Effectiveness of a specific strength program of the gluteus maximus muscle to improve dynamic postural control in female basketball players. A randomized controlled trial.

BACKGROUND: Basketball is a team sport in which players perform multidirectional movements, jumps and landings, experiencing abrupt accelerations and decelerations and numerous changes of rhythm. In this sport, speed and intensity are two key factors that are associated with an increased risk of injury. The aim of this randomized controlled trial was to determine the effectiveness of a specific gluteus maximus strength programme as preventive work for young female basketball players, to improve dynamic postural stability and to observe its impact in the rate of lower limb injuries, vertical jump, dynamic knee valgus and pain. RESEARCH QUESTION: Is effective a strength programme to improve dynamic postural stability, vertical jump and dynamic valgus in female basketball players? METHODS: A hundred and thirteen female basketball players that play in professional clubs were recruited, reaching the final stage 92 (46 per group). One group (CG) received conventional injury prevention training while the experimental group (EG) added to the conventional team prevention program, a gluteus maximus strength programme of 5 months composed of 4 exercises/2 days per week/2 sets of 10 repetitions per leg. RESULTS: The total injury incidence decreased from 0.33 to 0.16 cases (control group pre=0.43 to post=0.14 cases, EG pre=022 to post=0.19). The EG improved overall (p = 0.000), posterior (p = 0.001), posteromedial (p = 0.001) and posterolateral (p = 0.000) dynamic stability of the right leg; anterior (p = 0.024), medial (p = 0.07) and posteromedial (p = 0.01) of the left leg. Both groups improved vertical jump (GC: p = 0.045 and GE: p = 0.000). There was no significant improvement in pain or valgus. SIGNIFICANCE: This strength programme is effective in improving dynamic stability especially of the dominant leg and jump height.

Real-time ultrasound evaluation of CORE muscle activity in a simultaneous contraction in subjects with non-specific low back pain and without low-back pain. Protocol of an observational case-control study.

Non-specific low back pain represents 90-95% of all cases of low back pain and it has a prevalence of 18% in the adult population, assuming a great socioeconomic impact. The main objective of this observational case-control study study is to evaluate if there are differences in the simultaneous contraction of the core muscles between nonspecific low back pain and healthy subjects. This study will be carried out in the Physiotherapy department of the University of Alcalá. Eighty-two participants <18 years old, will be recruited, paired with NSLBP (n = 41) and healthy (n = 41). The main outcome will be the onset muscle contraction of lateral abdominal wall (internal oblique, external oblique and transversus abdominis), pelvic floor, lumbar multifidus and respiratory diafragm. The maneuvers that the subjects will perform will be abdominal drawing in maneouver, contralateral arm lift, valsalva, and voluntary pelvic floor contraction in sitting and standing. As a secondary objective, to analyze the amount of contraction of each muscle group and the capacity of the diaphragms to be excreted in both groups of subjects. Finally, to relate pain and disability.

Telerehabilitation for the treatment in chronic low back pain: A randomized controlled trial.

INTRODUCTION: Although there is growth in the approach to telerehabilitation (TLRH) in different pathologies, research on TLRH for the management of low back pain is scarce and controversial. Thus, the purpose of this study was to analyze whether a TLRH program is as effective as a clinical exercise program in improving pain and different functional variables in patients with nonspecific low back pain (NLBP). METHOD: A single-blind, two-armed randomized controlled trial was carried out with 68 individuals with chronic NLBP. Participants were randomly allocated to either the TLRH group (TG) (n = 34) or the clinic group (CG) (n = 34). The TG received an exercise-based TLRH video and an educational program on the neurophysiology of pain. The CG received the same pain education and exercise program at the clinic facility supervised by a clinician. Both groups performed 2 weekly sessions for 8 weeks. Active movements of the lumbar spine, pain and range of motion, and kinesiophobia were assessed at baseline, at the end of 8 weeks of treatment, and at 3 months. RESULTS: Statistically significant differences for time-by-group interaction were identified in range of motion of right (F = 11.668; p = 0.001) and left (F = 4.219; p = 0.042) legs when knee extended test is performed; as well as in pain intensity when the same test (F = 5.176; p = 0.043). Moreover, higher pain level during flexion (F = 5.133; p = 0.009) and extension movements (F = 6.335; p = 0.003) in patients with bilateral pain location than those with unilateral or central pain location has been appreciated. CONCLUSION: A TLRH rehabilitation program via mobile app is as effective as the same exercise program supervised in a clinic.

