475230].

The Relationship between Heart Rate Variability, Pain Intensity, Pain Catastrophizing, Disability, Quality of Life and Range of Cervical Motion in Patients with Chronic Non-Specific Neck Pain: A Cross-Sectional Study.

The purpose of the present cross-sectional study was to examine the relationship between heart rate variability (HRV) and the range of cervical motion, disability, pain intensity, pain catastrophizing, and quality of life in patients with chronic, non-specific neck pain. Thirty-five patients, aged 20-48 years, with chronic non-specific neck pain, completed validated questionnaires regarding neck pain intensity, pain-associated disability, catastrophic thoughts, and quality of life. The range of cervical motion was assessed using a digital goniometer. HRV indices were recorded in three positions (supine, sitting, and standing) through a smartphone application. Several significant correlations were observed between HRV indices and neck pain disability, the helplessness factor of catastrophizing, neck rotation, and quality of life. These correlations were only observed in the standing position. Pain catastrophizing was positively correlated with disability and pain intensity during active neck movement (Pearson r = 0.544, p < 0.01; Pearson r = 0.605, p < 0.01, respectively). Quality of life was negatively correlated with pain intensity during active movement (Pearson r = -0.347, p < 0.05). HRV indices were correlated with the psychological and physical domains of neck pain. These cardiac indices have been related to neck pain variables in some previous studies. Further research is needed to confirm this relationship in different daily conditions.

Pole Dancing-Specific Muscle Strength: Development and Reliability of a Novel Assessment Protocol.

BACKGROUND: Pole dancing is a physically demanding sport that combines dance and acrobatic movements on a vertical pole. Despite its highly growing popularity, there is currently limited research in the field. The aim of this study was to create and evaluate a strength assessment protocol for athletes in pole dancing, with a specific focus on functional positions on the pole. METHODS: Thirty-two female pole dancing athletes participated in this study. Maximal voluntary isometric contractions (MVIC) were measured at three different sport-specific positions on the pole (shoulder abduction and adduction, and hip adduction), on two separate days (test and re-test) with a five to seven day interval between them. A hand-held dynamometer (Activ5- Activbody) stabilized on the pole was used for this study. RESULTS: The intra-session reliability was good to excellent for all sports-specific positions and for both sides of the body, across all different movements (ICC = 0.837-0.960, SEM = 5.02Kg-2.24Kg, and SDD = 27.46%-14.92%). Slightly better results were found regarding inter-session reliability (ICC = 0.927-0.970, SEM = 3.72Kg-1.97Kg, and SDD = 22.86%-15.19%). There was not a statistically significant difference between the MVICs between the left and right or dominant and non-dominant side in shoulder abduction (p = 0.105) and hip adduction (p = 0.282), in contrast to shoulder adduction (p = 0.00). CONCLUSION: The strength assessment protocol developed in the current study has proven to be a reliable and functional tool, with the potential for utilization in clinical practice as part of objective strength testing. Further studies are needed in order to expand the protocol to other muscle groups and positions and to generalize the results in all pole dancing populations such as male athletes.

Injuries and Persistent Pain in Elite Adolescent Archery Athletes: A Cross-Sectional Epidemiological Study.

This cross-sectional epidemiological study aimed to evaluate the prevalence of injuries among young archers engaged in high-intensity training during the European Youth Championship. A total of 200 participants (104 males/96 females) from 34 countries were included, with a mean age of 16.9 years and average competitive experience of 6.5 years. Structured questionnaires, administered by four physiotherapist interviewers, gathered comprehensive data. Results revealed that 43.5% of participants experienced shoulder pain during training, highlighting the vulnerability of upper limbs in archers. Additionally, 30% required medications to facilitate training, underscoring the impact of injuries on continued participation. Physiotherapy was utilized by 52.3% of participants, emphasizing the need for therapeutic intervention. Furthermore, 31.8% had to cease training due to injuries, indicating a substantial hindrance to athletic progression. The mean pain duration was 3.9 months, with an average intensity of 5.94, and 8% exhibited symptoms of central sensitization. In conclusion, this study demonstrates a noteworthy prevalence of injuries, particularly in the upper limbs, among young archers undergoing intensive training. The findings underscore the importance of targeted injury prevention strategies and comprehensive rehabilitation approaches to ensure the well-being and sustained participation of young athletes in competitive archery.

