The immediate effect of thoracolumbar fascia taping on biomechanical properties, low back pain and balance in individuals with transfemoral amputation.

BACKGROUND: In individuals with transfemoral amputation (TFA), adaptations caused by prosthesis use may adversely affect contractile/noncontractile structures. OBJECTIVE: To investigate the immediate effect of the thoracolumbar fascia (TLF) kinesiology taping (KT) on the tone and stiffness of the fascia, low back pain (LBP) and standing balance in individuals with TFA. METHODS: Syrian male participants with TFA were enrolled in the prospective, single-blind, randomised controlled trial. Participants were divided into two groups: Experimental (EG with KT, n= 15) and Control (CG with sham KT, n= 14). A 6-minute walk test (6MWT) was performed, after which KT was applied. Measurements were taken at baseline, immediately after the 6MWT and 30 minutes after KT. RESULTS: Although pain decreased below baseline in both groups at 30 minutes post intervention (p< 0.001), the rate of pain reduction was significantly higher in the EG (p= 0.016). Anterior-posterior sway with eyes open improved significantly 30 minutes after KT application only in the EG (p= 0.010). In the eyes closed condition, anterior-posterior and medio-lateral sway decreased significantly compared to baseline 30 minutes after taping in the EG (p= 0.010-0.032). CONCLUSION: KT can be used as an effective method to support standing balance and reduce LBP in individuals with TFA.

Biomechanical and Viscoelastic Properties of the Achilles Tendon and Plantar Fascia in Pregnant Women with Pelvic Girdle Pain: A Case-Control Study.

This cross-sectional study examined the biomechanical and viscoelastic properties of the Achilles tendon (AT) and plantar fascia (PF) and analyzed their relationship in pregnant women with pelvic girdle pain (PGP). The study was conducted in a public hospital between January and May 2021. Forty-four pregnant women (PGP+, n: 22; PGP-, n: 22) and 21 non-pregnant women were included. Navicular drop was determined and the tonus, stiffness, and creep of PF and AT were measured by Myometer. Navicular drop was significantly different between the PGP+ and the non-pregnant group in both feet (Right, p = .001; Left, p =< .001), and the PGP- and the non-pregnant group in the left foot (p = .009). At the right AT, the stiffness was found to be higher in non-pregnant women compared to the PGP+ group (p = .007). Furthermore, creep was higher in PGP- compared to the non-pregnant group (p = .016). Tissue properties of PF were similar in all groups (p > .05). A correlation between tissue properties and the presence of PGP was not found. No findings indicated that the biomechanical and viscoelastic properties of the AT and PF were affected by the physiology of pregnancy. Moreover, no relationship was observed between the presence of PGP and the tissue properties of the AT and PF.

The effect of gestational diabetes mellitus on occurrence of the pelvic girdle pain and symptom severity in pregnant women.

The primary objective of this study was to examine the effect of gestational diabetes mellitus (GDM) on pelvic girdle pain (PGP) occurrence and symptom severity. Pregnant women who were with/without GDM, 20-40 years of age, and also in the second and third trimesters of pregnancy were included in the study. PGP provocation tests were administered to 187 pregnant women to determine the presence and severity of PGP. Based on the test results, the study subjects were divided into two groups; Group 1 (GDM+, PGP+; n:32) and Group 2 (GDM-, PGP+; n:35). Both groups were asked to fill in the Pelvic Girdle Questionnaire (PGQ). The relationship between the presence of GDM and the presence of PGP was found to be significant (p = .043). It was found the groups were similar in view of pain, and also in PGQ total/subscale scores (p > .05). Although GDM has no effect on symptom severity, it has been determined that it may relate to the development of PGP. Therefore, early interventions (nutrition, exercise, belt using, etc.) are recommended to prevent the development of PGP in pregnant women with a family history of diabetes, with a previous diagnosis of diabetes and/or with GDM detected in their previous pregnancies. Clinical Trial Number: 04769375Impact of StatementWhat is already known on this subject? Gestational diabetes mellitus and pelvic girdle pain are pathologies that develops secondary to pregnancy-related systemic and biomechanical changes.What do results on this study add? GDM may related the development of PGP.What are the implications of these findings for clinical practice and/or further research? Early interventions (nutrition, exercise, belt using, etc.) and strict control of pregnant women in view of PGP is recommended to prevent the development of PGP in pregnant women with a family history of diabetes, with previous diagnosis of diabetes and/or with GDM detected in their previous pregnancies. The evaluation of pregnant women for PGP before administering interventions, such as exercise and diet (both decrease the pro-inflammatory markers), following the diagnosis of GDM and the measurement of plasma anti- and pro-inflammatory marker values in the same time period will further reveal the relationship between GDM and PGP.