Effectiveness of Transcutaneous Neuromodulation on Abductor Muscles Electrical Activity in Subjects with Chronic Low Back Pain: A Randomized, Controlled, Crossover Clinical Trial.

Introduction: Non-specific chronic low back pain (NSCLBP) is a major cause of functional impairment, resulting in consequences like job absenteeism and reduced quality of life. Risk factors such as muscle weakness and tightness have been implicated. Electromagnetic fields have therapeutic effects on human tissue, including pain relief and muscle relaxation. This study aimed to examine the impact of a tape with magnetic particles (MPT) applied to the lumbar area on abductor muscle strength and surface electromyography (sEMG) of the Gluteus Medius and Tensor of the Fascia Lata muscles in individuals with NSCLBP. Methods: It was carried out a double-blind, randomized, controlled, crossover trial and with test retest, with 41 consecutive patients younger than 65 years who previously diagnosed with NSCLBP to assess the effect of a MPT over hip abductor muscle strength and activity. sEMG and force data were obtained during the Hip Stability Isometric Test (HipSIT). The HipSIT was used to assess the abduction strength using a hand-held dynamometer and sEMG. The HipSIT uses the maximum voluntary isometric contraction (MVIC). Four trials were recorded and the mean extracted for analysis. The tape was applied with either a MPT or a sham magnetic particle tape (SMPT) bilaterally without tension on from L1 to L5 paravertebral muscles. Results: The significant increase in the recruitment of fibers and the significant increase in the maximum voluntary contraction by applying MPT with respect to the SMPT, correspond to the increases in the Peak Force and the decrease in the time to reach the maximum force (peak time) of both muscles. Conclusion: Application of a MPT in patients with NSCLBP suggests an increase in muscle strength of the Gluteus Medius and Tensor Fascia Lata bilaterally during the HipSIT test. Lumbar metameric neuromodulation with MPT improves muscle activation of the hip musculature.

In non-specific low back pain, is an exercise program carried out through telerehabilitation as effective as one carried out in a physiotherapy center? A controlled randomized trial.

BACKGROUND: s:The effectiveness of telerehabilitation (TLRH) in patients with non-specific low back pain (NLBP) remains unknown. No study till date has investigated the efficacy of a mobile-based TLRH in patients with NLBP. OBJECTIVES: To investigate if a TLRH program is as effective as a clinical exercise programme in improving disability, pain intensity, pain catastrophizing, and hip pain and strength in patients with NLBP. DESIGN: Single-blind, two-armed, randomized controlled study. METHOD: A total of 71 individuals with NLBP were randomly allocated to either the TLRH home group (TLRH) or clinic group (CG). The TLRH followed exercise videos and read information on pain neurophysiology. The CG performed the same exercises and received on-site pain education. Both groups performed the exercises twice weekly for 8 weeks. Disability, pain intensity, pain catastrophizing, and hip pain and strength were assessed at baseline, at post-treatment, and at three months. RESULTS: Statistically significant differences for time-by-group interaction were detected in the strength of left hip flexors (supine [F = 8.356; p = .005]; sitting [F = 9.828; p = .003]), right hip extensors with extended knee [F = 7.461; p = .008], left hip extensors (extended knee [F = 13.175; p = .001]; flexed knee [F = 13.505; p < .001]), pain during flexion of the right [F = 5.133; p = .027] and left [F = 4.731; p = .033] hips in the supine position, disability [F = 4.557; p = .014], and pain catastrophizing [F = 14.132; p < .001]. CONCLUSION: A TLRH mobile-based is as effective as clinical treatment in improving disability, pain catastrophizing, and pain and strength of the hip structures in patients with NLBP.