Translation, Adaptation and Validation of the Greek Version of the Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow Score in Greek Overhead Athletes.

Athletes engaging in overhead activities often face injury risks, emphasising the need for reliable assessment tools. This study focused on the translation and psychometric evaluation of the Kerlan-Jobe Orthopaedic Clinic (KJOC) Shoulder and Elbow Score into Greek (Gr-KJOC) for assessing upper limb function in Greek-speaking overhead athletes. The Gr-KJOC underwent meticulous translation and adaptation processes, ensuring linguistic equivalence and cultural relevance. A sample of 60 athletes participated in the psychometric evaluation, including assessments of internal consistency, test-retest reliability, construct validity, and structural validity. The Gr-KJOC demonstrated excellent internal consistency (Cronbach's alpha = 0.95), indicating consistent measurement of the underlying construct. Test-retest reliability was excellent (ICC = 0.95), with low measurement errors. Construct validity was confirmed through correlations with the Disabilities of the Arm, Shoulder and Hand (DASH) Questionnaire. Structural validity revealed a unidimensional structure with high explained variance (75%). No floor or ceiling effects were observed, and the questionnaire proved feasible, with an average completion time of 6 min. The Gr-KJOC emerges as a reliable, valid, and feasible tool for evaluating upper limb function in Greek-speaking overhead athletes. Its psychometric properties support its utility in clinical and research contexts, contributing to the effective assessment and management of shoulder and elbow conditions in the realm of overhead sports in Greece.

The Effectiveness of External Verbal Feedback on Balance in Athletes with Chronic Ankle Instability.

Chronic ankle instability (CAI) is characterized by muscle weakness and impaired neuromuscular control. This study aimed (a) to assess the impact of external verbal feedback on the dynamic balance of athletes with CAI and (b) to examine the maintenance of dynamic balance ability after the end of the completion of the intervention balance program. Thirty athletes (mean age 21.63 ± 1.53) were randomly divided into three groups: an experimental group with external verbal feedback, 1st control group without external verbal feedback and the 2nd control group without balance training and without feedback. Assessments using a balance board and the 'Y-balance' test were conducted before and after the balance training period. Additionally, participants completed the Cumberland Ankle Joint Instability Tool. A retention test of balance ability was administered after the 4-week intervention period. Statistical analysis revealed a significant overall improvement in balance (F(2,36) =5.96, p = 0.006, partial η2 =0.249), including those with no balance training, but no significant differences between the groups. Thus, the external verbal feedback did not show a positive impact on the balance ability between the three different groups. Also, the experimental group with the external verbal feedback demonstrated maintenance of dynamic balance learning ability. Although it appears that balance training has a positive effect on the dynamic balance of individuals with CAI, a non-positive impact of external verbal feedback was found. Also, it appears that external verbal feedback significantly led to sustained retention of balance learning ability. Further research is recommended to validate these findings.

Preliminary Insights into the Diagnostic Accuracy of the Modified Arm Care Screen Test for Overhead Athletes: An On-Field Tool for Injury Prevention.

BACKGROUND: The Arm Care Screen was developed to detect musculoskeletal limitations that could affect performance or even increase the risk for shoulder injuries in overhead athletes. This study aimed to assess the discriminant validity of the modified Arm Care Screen in overhead athletes. METHODS: Sixty-two overhead athletes (mean age: 24.5 ± 4.2 years) were recruited. The athletes underwent a comprehensive Arm Care Screen evaluation, including reciprocal shoulder mobility, total body rotation, lower body diagonal reach, and rotary stability assessments. Ten different musculoskeletal measurements were independently measured by two physical therapists. RESULTS: The modified Arm Care Screen showed moderate to strong associations (phi values ranged from 0.273 to 0.905) with the respective musculoskeletal range of motion and balance measurements. Sensitivity ranged from 81.25% to 88.57%, indicating a high true positive rate, and specificity ranged from 43.75% to 94.44%, indicating a moderate to strong positive rate. Positive and negative likelihood ratios ranged from 1.48 to 15.92 and 0.12 to 0.38, respectively. The positive and negative predictive value ranged from 58.14% to 92% and from 73.68% to 93.18%, respectively. The accuracy of the modified ACS ranged from 62.90% to 91.94%. CONCLUSION: The modified Arm Care Screen demonstrated promising diagnostic accuracy in identifying significant movement restrictions.