Acute effects of cold spray application on mechanical properties of the rectus femoris muscle in athletes.

INTRODUCTION: Cold spray is a form of cryotherapy used in acute injuries at sports medicine. In the current study, we aimed to investigate the acute effect of cold spray application as a treatment strategy for acute sports injuries on the mechanical properties of the rectus femoris muscle in athletes. METHODS: The study included 23 volunteer active male athletes between the ages of 18-23 with a subepidermal fold thickness of the rectus femoris muscle between 5 mm and 15 mm. Skin temperature (thermal camera) and mechanical property evaluations of the muscle (Myoton Pro) were measured before, immediately after, and in 2 min, 5 min, 10 min and 15 min intervals following cold spray application. RESULTS: The skin temperature value of the athletes were significantly lower even in the 15-min interval following application (p < 0.001). Muscle tone increased significantly after the application and in the second minute compared to the pre-application (p < 0.001). Muscle stiffness increased significantly only after the second and fifth minutes compared to the pre-application (p < 0.001). Muscle decrement showed an increase in all time-points compared to the pre-application (p < 0.05). CONCLUSION: In athletes, the rectus femoris muscle has been observed to become harder and less elastic following cooling with cold spray. These changes did not improve completely following the 5 min. The muscle regained its mechanical properties at the earliest approximately 10 min after the cold spray application.

Immediate effect of stair exercise on stiffness, tone, and pressure pain threshold of thoracolumbar fascia in individuals with lower limb amputation: a preliminary report.

BACKGROUND: Adaptations to the use of prosthesis in individuals with a lower limb amputation may cause changes in lumbopelvic region structures during daily life activities. OBJECTIVE: To investigate the effect of stair exercise on the stiffness, tone, and pressure pain threshold (PPT) of the thoracolumbar fascia (TLF) in individuals with unilateral lower limb amputation. DESIGN: This is a prospective preliminary study. METHODS: The study was conducted in Prosthetic Orthotic Centers in Istanbul. Syrian individuals with unilateral transtibial (n = 17) and transfemoral (n = 15) amputation who received prosthesis and rehabilitation services at the centers between February 2020 and December 2020 were included in the study. The subjects were instructed to ascend and descend a nine-step stair one at a time at their maximum possible speed. Measurements were made before and immediately after the stair exercise. Tone and stiffness of TLF was measured using myometer. PPT was measured using algometer. Low back pain was evaluated using numerical pain rating scale. RESULTS: In the transfemoral amputation group, PPT measurements taken immediately after stair exercise were significantly decreased in both the amputated ( P = 0.001) and intact ( P = 0.021) sides, whereas significant reduction in stiffness when compared with the prestair levels was observed only at the intact side ( P = 0.019). The change in PPT values on the amputated side was significantly higher in individuals with transfemoral amputation than those in individuals with transtibial amputation ( P = 0.011). CONCLUSION: The decrease in PPT values of TLF in the transfemoral amputation group was considered as a precursor sign for low back pain development. Thus, exercises and preventive rehabilitation programs targeting TLF may be needed, especially in this group.

Plantar Venous Pump Activity, Generalized Joint Hypermobility, and Foot Mobility in Ballerinas: A Case-Control Study.