Diaphragmatic Activation Correlated with Lumbar Multifidus Muscles and Thoracolumbar Fascia by B-Mode and M-Mode Ultrasonography in Subjects with and without Non-Specific Low Back Pain: A Pilot Study.

Background and Objectives: The diaphragm, the lumbar multifidus muscles, and the thoracolumbar fascia (TLF) execute an important role in the stability of the lumbar spine and their morphology has been modified in subjects with non-specific low back pain (NS-LBP). While it is true that three structures correlate anatomically, the possible functional correlation between them has not been investigated previously in healthy subjects nor in subjects with NS-LBP. The aim of the present study was to examine this functional nexus by means of a comparison based on ultrasonographic parameters of the diaphragm, the lumbar multifidus muscles, and the TLF in subjects with and without NS-LBP. Materials and Methods: A sample of 54 (23 NS-LBP and 31 healthy) subjects were included in the study. The thickness and diaphragmatic excursion at tidal volume (TV) and force volume (FV), the lumbar multifidus muscles thickness at contraction and at rest, and the TLF thickness were evaluated using rehabilitative ultrasound imaging (RUSI) by B-mode and M-mode ultrasonography. The diaphragm thickening capacity was also calculated by thickening fraction (TF) at tidal volume and force volume. Results: There were no significant differences recorded between the activation of the diaphragm and the activation of the lumbar multifidus muscles and TLF for each variable, within both groups. However, there were significant differences recorded between both groups in diaphragm thickness and diaphragm thickening capacity at tidal volume and force volume. Conclusions: Diaphragmatic activation had no functional correlation with the activation of lumbar multifidus muscles and TLF for both groups. Nevertheless, subjects with NS-LBP showed a reduced diaphragm thickness and a lower diaphragm thickening capacity at tidal volume and force volume, compared to healthy subjects.

Ultrasound imaging assessment of the diaphragm and abdominal muscles in people with a recent history of moderate Covid-19 infection and healthy participants: A cross-sectional pilot study.

Coronavirus disease (Covid-19) is a highly infectious disease caused by the SARS-CoV-2 virus and is associated with a decrease of respiratory, physical, and psychological function, subsequently affecting quality of life. The aim of the present pilot study was to use ultrasound imaging (USI) to evaluate and compare the thickness of the diaphragm and abdominal muscles between individuals recently diagnosed with moderate Covid-19 infection and healthy individuals. METHODS: A cross-sectional observational pilot study was performed. A total sample of 24 participants were recruited from a private medical center (Madrid, Spain): Covid-19 (n = 12) and healthy controls (n = 12). The external oblique (EO), internal oblique (IO), transversus abdominis (TrA), rectus abdominis (RA), interrecti distance (IRD) and diaphragm thickness were assessed using USI during inspiration, expiration and during contraction. RESULTS: USI measurements of the thickness of EO, IO, TrA, RA, IRD and the diaphragm did not differ significantly between groups during inspiration, expiration or during contraction (all P > 0.05). CONCLUSIONS: These preliminary results suggest that the morphology of the abdominal muscles and diaphragm is not altered in people with a recent history of moderate Covid-19 infection.

Validation of the Measuring Protocol for the Infraspinatus Muscle with M-Mode Ultrasound in Asymptomatic Subjects. Intra- and Inter-examiner Reliability Study.