Cross-Cultural Adaptation, Reliability, and Validity of the Greek Version of the Fremantle Shoulder Awareness Questionnaire (FreSHAQ-GR) in Patients with Chronic Shoulder Pain.

Shoulder pain is one of the most common musculoskeletal pathologies. The association of shoulder pain with impaired proprioception and bodily self-awareness called for the cross-cultural adaptation of the Fremantle Shoulder Awareness Questionnaire (FreSHAQ) in Greek. The FreSHAQ is a relatively new self-assessment 9-item scale for impaired somatic awareness in patients with shoulder pain. The study included 100 participants (54 women) between 20 and 80 years old, with chronic shoulder pain (>3 months duration), able to comprehend and speak Greek, and recruited from three private physical therapy practices. The cross-cultural adaptation process was followed to develop the Greek version of the questionnaire (FreSHAQ-GR). Further testing for construct validity via exploratory factor analysis and correlational analysis with the Shoulder Pain and Disability Index (SPADI), the Quick Disabilities of Arm, Shoulder, and Hand (QuickDASH), the pain catastrophizing scale (PCS), a pain intensity visual analog scale (PI-VAS) in the last week, and the demographic characteristics followed. Test-retest reliability of the FreSHAQ-GR in a sub-sample of patients (n = 25) was tested upon repeated completion of the scale after a week and examined with the intraclass correlation coefficient (ICC2,1), the standard error of the measurement (SEM), and the minimum detectable change (MDC) indices. The internal consistency of the scale was also assessed. The factor analysis revealed that the scale comprised one factor relevant to shoulder awareness but with fewer items (first 6 items) than the original FreSHAQ. Additionally, the FreSHAQ-GR (both versions) demonstrated statistically significant correlations (Spearman's r) with participants' age (r = -0.31/-0.29, p < 0.002), the PI-VAS (r = 0.54/0.52, p < 0.001), the SPADI total score and both of its subscales (r = 0.39-0.45/0.34-0.39, p < 0.001), the QuickDASH (r = 0.37/0.34, p < 0.001), and the PCS (r = 0.50/0.40, p < 0.001). The questionnaire's internal consistency (Cronbach's α/McDonald's ω) was 0.833/0.827 for the 9-item and 0.871/0.867 for the 6-item FreSHAQ-GR. Test-retest reliability was excellent for both versions of the FreSHAQ-GR (ICC2,1(95% CI) = 0.97/0.98 (0.91-0.99/0.94-0.99), and with a low error margin (SEM = 1.31/0.94 and MDC95% = 3.63/2.61). Therefore, the FreSHAQ-GR (6-item version) possesses very good measurement properties and can be administered to Greek-speaking patients with chronic shoulder pain.

Greek Cross-Cultural Adaptation, Reliability, and Validity of the Quick Foot and Ankle Ability Measure Questionnaire.