CONTEXT: The plantar venous pump (PVP) is a vascular network located between the muscles of the foot arch. It has been suggested foot mobility is critical for PVP activation. OBJECTIVE: This study investigates the effect of generalized joint hypermobility (GJH) on foot mobility and PVP activity in ballerinas and to determine how a short-term warm-up exercise impacts these parameters in the presence of GJH. DESIGN: Prospective study. METHODS: Twelve ballerinas (age = 16.73 [1.8] y) and 15 non-dancer-matched controls (age = 16.31 [2.1] y) were included. When performing weight-bearing activities, venous return parameters (diameter, velocity, and flow volume) from the posterior tibial vein were measured using color and spectral Doppler ultrasonography. Foot mobility was determined using navicular drop test. The participants performed a 10-minute cycling exercise to reveal its effect on reducing tissue stiffness. All measurements were performed synchronously and twice-before and after the cycling exercise. RESULTS: The results showed the navicular height obtained before and after exercise in the ballerinas was significantly different compared with that obtained in the sitting position, and the values obtained in the 3 measurement positions in the nondancer group were significantly different from each other (P < .05). The difference between the venous diameter values measured before and after exercise and the reference value was significant in both groups (P < .001). There was a significant decrease in venous velocity following exercise in the nondancer group (P = .044). The venous volume values obtained after exercise were significantly different between the groups (P = .039). CONCLUSIONS: The GJH has no distinctive effect on foot mobility and PVP activity in ballerinas. The presence of GJH did not influence the effect of short-term warm-up exercise on foot mobility and PVP activity. We believe that measuring the navicular drop and venous return with a more precise synchronization may provide additional information regarding the link between arch tension and venous return.

Psychometric evaluation of the Arabic version of the Quebec user evaluation of satisfaction with assistive technology (A-QUEST 2.0) in prosthesis users.

BACKGROUND: The evaluation of patient satisfaction and perceptions plays a vital role in determining the quality of prosthesis users' devices and the competency of healthcare services. AIM: To evaluate the psychometric properties of the Arabic Quebec User Evaluation of Satisfaction with Assistive Technology (A-QUEST 2.0) with prosthetics users. DESIGN: A methodological study. SETTING: Saudi Arabia, Turkey. POPULATION: A convenience sample of outpatient prosthesis users (N.=183). METHODS: The A-QUEST 2.0 includes two subscales respectively evaluating the user's satisfaction with the device and the services provided. The data for each subscale were investigated using Rasch analysis to evaluate the item fit, reliability indices, item difficulty, local item dependency, and differential item functioning (DIF). RESULTS: Both subscales met the Rasch criteria for the functioning of rating scale categories. All items showed an acceptable fit to the Rasch model. The person separation indices for the Device and Services subscales were 2.21 (Cronbach's α=0.90) and 1.72 (Cronbach's α=0.85), respectively. Therefore, the two subscales are sensitive enough to distinguish between at least three different levels of satisfaction. The unidimensionality of each subscale was confirmed, and none of the items displayed differential item functioning across age, gender, location of amputation, country, and duration of use. CONCLUSIONS: Overall, the findings indicate the psychometric evaluation of A-QUEST 2.0 is effective with prosthesis users across different clinical contexts and cultures. Thus, the A-QUEST 2.0 allows for a comprehensive understanding of users' perceptions of prosthesis characteristics, particularly among subjects with lower limb amputations caused by traumatic injuries. CLINICAL REHABILITATION IMPACT: Our paper provides clinicians dealing with Arabic patients a validated outcome measure for satisfaction with prosthesis. Besides providing information in the development of new products and service delivery. Further studies are necessary to improve the measure's metric quality in different contexts and for different prosthesis devices.

Incidence and demographic characteristics of Syrian Civil War-related amputations: A multi-center study.

OBJECTIVES: The aim of this study was to identify the causes, levels, and rates of amputations performed in civilians during the Syrian Civil War and to present epidemiological data of the amputees. PATIENTS AND METHODS: Between August 2017 and February 2019, a total of 363 amputations of 307 amputees (266 males, 41 females; mean age 29.9±13.3 years; range, 6 to 86 years) were retrospectively analyzed in four prosthesis and orthosis centers managed by an international non-governmental organization and serving to individuals who experienced amputation during Syrian Civil War. Level, etiology, number of amputations and distribution of the amputations by years were investigated. RESULTS: Of the patients, 25.4% were under the age of 18 years. A total of 74% of all amputations were of the lower extremities. Transtibial and transfemoral amputations were the most common amputation levels. Of the amputees, 89.3% reported the cause of amputation as bombing. CONCLUSION: Civil amputations during the Syrian Civil War are different from those in other civil wars due to the high rate of bombing-induced amputations and also the high rate of victims under the age of 18 years. Our study results show a high ratio of both lower and upper extremity amputations in these civilians.