M-mode ultrasound is a reliable and valid instrument for assessing muscle activity. However, it has not been studied in any of the muscles belonging to the shoulder joint complex, particularly in the infraspinatus muscle. The aim of this study is the validation of the infraspinatus muscle activity measurement protocol with the M-mode ultrasound in asymptomatic subjects. Sixty asymptomatic volunteers were evaluated by two physiotherapists who were blinded; each of them carried out three measurements with the M-mode ultrasound in infraspinatus muscle and analysed the muscle thickness at rest and contraction, velocity of muscle activation and relaxation and Maximum Voluntary Isometric Contraction (MVIC). Intra-observer reliability was significant in both observers, showing good thickness at rest (ICC = 0.833-0.889), thickness in contraction (ICC = 0.861-0.933) and MVIC (ICC = 0.875-0.813); moderate in the activation velocity (ICC = 0.499-0.547) and relaxation velocity (ICC = 0.457-0.606). The inter-observer reliability also had good thickness at rest (ICC = 0.797), thickness in contraction (ICC = 0.89) and MVIC (ICC = 0.84); poor in relaxation time variable (ICC = 0.474) and not significant at the activation velocity (ICC = 0). The muscle activity measurement protocol of the infraspinatus muscle measured with M-mode ultrasound has been found to be reliable in asymptomatic subjects, for both the intra-examiner and inter-examiner.

Inspiratory muscle strength and function in mechanically ventilated COVID-19 survivors 3 and 6†months after intensive care unit discharge.

Background: Knowledge regarding the long-term impact of invasive mechanical ventilation on the inspiratory muscles and functional outcomes in COVID-19 survivors is limited. Methods: In this single-centre prospective cohort study, we evaluated invasively ventilated patients with COVID-19 pneumonia 3 and 6 months post-intensive care unit (ICU) discharge. Outcomes included: maximal inspiratory pressure (MIP), ultrasound parameters for diaphragm function, 6-min walk distance (6MWD), dyspnoea and quality of life. We evaluated associations between MIP and duration of mechanical ventilation with follow-up outcomes. Results: 50 COVID-19 survivors discharged from ICU between 15 October 2020 and 1 April 2021 were enrolled. Overall, survivors showed a recovery trajectory over time. However, impaired MIP remained in 24 (48%) and 12 (24%) at 3 and 6 months, respectively. Diaphragm dysfunction was not observed. At 3 months, 23 (46%) had impaired functional capacity versus 10 (20%) at 6 months. Dyspnoea persisted in 44 (88%) patients at 3 months and 38 (76%) at 6 months. Quality of life was slightly decreased at 3 months with further improvements at 6 months. MIP was correlated to 6MWD, 6MWD % predicted, dyspnoea across follow-up, and quality of life at 3 months. The duration of invasive ventilation was correlated with 6MWD and 6MWD % predicted. Conclusion: In invasively ventilated COVID-19 survivors, inspiratory muscle strength impairments persisted 6 months after ICU discharge, while maintaining normal diaphragm function. Decreased functional capacity, dyspnoea and slightly reduced health status were observed. Early screening of survivors is of utmost importance to identify those with impairments and at risk of delayed or incomplete recovery.

Correlation between Anthropometric and Ultrasound Measurement for Dry Needling of the Iliocostalis Lumborum Muscle with a Safety Protocol: A Cross-Sectional Observational Study.