CONTEXT: An easy-to-administer, function-based questionnaire to assess patients with various foot problems was required for a Greek-speaking population. This study aimed to translate and cross-culturally adapt the Quick Foot and Ankle Ability Measure (Quick-FAAM) into Greek and evaluate its reliability and validity. DESIGN: Cross-sectional study. METHODS: Established international guidelines for the cross-cultural adaptation of questionnaires were followed. The face and content validity of the Greek version of the Quick-FAAM (Quick-FAAM-GR), as well as the internal consistency and test-retest reliability upon repeated administration after 5 days, were examined. In addition, the construct validity of the scale was examined via exploratory factor analysis as well as by testing for associations with the Manchester Foot Pain and Disability Index, the 12-item Short-Form Survey (version 2), and a functional balance assessment test-the Y-Balance Test. RESULTS: Sixty participants (18 women) with self-reported chronic ankle instability symptoms, with a median (interquartile range) age of 27 (7.7) years, participated in the study. Half of the participants were included in the test-retest reliability study. The Quick-FAAM-GR demonstrated face and content validity. Excellent internal consistency (Cronbach α = .961) and intrarater test-retest reliability (intraclass correlation coefficient ICC[2,1] = .93) were demonstrated, with a comparable error margin to the original version (standard error of the measurement = 2.1, 95% minimum detectable change = 5.9). Associations of the Quick-FAAM-GR scores to other questionnaires ranged from weak to strong (Spearman rho), all being statistically significant (Manchester Foot Pain and Disability Index from -.26, P = .04, to -.67, P < .001, and 12-item Short-Form Survey, version 2, between .41 and .72, P < .001), and to the Y-Balance Test between lower-limb differences (-.35 to -.58, P < .001). The exploratory factor analysis confirmed the single-factor structure of this scale. No floor/ceiling effects were observed. CONCLUSIONS: The Greek Quick-FAAM has proven to be a valid and reliable tool for evaluating chronic ankle instability and can be used for clinical and research purposes in Greek-speaking individuals.

A Pilot Test of the Measures of the Greek Version of Upper Extremity Functional Index in Patients with Lateral Elbow Tendinopathy.

Lateral elbow tendinopathy (LET) is a common upper limb pathology in people involved in manual occupations. The upper extremity functional index (UEFI) was specifically designed to evaluate functional limitations in patients with upper limb pathology. The UEFI was developed in English and has been translated into several languages, including Greek. However, it has been assessed only in patients with shoulder pathology. Thus, the aim of this study was to pilot-test the Greek version of the UEFI (GV-UEFI) questionnaire and assess its measurement properties in patients with LET. Thirty patients with LET were recruited and asked to fill in the GV-UEFI twice and the disabilities of arm, shoulder, and hand questionnaire (DASH) once. The internal consistency and test-retest reliability were examined using Cronbach's alpha and the intraclass correlation coefficient (ICC). The standard error of measurement (SEM) and the minimum detectable change (MDC) were calculated and possible ground or ceiling effects were also examined. Convergent validity was evaluated with the Greek DASH using Pearson's correlation. Lastly, the unidimensionality of the scale was examined through principal component analysis to verify construct validity. Internal consistency was high for the GV-UEFI (Cronbach's a = 0.98) and test-retest reliability was excellent (ICC = 0.98). The SEM was 2.95 and the MDC was 6.85. Test-retest reliability of each item was good (ICC > 0.87). The correlation analysis demonstrated a strong correlation between the GV-UEFI and the DASH. No floor or ceiling effects were found. Principal component analysis verified the construct validity and the unidimensionality of the scale. The GV-UEFI was successfully tested in patients with LET. It seems that the GV-UEFI can be used reliably in Greek-speaking patients with LET. However, the measurement properties of this scale should be examined in a larger sample of LET patients.

Reliability and measurement error of tests used for the assessment of throwing performance in overhead athletes: A systematic review.

BACKGROUND: Throwing Performance (TP) is important in throwing sports. Several tests have been designed to assess TP, and the reliability of these tests was examined in various studies. The aim of this systematic review was to critically appraise and synthesize the studies that examined the reliability of TP tests. METHODS: A systematic search was conducted on PubMed, Scopus, CINAHL and SPORTDiscus to identify studies related to TP and reliability. The quality of the included studies was examined through the Quality Appraisal of Reliability Studies (QAREL) tool. Reliability was assessed using the intraclass correlation coefficient (ICC), while responsiveness was assessed using the minimal detectable change (MDC). Sensitivity analysis was conducted to identify whether low-quality studies may have biased the recommendations of this review. RESULTS: Seventeen studies were found eligible. The results showed a moderate level of evidence to suggest that TP tests have good reliability (ICC≥0.76). This recommendation was also applied separately when TP tests were used to measure throwing velocity, distance covered, endurance and throwing accuracy. Also, summated MDC scores were reported to assist coaches in decision-making when using TP tests to detect real performance changes. However, sensitivity analysis showed that there is a significant number of low-quality studies. CONCLUSIONS: This review revealed that the tests used for throwing performance assessment are reliable; however, due to a significant number of low-quality studies, these results should be used cautiously. Important recommendations of this review may be used in future studies to design high-quality studies.