The client satisfaction with device: a Rasch validation of the Arabic version in patients with upper and lower limb amputation.

BACKGROUND: The Client Satisfaction with Devices (CSD) module of the Orthotics and Prosthetics Users' Survey is an extensively used questionnaire that measures patients' satisfaction with orthosis and prosthesis. However, the validated version for Arabic speakers (CSD-Ar) is only applicable for orthosis users. OBJECTIVES: The aim of this study was to evaluate the psychometric proprieties of the CSD-Ar for prosthetics users. METHODS: The study used a convenience sample of prosthesis users from Saudi Arabia and Turkey (N = 183), who completed the CSD-Ar. The collected data were analysed using Rasch analysis to evaluate item fit, reliability indices, item difficulty, local item dependency, and differential item functioning (DIF) using WINSTEPS version 4.6.1. RESULTS: Based on the analysis, the four-response Likert-scale was acceptable, as shown by the category functioning test, All eight items did achieve a fit to the Rasch Model [(infit) and (outfit) mean-square 0.75 to 1.3]. Person separation reliability was 0.76, and item separation reliability was 0.94. A principal component analysis (PCA) showed satisfactory unidimensionality and no local item dependency. The DIF analysis showed no notable dependency among items on participant characteristics in terms of age, gender, duration of use, country, and level of amputation. CONCLUSION: This study contributes to the confidence of using CSD-Ar to evaluate users' satisfaction with different prostheses, affirming the need for further refinement of the quality of the outcome measure.

Comparison of the Immediate Effect of Petrissage Massage and Manual Lymph Drainage Following Exercise on Biomechanical and Viscoelastic Properties of the Rectus Femoris Muscle in Women.

CONTEXT: Fast and adequate recovery after exercise and activity is important for increasing performance and preventing injuries. Inadequate recovery usually causes changes in the biomechanical and viscoelastic properties of the muscle. OBJECTIVE: To compare the immediate effect of petrissage massage (PM) and manual lymph drainage (MLD) following submaximal exercise on the biomechanical and viscoelastic properties of the rectus femoris muscle in healthy women. DESIGN: Cross-sectional, repeated-measures. SETTING: Marmara University. PARTICIPANTS: 18 healthy female students. INTERVENTION(S): Following the submaximal quadriceps strengthening exercise performed in 3 sets of 8 repetitions with intensity of 75% of 1 maximum repetition, participants' right leg received a 5-minute PM (PM group) and the contralateral leg received a 5-minute MLD application (MLD group). MAIN OUTCOME MEASURES: Skin temperature was measured using P45 thermographic thermal camera (Flir System; ThermaCAM, Danderyd, Sweden), and muscle tone, biomechanical, and viscoelastic features were measured with a myometer (Myoton AS, Tallinn, Estonia) at baseline, immediately postexercise, post-PM/MLD application, and 10 minutes postexercise. RESULTS: In the PM group, the tonus (P = .002) and stiffness (P < .001) values measured after the massage and at the end of the 10-minute resting period were found to be statistically different than those measured right after the exercise (P < .05). Relaxation time and creep values at all measurement times were significantly different (P < .05). In the MLD group, it was observed the tonus (P < .001), stiffness (P = .025), and relaxation time (P < .01) values decreased significantly after the MLD compared with the values measured after the exercise; however, the creep value was found to be significantly different in all measurements (P < .05). CONCLUSION: PM and MLD reduce passive tissue stiffness and improve the extent of muscle extensibility over time against the muscle tensile strength. PM and MLD are therapeutic methods that can be used to support tissue recovery after exercise and prevent injuries.

Acute Effects of Cold Pack for Different Periods on the Biomechanical Properties of the Rectus Femoris Muscle.