INTRODUCTION: the management of musculoskeletal pain through the application of dry needling (DN) is effective. The application of this technique can carry very infrequent major risks on muscles, such as on the iliocostalis lumborum due to its proximity to the kidney and the peritoneum. It is important to establish a DN protocol based on the different anthropometric variables of the subjects. MAIN OBJECTIVE: the main objective of this study was to investigate the correlation between different anthropometric variables and the skin-kidney and skin-peritoneum distances to establish the size of the needle that could perform DN in the iliocostalis lumborum muscle without risk. DESIGN: a cross-sectional observational study was conducted. METHODOLOGY: a total of 68 healthy subjects were evaluated. Demographic and anthropometric data, such as age, gender, weight, height, body mass index (BMI), chest (xiphoid process and axilla) and abdomen circumferences, and skinfold thickness were collected. The measurements of skin-upper and lower edge of the iliocostalis lumborum muscle and the skin-peritoneum and/or kidney in the regions of L2 and L4, and on both sides, were assessed using ultrasound imaging. RESULTS: a multiple linear regression analysis was performed, confirming that, in L2 without compression, gender significantly predicted the distance, with the distance being greater in women than in men. The measurement without compression increased with age up to 50 years, and it also increased with higher measurements for the chest-triceps, iliac crest, and thigh skinfold thickness, and decreased with higher measurement for the abdominal circumference. It was verified that the measurement with compression in L2 decreased as the neutral axillary circumference and the skinfold thickness in the abdomen-iliac crest increased, while the distance increased with larger measurements obtained in the neutral abdominal circumference and in the skinfold thickness of the chest-triceps. It was also verified that the measurement with compression in L4 increased up to a body mass index of 25 and then decreased even if the index increased further, and it decreased as the skinfold thickness in the abdomen-iliac crest decreased and increased as the measurements of the neutral abdominal circumference and the skinfold thickness in the chest-triceps increased. In L4 without compression, the gender variable significantly predicted changes in the measurement, with women tending to have a smaller distance compared to men. CONCLUSIONS: the measurements of the neutral abdominal circumference, chest-triceps, and abdomen-iliac crest skinfold thickness could help clinicians predict the skin-kidney and skin-peritoneum distances for dry needling of the iliocostalis lumborum with the methodology described.

Core Synergies Measured with Ultrasound in Subjects with Chronic Non-Specific Low Back Pain and Healthy Subjects: A Systematic Review.

Low back pain represents the leading cause of disability since 1990. In 90% of cases, it is classified as non-specific low back pain, being chronic in 10% of subjects. Ultrasound has proven to be an effective measurement tool to observe changes in the activity and morphology of the abdominal muscles. This article reviews which core synergies are studied with ultrasound in healthy subjects and with chronic non-specific low back pain. A systematic review was conducted on studies analyzing synergies between two or more core muscles. Publications from 2005 until July 2021 were identified by performing structured searched in Pubmed/MEDLINE, PEDro and WOS. Fifteen studies were eligible for the final systematic review. A total of 56% of the studies established synergies between the core muscles and 44% between the homo and contralateral sides of the core muscles. The most studied core synergies were transversus abdominis, internal oblique and external oblique followed by the rectus abdominis and the lumbar multifidus. No studies establishing synergies with diaphragm and pelvic floor were found. Eight studies were conducted in healthy subjects, five studies in subjects with chronic non-specific low back pain compared to healthy subjects and two studies in subjects with chronic non-specific low back pain.

Myofascial Trigger Points and Central Sensitization Signs, but No Anxiety, Are Shown in Women with Dysmenorrhea: A Case-Control Study.

Background primary dysmenorrhea (PD) is considered to be a cyclic chronic pelvic pain, with its onset in menstrual periods, often accompanied by the presence of myofascial trigger points (MTP). Most MTPs in subjects with chronic pelvic pain are in the inferior part of the abdomen, in the rectus abdominis (RA) area. Central sensitization is closely related to chronic pain processes. Previous studies in women with chronic pelvic pain reported central sensitization signs in their subjects, such as lower pain pressure threshold (PPT). Several authors agree that PPT in the tibialis anterior (TA) muscle, seems to be a reliable reference for signs of central sensitization. Amongst the factors that seem to accompany central sensitization, the presence of anxiety needs to be considered. The aim of the present study was to analyze the existence of hyperalgesic MTPs in RA, central sensitization signs and anxiety in women with PD, in comparison with a control group (CG). Methods: This study was designed following an observational, cross-sectional, case-control model. A total sample of 80 subjects was recruited trough social webs and advertising (PD n = 39) (CG n = 41). PPT in RA and AT was assessed bilaterally through algometry, and anxiety was evaluated through the State−Trait Anxiety Inventory. Results: Statistically significant differences (p < 0.001) were shown for NRS average and maximum increase, as well as lower bilaterally RA and TA PPT in favor of PD group compared to CG. State or trait STAI did not show any statistically significant differences (p > 0.05) between groups. Conclusions: In this study, women with PD reported symptoms of myofascial pain syndrome and central sensitization, when compared with healthy controls, without any sign of anxiety acting as a confounder for pain sensitivity.