The Changing Landscape in Upper Limb Sports Rehabilitation and Injury Prevention.

This editorial aims to feature authors who intend to submit their research to this Special Issue of Sports entitled "Clinical Advances in Upper Limb Sports Rehabilitation and Injury Prevention" in areas that need special consideration [...].

A Systematic Review of the Aerobic Exercise Program Variables for Patients with Non-Specific Neck Pain: Effectiveness and Clinical Applications.

Studies have shown that aerobic exercise (AE) may improve symptoms related to non-specific neck pain (NNP); however, the variables of the exercise programs and the overall effectiveness of AE have not been evaluated in a systematic review. Therefore, this review aimed to describe and discuss the variables of the AE programs used in clinical trials for patients with NNP. Included studies were analyzed for the selected AE variables such as intensity, frequency, duration, delivery, supervision, and adherence. The PEDro scale was used to assess the methodological quality of the studies. From the literature search, six studies met the inclusion criteria and were evaluated. After reviewing all the included studies, it was found that a range of AE interventions were used such as cycling, brisk walking, aerobics, stationary bike, treadmill running, circuit training, and swimming. Further, the duration was between 30 and 45 min for each session, with or without progressive increases from week to week. The intervention periods ranged from 1 month to 6 months in duration. Most studies used AE three times per week. Furthermore, exercise intensity was measured with either subjective (BORG) or objective measures (heartrate reserve). Justification for the specified intensity and reporting of adverse events was reported only in two studies and differed between studies. Exercise interventions were poorly reported. This review showed that moderate-intensity AE undertaken three times per week, in patients with NNP, may be beneficial for pain and function; however, the development of reporting standards is essential for the successful replication of studies.

The effectiveness of neuromobilization exercises in carpal tunnel syndrome: Systematic review and meta-analysis.

PURPOSE: To examine the effectiveness of Neuromobilization Exercises (NE) on pain, grip and pinch strength, two-point discrimination, motor and sensory distal latency, symptom severity, and functional status using the Boston Carpal Tunnel Questionnaire (BCTQ) in Carpal Tunnel Syndrome (CTS). METHODS: Major electronic databases were searched from inception up to September 2021 for randomized trials comparing the effects of NE with or without other interventions against no treatment, surgery, or other interventions in patients with CTS. Standardized Mean Differences (SMD) and 95% confidence interval (CI) were calculated using a random-effects inverse variance model according to the outcome of interest and comparison group. Methodological quality was assessed with PEDro and quality of evidence with the GRADE approach. RESULTS: Twenty-five articles were included and sixteen of them demonstrated high methodological quality. NE was superior to no treatment on pain (very low-quality evidence; SMD = -2.36, 95% CI -4.31 to -0.41). NE was superior to no treatment on the functional scale of the BCTQ (low-quality evidence; SMD = -1.27 95% CI -1.60 to -0.94). Most importantly, NE did not demonstrate evidence of clinical effectiveness. CONCLUSION: Low to very low-quality evidence suggests that there are no clinical benefits of NE in patients with mild to moderate CTS.

Effectiveness of Combined Program of Manual Therapy and Exercise Vs Exercise Only in Patients With Rotator Cuff-related Shoulder Pain: A Systematic Review and Meta-analysis.