CONTEXT: Cold packs are silica gel packs that are commonly used in clinics. However, the packs are applied for various amounts of time, and the relationship between these times and temperature changes isn't fully understood. OBJECTIVES: The study intended to investigate the acute effects of cold-pack application for different periods of time on the biomechanical properties of the rectus femoris muscle. DESIGN: The study was randomized, controlled trial. SETTING: The study took place at Acibadem Mehmet Ali Aydinlar University in Istanbul, Turkey. PARTICIPANTS: Participants were 60 healthy volunteers from the community, aged 18 to 23 years. INTERVENTIONS: Participants were divided into four groups with n = 15 in each group. The cold packs were applied on the dominant rectus femoris muscle: (1) for 10 minutes in Group 1, (2) for 12 minutes in Group 2, (3) for 15 minutes in Group 3, and (4) for 20 minutes in Group 4. OUTCOME MEASURES: The outcome measures were the skin temperature, determined using a thermal camera, and biomechanical properties-tone and stiffness and muscle decrement-using a device that delivers a short mechanical impulse to the tissue. Outcomes were measured at baseline before the cold application, immediately post intervention after the cold application, and at 5, 10, 15, 20, and 30 minutes post intervention. RESULTS: The mean skin temperatures were significantly lower in all groups compared to those before cold application (P < .05), and no significant differences existed between any of the groups (P > .05). Post intervention, while Groups 1 and 2 showed an increase in muscle tone and stiffness and a decrease in elasticity (P < .05), they began to approach their baseline state by the fifth and fifteenth minutes, respectively (P > .05). In Groups 3 and 4, the muscle stiffness increased at all time points (P < .05). CONCLUSIONS: The study showed that the rectus femoris muscle of healthy people becomes stiffer and less elastic as a result of cooling with cold packs that were applied for different time periods. The amount of cold-pack time that minimized the biomechanical corruption of the muscle and provides cooling was 10 minutes. Careful warming up is recommended before and after intense athletic performance, and caution in cooling the skeletal muscle should be exercised.

The role of kinesiotaping combined with botulinum toxin to reduce plantar flexors spasticity after stroke.

PURPOSE: To evaluate the effect of kinesiotaping as an adjuvant therapy to botulinum toxin A (BTX-A) injection in lower extremity spasticity. METHODS: This is a single-center, randomized, and double-blind study. Twenty hemiplegic patients with spastic equinus foot were enrolled into the study and randomized into 2 groups. The first group (n=10) received BTX-A injection and kinesiotaping, and the second group (n=10) received BTX-A injection and sham-taping. Clinical assessment was done before injection and at 2 weeks and 1, 3, and 6 months. Outcome measures were modified Ashworth scale (MAS), passive ankle dorsiflexion, gait velocity, and step length. RESULTS: Improvement was recorded in both kinesiotaping and sham groups for all outcome variables. No significant difference was found between groups other than passive range of motion (ROM), which was found to have increased more in the kinesiotaping group at 2 weeks. CONCLUSION: There is no clear benefit in adjuvant kinesiotaping application with botulinum toxin for correction of spastic equinus in stroke.

Quantitative forearm muscle strength influences radial bone mineral density in osteoporotic and healthy males.

Fractures are not rare in male osteoporosis and bone mineral density (BMD) measurement is used in the diagnosis and monitoring, preventing and/or treating the disease. Muscle strength and BMD are highly related to each other. The distal radius is one of the most common sites of osteoporotic fractures. The relationship of quantitative muscle strength and BMD of the forearm has not yet been established. The objective of this study was to assess forearm muscle strength and grip strength in relation to BMD in 46 osteoporotic and randomly selected 45 healthy male participants. Forearm muscle strength and BMD were quantitatively measured using an isokinetic dynamometer and dual-energy-X-ray-absorptiometry (DEXA), respectively. Significant correlation was found among the muscle strength and dominant forearm BMD in 60 and 120 deg/s velocities. In the non-dominant arm, the 120 deg/s velocity was only significantly positively correlated to forearm BMD. Pearson's Product coefficient presented a moderate correlation between muscle strength and BMD at the dominant arms of both groups, whereas, the difference in the non-dominant forearm came from the difference of usage frequency. In conclusion, quantitative forearm muscle strength and BMD is moderately correlated and exercise can be advised to prevent distal radius fractures in male osteoporosis.