Myofascial Pain Syndrome in Women with Primary Dysmenorrhea: A Case-Control Study.

There is limited information on myofascial trigger points (MTrPs) and specific symptoms of chronic pelvic pain and, more specifically, dysmenorrhea. The objective of this study was to determine whether patients suffering from primary dysmenorrhea present alterations in mechanosensitivity and pain patterns, and greater presence of MTrPs in the abdominal and pelvic floor muscles. A case-control study was carried out with a total sample of 84 participants distributed based on primary dysmenorrhea and contraceptive treatment. The sample was divided into four groups each comprising 21 women. Data on pain, quality of life, and productivity and work absenteeism were collected; three assessments were made in different phases of the menstrual cycle, to report data on pressure pain threshold, MTrP presence, and referred pain areas. One-way ANOVA tests showed statistically significant differences (p < 0.01) between the groups, for the Physical Health domain and the total score of the SF-12 questionnaire, and for all the domains of the McGill questionnaire; but no significant differences were found in the data from the WPAI-GH questionnaire. Statistically significant data (p < 0.01) were found for mechanosensitivity in the abdominal area and limbs, but not for the lumbar assessment, within the group, with very few significant intergroup differences. The frequency of active MTrPs is higher in the groups of women with primary dysmenorrhea and during the menstrual phase, with the prevalence of myofascial trigger points of the iliococcygeus muscle being especially high in all examination groups (>50%) and higher than 70% in women with primary dysmenorrhea, in the menstrual phase, and the internal obturator muscle (100%) in the menstrual phase. Referred pain areas of the pelvic floor muscles increase in women with primary dysmenorrhea.

Dry Needling of the Popliteus Muscle Validation by Ultrasound Imaging: A Cross-Sectional Observational Study.

Dry needling is a widely used technique for the treatment of painful syndromes in the musculature, however, its usefulness is of greater relevance in deep structures, such as the popliteus muscle, as it is more difficult to access. This muscle is heavily involved in knee pathology, being a source of pain and functional impairment, especially secondary to underlying pathologies. The method selected for the observation and study of the soft tissues, by means of imaging tests that do not use ionising radiation, is ultrasound. A cross-sectional observational study is proposed. It will be carried out in a healthy population, during the years 2021 and 2022, observing, by ultrasound, the results of the popliteal puncture technique, recorded by Mayoral del Moral et al. A popliteus muscle needle reach of 92% was achieved with this technique, in 48 of 50 patients. The results of the present cross-sectional observational study in living subjects, support that the popliteal puncture, described by Mayoral et al. is a reliable and safe approach, when performed with a 0.30 × 50 mm needle, and no adverse reactions or punctures of the vascular-nerve structures have been reported during the interventions.

Abdominal and Pelvic Floor Activity Related to Respiratory Diaphragmatic Activity in Subjects with and without Non-Specific Low Back Pain.

One of the advances in physiotherapy in recent years is the exploration and treatment by ultrasound imaging. This technique makes it possible to study the relationship between the musculature of the anterolateral wall of the abdomino-pelvic cavity, the pelvic floor muscles and the diaphragm muscle, among others, and thus understand their implication in non-specific low back pain (LBP) in pathological subjects regarding healthy subjects. OBJECTIVE: To evaluate by RUSI (rehabilitative ultrasound imaging) the muscular thickness at rest of the abdominal wall, the excursion of the pelvic floor and the respiratory diaphragm, as well as to study their activity. METHODOLOGY: Two groups of 46 subjects each were established. The variables studied were: non-specific low back pain, thickness and excursion after tidal and forced breathing, pelvic floor (PF) excursion in a contraction and thickness of the external oblique (EO), internal oblique (IO) and transverse (TA) at rest. DESIGN: Cross-sectional observational study. RESULTS: Good-to-excellent reliability for measurements of diaphragm thickness at both tidal volume (TV) (inspiration: 0.763, expiration: 0.788) and expiration at forced volume (FV) (0.763), and good reliability for inspiration at FV (0.631). A correlation was found between the EO muscle and PF musculature with respect to diaphragmatic thickness at TV, inspiration and expiration, and inspiration at FV, in addition to finding significant differences in all these variables in subjects with LBP. CONCLUSION: Subjects with LBP have less thickness at rest in the OE muscle, less excursion of the pelvic diaphragm, less diaphragmatic thickness at TV, in inspiration and expiration, and in inspiration to FV.

