Instrument-assisted soft tissue mobilization versus myofascial release therapy in treatment of chronic neck pain: a randomized clinical trial.

OBJECTIVE: The purpose of this study was to investigate the effect of instrument-assisted soft tissue mobilization (IASTM) versus myofascial release therapy (MRT) on college students with chronic mechanical neck pain (CMNP). METHODS: Thirty-three college students with a mean age of 21.33 ± 0.98 involved in distance learning due to the Corona Virus 2019 (COVID-19) restriction were randomized to receive either IASTM on the upper trapezius and levator scapulae muscles or MRT. Researchers measured their pain with a visual analog scale (VAS), function with neck disability index (NDI), and pain pressure threshold (PPT) with a pressure algometer. The subjects received eight therapy sessions over four weeks and outcome measures were assessed pre and post-intervention. The study was registered as a clinical trial on clinicaltrials.gov (registration number: NCT05213871). RESULT: Unpaired t-test showed no statistical significance between the two groups post-intervention regarding improvement in pain, function, and PPT (p > 0.05). CONCLUSION: This study showed insignificant differences between groups. However, we did not use a control group, indicating that the improvement in outcomes may not have been caused by the intervention. STUDY DESIGN: Quasi-experimental two groups pre-posttest clinical trial. LEVEL OF EVIDENCE: Therapy, level 2b.

Core muscles' endurance in flexible flatfeet: A cross - sectional study.

OBJECTIVE: Flexible flatfoot is a common deformity in adults that has been thought to be a causative factor of a lot of lower limb injuries and back pain. Core muscles act as stabilizers for the trunk and weak core places a person at greater risk of low back pain and lower limb injuries. We aimed to compare the core muscles' endurance between individuals with and without flatfeet. METHODS: Thirty subjects with bilateral flexible flatfeet (study group) were compared with thirty healthy subjects (control group). Navicular drop test was used to evaluate the medial longitudinal arch. Modified back extensors, modified flexion and lateral muscles' endurance tests were used to evaluate the endurance of the core muscles. RESULTS: The lateral muscles' endurance time in the flatfeet group was found to be significantly lower than that of the healthy group on both sides (p=0.0001). However, no significant difference was found in the trunk flexors' (p=0.15) and trunk extensors' (p=0.27) endurance time between both groups. CONCLUSIONS: Impairment of the lateral core muscles' endurance was observed in subjects with bilateral flexible flatfeet which may predispose to low back pain and other lower limb injuries in those subjects.

Improved Pain and Function in Knee Osteoarthritis with Dexamethasone Phonophoresis: A Randomized Controlled Trial.

BACKGROUND: Intraarticular corticosteroid injection is an adjunct to core treatments for relief of moderate-to-severe pain in osteoarthritis (OA) patients. This randomized controlled trial was conducted to determine the effect of dexamethasone phonophoresis (DxPh) on knee OA. PATIENTS AND METHODS: Forty six female patients with knee OA were randomized into two equal groups. The study group received DxPh over the medial side of the knee, transcutaneous electrical nerve stimulation (TENS), and quadriceps strengthening exercises. Control group received ultrasound therapy and the same TENS and exercise program. Pain was assessed using the visual analog scale (VAS) and the pain subscale of Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pre- and posttreatment. Functional mobility was assessed by the Timed Up and Go (TUG) test, total WOMAC, and the joint stiffness and physical function subscales of WOMAC. The minimal clinically identifiable difference was used to calculate treatment effect sizes of both modalities, which was compared to intraarticular steroid injections. RESULTS: The VAS, TUG, and WOMAC scores improved with both modalities. Pain intensity improved by 50.6%-58.0% in the study group (VAS and pain subscale of WOMAC, respectively) compared to 17.8%-28.6% for the control group. Functional mobility showed a higher rate of improvement in the DxPh group compared to control (37.7 vs. 17.5% for TUG and 53.2 vs. 23.0 and 56.1 vs. 26.4% for the joint stiffness and physical function subscales of WOMAC, respectively). Posttreatment results revealed statistically and clinically significant improvement in pain intensity and functional mobility in the DxPh group. CONCLUSION: DxPh resulted in a greater improvement in pain and function in patients with knee OA than therapeutic ultrasound combined with exercise and TENS. The effect size of phonophoresis was clinically significant and higher than that reported for intraarticular steroid injection from pooled data in the literature.

The Relationship Between Forward Head Posture and Neck Pain: a Systematic Review and Meta-Analysis.

PURPOSE OF REVIEW: Forward head posture (FHP) is the most common cervical postural fault in the sagittal plane that is found with different severity levels in almost all populations. Despite claims that FHP may be related to neck pain, this relation seems to be controversial. Thus, our purpose is to determine whether FHP differs between asymptomatic subjects and those with neck pain and to investigate if there is a relationship between head posture and neck pain. RECENT FINDINGS: A total of 15 cross-sectional studies were eligible for inclusion for this systematic review and meta-analysis. Ten studies compared FHP between a group of asymptomatic participants and a group of participants with neck pain and an overall mean difference (MD) of 4.84 (95% CI = 0.14, 9.54), indicating a significant between-group difference, contrary to adolescent (MD = - 1.05; 95% CI = - 4.23, 2.12). Eight studies showed significant negative correlations between FHP and neck pain intensity (r = - 0.55; 95% CI = - 0.69, - 0.36) as well as disability (r = - 0.42; 95% CI = - 0.54, - 0.28) in adults and older adults, while in adolescents, only lifetime prevalence and doctor visits due to neck pain were significant predictors for FHP. This systematic review found that age played an important role as a confounding factor in the relation between FHP and neck pain. Also, the results showed that adults with neck pain show increased FHP when compared to asymptomatic adults and that FHP is significantly correlated with neck pain measures in adults and older adults. No association was found between FHP and most of neck pain measures in adolescents.