CONTEXT: Therapeutic exercise is considered the mainstay in the management of rotator cuff-related shoulder pain (RCRSP). Manual therapy (MT) interventions have also shown to be effective in RCRSP. However, the benefits of adding MT along with exercise interventions for the management of RCRSP remain unknown. OBJECTIVE: To evaluate the additional benefits of MT with exercise compared with exercise in isolation for the management of RCRSP. DATA SOURCES: A search of PubMed, Scopus, PEDro, and EBSCO from the inception date of each database through April 20, 2022, was conducted for randomized trials comparing the additional effects of MT in exercise interventions compared with exercise alone for pain management and function in patients with RCRSP. Standardized mean differences (SMDs) and 95% CIs were calculated using a random-effects inverse variance model according to the outcome of interest and comparison group. Methodological quality was assessed with PEDro and quality of evidence with the grading of recommendations assessment, development and evaluation approach. STUDY DESIGN: Meta-analysis of randomized controlled trials. LEVEL OF EVIDENCE: Level 2. RESULTS: Twelve articles were found eligible and 8 of them demonstrated high methodological quality. Eleven articles were included for quantitative analysis. Pain with movement was not significantly different between MT and exercise versus exercise alone (SMD [95% CI] = -0.15 [-0.41 to 0.12]; I2 = 0%), whereas pain at rest was significantly improved in the groups that used exercise only with a moderate effect size (SMD [95% CI] = 0.47 [0.04 to 0.89]; I2 = 75%). Furthermore, shoulder function was not significantly different between MT and exercise versus exercise alone in the short term (SMD [95% CI] = 0.23 [-0.22 to 0.69]; I2 = 88%) or the long term (SMD [95% CI] = -0.02 [-0.21 to 0.16]; I2 = 2%). CONCLUSION: Adding MT to exercise interventions for the management of RCRSP is not more effective than exercise alone for pain and function in adult patients.

The Effectiveness of Neuromobilization in Patients With Cervical Radiculopathy: A Systematic Review With Meta-Analysis.

CONTEXT: Neuromobilization exercises (NE) could be a useful therapeutic tool to induce analgesia and increase function and range of motion (ROM) in patients with musculoskeletal pathologies with neuropathic components; however, the effectiveness of this intervention in patients with cervical radiculopathy (CR) is unknown. OBJECTIVE: To determine the effectiveness of NE in CR on pain, function, and ROM. DESIGN: Systematic review and meta-analysis. EVIDENCE ACQUISITION: An electronic search was performed in the MEDLINE, Scopus, PEDro, and EBSCO databases from inception until June 2022. The authors included randomized clinical trials that evaluated the effectiveness of NE against control groups or other interventions that aimed to treat patients with CR. EVIDENCE SYNTHESIS: Seven clinical trials met the eligibility criteria, and for the quantitative synthesis, 5 studies were included. For the studies that compared NE with a control group, the standardized mean difference for pain was -1.33/10 (95% confidence interval [CI], -1.80 to -0.86; P < .01; I2 = 0%), for function with the Neck Disability Index was -1.21/50 (95% CI, -1.67 to -0.75; P < .01; I2 = 0%), and for neck flexion and extensions was 0.66 (95% CI, 0.23 to 1.10; P < .01; I2 = 0%) and 0.47 (95% CI, 0.04 to 0.90; P < .01; I2 = 0%), respectively, with evidence of clinical effectiveness. These findings were based on moderate-quality evidence according to the Grading of Recommendation, Assessment, Development, and Evaluation rating. In studies that compared NE with other interventions, the meta-analysis failed to demonstrate the statistical or clinical superiority of NE. CONCLUSIONS: Moderate quality of evidence suggests that NE may be superior to no treatment for pain, function, and ROM in patients with CR. In contrast, NE are not superior to other interventions in the same outcomes, based on low- to very low-quality evidence. More high-quality research is needed to assess the consistency of these results.

The Effects of Motor Imagery on Pain in Lower Limb Sports Injuries: A Systematic Review and Meta-Analysis.