Reliability of the Spanish Version of the Movement Imagery Questionnaire-3 (MIQ-3) and Characteristics of Motor Imagery in Institutionalized Elderly People.

Motor imagery (MI) training is increasingly used to improve the performance of specific motor skills. The Movement Imagery Questionnaire-3 (MIQ-3) is an instrument for assessing MI ability validated in Spanish although its reliability has not yet been studied in the elderly population. The main objective of this study was to test its reliability in institutionalized elderly people. Secondarily, we studied whether there are differences according to gender and age in MI ability (measured by the MIQ-3) and in temporal congruency (measured by mental chronometry of elbow and knee flexion-extension and getting up and sitting down from chair movements). The subjects were 60 elderly, institutionalized, Spanish-speaking individuals without cognitive impairment or dementia, and aged between 70 and 100 years. Cronbach's alpha showed high internal consistency in the internal visual and external visual subscales and moderate in the kinesthetic subscale. The intraclass correlation coefficient showed good test-retest reliability for all three subscales. Mixed factorial analysis of variances (ANOVAs) showed that MI ability decreased with increasing age range, the imagery time decreased concerning the execution of the same movement, and there were no gender differences in either IM ability or temporal congruence. The Spanish version of the MIQ-3 is a reliable instrument for measuring MI ability in institutionalized elderly.

Real versus Sham Manual Therapy in Addition to Therapeutic Exercise in the Treatment of Non-Specific Shoulder Pain: A Randomized Controlled Trial.

The aim of this study was to evaluate if manual therapy added to a therapeutic exercise program produced greater improvements than a sham manual therapy added to same exercise program in patients with non-specific shoulder pain. This was an evaluator-blinded randomized controlled trial. Forty-five subjects were randomly allocated into one of three groups: manual therapy (glenohumeral mobilization technique and rib-cage technique); thoracic sham manual therapy (glenohumeral mobilization technique and rib-cage sham technique); or sham manual therapy (sham glenohumeral mobilization technique and rib-cage sham technique). All groups also received a therapeutic exercise program. Pain intensity, disability and pain-free active shoulder range of motion were measured post treatment and at 4-week and 12-week follow-ups. Mixed-model analyses of variance and post hoc pairwise comparisons with Bonferroni corrections were constructed for the analysis of the outcome measures. All groups reported improved pain intensity, disability and pain-free active shoulder range of motion. However, there were no between-group differences in these outcome measures. The addition of the manual therapy techniques applied in the present study to a therapeutic exercise protocol did not seem to add benefits to the management of subjects with non-specific shoulder pain.

Test-Retest Reliability of Ultrasonographic Measurements from the Rectus Femoris Muscle 1-5 Years after Anterior Cruciate Ligament Reconstruction in the Ipsilateral and Contralateral Legs: An Observational, Case-Control Study.

About 40% of traumatic injuries in sports are related to the knee. Of these, 33% require arthroscopic surgery. The rehabilitative ultrasound imaging technique is a simple method to obtain objective real-time results on the state and measurement of the musculoskeletal tissue and its use can represent an important change in the process of functional diagnosis and recovery of these injuries. The aim was to quantify the differences in the thickness, muscle contraction time, and muscle relaxation time of the rectus femoris muscle between individuals with knee arthroscopy and healthy individuals and to verify the reliability of the inter-examiner measurements in these ultrasound variables. An observational case-control study with individuals (18−60 years aged) who underwent surgery for anterior cruciate ligament through knee arthroscopy a year or more before. A total of 38 subjects were divided into 2 groups, case and control. Ultrasound measurements were taken of the following outcomes: thickness at rest and contraction, muscle contraction time, and muscle relaxation time of the rectus femoris muscle. Excellent inter-examiner reliability was obtained for all ultrasound measurements (ICC3.3 > 0.90). No significant changes were found in the rate of contraction or rest of the rectus femoris muscle. On the other hand, if significant changes in the thickness of the rectus femoris muscle were found between control and case group. Arthroscopic surgery for anterior cruciate ligament reconstruction does not appear to modify function but does modify the thickness of the rectus femoris muscle on ultrasound examination. Ultrasound appears to be a reliable tool for the study of these measurements in the rectus femoris muscle.

Mechanical Hyperalgesia but Not Forward Shoulder Posture Is Associated with Shoulder Pain in Volleyball Players: A Cross-Sectional Study.

Shoulder antepulsion, altered scapular kinematics and imbalance of muscle activity are commonly associated with shoulder pain. This study aimed to observe if there is an association between the forward shoulder angle (FSA) and the pectoralis minor length index (PMI) in volleyball players with and without shoulder pain. Furthermore, this study observed if there is an association between shoulder posture and upper limb mechanical hyperalgesia in volleyball players with and without shoulder pain. Methods: a cross-sectional study was conducted in the Physiotherapy and Pain Research Center in Alcalá de Henares (Spain). A total of 56 volleyball players met the inclusion criteria and agreed to enter the study. Subjects were divided into two groups: shoulder pain group (SPG) and control group (without pain). The following measurements of the dominant sides of the players were collected: FSA, PMI, and pressure pain threshold (PPT) in serratus anterior, lower trapezius, infraspinatus, teres minor, upper trapezius, levator scapulae, pectoralis major, radial nerve, cubital nerve, and median nerve. Results: The Spearman's Rho revealed no significant correlations were found between FSA and PMI. Moreover, Spearman's Rho test revealed in the SPG a negative moderate correlation between FSA and Infraspinatus-PPT (Rho = −0.43; p = 0.02); FSA and levator scapulae-PPT (Rho = −0.55; p < 0.01); FSA and pectoralis major-PPT (Rho = −0.41; p = 0.02); PMI and cubital nerve-PPT (Rho = −0.44; p = 0.01). Conclusions: No association was found between the forward shoulder angle and the pectoralis minor index in volleyball players with and without shoulder pain. There is a moderate negative association between shoulder forward angle and muscle mechanical hyperalgesia in volleyball players with shoulder pain, but no such associations were found in volleyball players without shoulder pain. Treatment of the infraspinatus, levator scapulae, pectoralis major, and pectoralis minor muscles could improve shoulder pain and ulnar nerve mechanosensitivity.

Dry needling in active or latent trigger point in patients with neck pain: a randomized clinical trial.

The purpose was to determine the efficacy of deep dry needling (DDN) applied on an active myofascial trigger point (MTrP) versus a latent-MTrP versus a non-MTrP location, on pain reduction and cervical disability, in patients with chronic neck pain. A randomized, double-blind clinical trial design was used. A sample of 65 patients was divided into non-MTrP-DDN, active-MTrP-DDN and latent-MTrP-DDN groups. The visual analog scale (VAS), reproduction of the patient's pain, number of local twitch responses, pressure pain threshold (PPT) and Neck Disability Index (NDI) were assessed before, during and after the intervention and up to 1 month post-intervention. The active-MTrP-DDN-group reduced pain intensity more than non-MTrP-DDN-group after a week and a month (P < 0.01), as well as showing the greatest improvement in tibialis muscle PPT. The treatment of both Active and Latent MTrPs was associated with the reproduction of the patient's pain. The application of DDN on an active-MTrP in the upper trapezius muscle shows greater improvements in pain intensity after 1 week and 1 month post-intervention, compared to DDN applied in latent-MTrPs or outside of MTrPs in patients with neck pain.