This review evaluated the efficacy of Motor Imagery intervention in athletes with lower limb sports injuries that could affect their pain levels during rehabilitation. We carried out a thorough research of the scientific literature for RCT studies in athletes with lower limb musculoskeletal sports injuries including search terms Motor Imagery AND pain, Motor Imagery AND sport injuries, Motor Imagery AND lower limb. We searched 3 major databases, PubMed, Scopus, and ScienceDirect, with the search period ranging from their inception until May 2022. We assessed the quality of the studies using the PEDro Scale and the data was recorded and extracted with the use of Mendeley software. The search criteria resulted in a pool of 10.107 possible articles. Upon completion of the selection procedure, only 3 RCT studies met the inclusion criteria with a total of 60 injured athletes (n = 18 with ankle sprain and n = 42 with ACL injuries). The meta-analysis showed no statistically significant positive effects of MI intervention on pain intensity after lower limb sports injuries (n = 60; MD = -1.57; 95% CI: -3.60 to 0.46; I2 = 50%; p = 0.13). The limited number of studies could justify the statistically insignificant effect of MI, but although the methodological quality of the studies was moderate to high, the heterogeneity of them was also relatively high. More RCT's are required to explore the effect of MI on pain in athletes with lower limb injuries in order to address psychophysiological processes during rehabilitation.

The Effectiveness of Spinal, Diaphragmatic, and Specific Stabilization Exercise Manual Therapy and Respiratory-Related Interventions in Patients with Chronic Nonspecific Neck Pain: Systematic Review and Meta-Analysis.

Patients with nonspecific chronic neck pain (NSCNP) exhibit respiratory dysfunction. This systematic review aimed to analyze randomized controlled trials (RCTs) investigating the effect of spinal and/or diaphragmatic and/or specific stabilization exercise manual therapy and/or respiratory exercises on musculoskeletal and respiratory diagnostic outcomes in patients with NSCNP. A systematic search and selection of RCTs was performed in three scientific databases (Pubmed, Scopus, and Physiotherapy Evidence Database (PEDro)) and one search engine (Google Scholar) from inception to April 2022. Relevant studies published in the English language were extracted, evaluated, and independently rated for methodological quality (PEDro scale). The quality of the evidence was assessed with the GRADE approach. Out of 1089 studies collected in total, 1073 were excluded (i.e., did not meet the inclusion criteria or were duplicates). Sixteen RCTs were finally included, rated on 5.62/10 (PEDro score) on average for methodological quality. Overall, there was sparse evidence that spinal and/or diaphragmatic manual therapy and/or trunk stabilization exercises and/or respiratory exercises significantly improved pain, disability, and respiratory outcomes in patients with NSCNP immediately post-treatment. However, the clinical heterogeneity between studies was significant, and the level of certainty of the evidence was low to very low. More, high-quality RCTs are required, contributing to the holistic diagnostic monitoring and management of patients with NSCNP.

The adjunctive benefits of mirror cross education on kinetic chain exercise approach in volleyball athletes with scapular dyskinesis.

BACKGROUND: Volleyball players as overhead athletes have the highest risk of developing scapular dyskinesis. The kinetic chain exercise-approach has gained a lot of attention because of its claims to provide an improved motor control and scapular kinematics. A form of cross exercise, known as mirror therapy, may enhance the effects of a kinetic-chain-approach on scapular posture, upper and lower limb performance. The aim of this study was to investigate the adjunctive benefits of mirror cross education in a kinetic chain approach, in volleyball athletes with SD. METHODS: Thirty-nine professional volleyball athletes were randomly assigned to three groups of 13 each, two experimental, the mirror cross education and kinetic chain approach, and one control. Both experimental groups performed a kinetic chain approach program, however, the mirror cross education group performed the exercise program with the addition of two mirrors that allowed athletes to observe their opposite non-dyskinetic scapula. Scapular posture asymmetries in cm, the Y-Balance and the Upper-Quarter Y-Balance after normalizing by limb length the reach distance in each direction, were assessed before and after performing each intervention for 6 weeks. RESULTS: 3×2 two-way Mixed ANOVAs detected significant interactions on scapular posture (P=0.001) on both experimental groups when compared with the control. The Y-Balance and the Upper Quarter Y-Balance scores at both mirror cross education and kinetic chain approach groups showed significant differences when compared with the control (P<0.05). Overall, variables showed significant superiority of the mirror cross education group. CONCLUSIONS: The Mirror-Cross-Education demonstrated significant effects in scapular posture and in the functional balance tests of volleyball athletes with scapular dyskinesis.