Local Heat Applications as a Treatment of Physical and Functional Parameters in Acute and Chronic Musculoskeletal Disorders or Pain.

OBJECTIVES: The aim of this systematic review and meta-analysis was to evaluate the effectiveness of local heat applications (LHAs) in individuals with acute or chronic musculoskeletal disorders. DATA SOURCES: An electronic search was conducted on MEDLINE, Cochrane Controlled Register of Trials, Current Nursing and Allied Health Literature, and the Physiotherapy Evidence databases up to December 2019. STUDY SELECTION: Studies incorporating adults with any kind of musculoskeletal issues treated by LHA compared with any treatment other than heat were included. DATA EXTRACTION: Two authors independently performed the methodological quality assessment using the Cochrane Risk of Bias tool. DATA SYNTHESIS: LHA showed beneficial immediate effects to reduce pain vs no treatment (P<.001), standard therapy (P=.020), pharmacologic therapy (P<.001), and placebo/sham (P=.044). Physical function was restored after LHA compared with no treatment (P=.025) and standard therapy (P=.006), whereas disability improved directly after LHA compared with pharmacologic therapy (P=.003) and placebo/sham (P<.028). Quality of life was improved directly after LHA treatment compared with exercise therapy (P<.021). Range of motion increased and stiffness decreased after LHA treatment compared with pharmacologic therapy (P=.009, P<.001) and placebo/sham (P<.001, P=.023). The immediate superior effects of LHA on muscular strength could be observed compared with no treatment (P<.001), cold (P<.001), and placebo/sham (P=.023). CONCLUSIONS: Individuals with acute musculoskeletal disorders might benefit from using LHA as an adjunct therapy. However, the studies included in this meta-analysis demonstrated a high heterogeneity and mostly an unclear risk of bias.

Criteria Used for the Diagnosis of Myofascial Trigger Points in Clinical Trials on Physical Therapy: Updated Systematic Review.

OBJECTIVE: The objective of this study was to conduct an updated systematic review of diagnostic criteria for myofascial trigger points (MTrPs) used in clinical trials of physical therapy interventions from 2007 to 2019. METHODS: MEDLINE and Physiotherapy Evidence Database (PEDro) were searched using the following MeSH keywords: "trigger points," "trigger point," "myofascial trigger point," "myofascial trigger points," "myofascial pain," and "myofascial pain syndrome." The MeSH keywords were combined by using Boolean operators "OR"/"AND." All physiotherapy clinical trials including patients with musculoskeletal conditions characterized by at least 1 active MTrP or latent MTrP in any body area were selected. We pooled data from an individual criterion and criteria combinations used to diagnose MTrPs. The protocol was developed in accordance with the PRISMA-P guidelines. RESULTS: Of 478 possibly relevant publications, 198 met the inclusion criteria. Of these 198 studies, 129 studies (65.1%) stated specifically the diagnostic criteria used for MTrPs in the main text, 56 studies (28.3%) failed to report any method whereby MTrP was diagnosed, and 13 studies (6.6%) adopted expert-based definitions for MTrPs without specification. Of 129 studies, the 6 criteria applied most commonly were: "spot tenderness" (n=125, 96.9%), "referred pain" (95, 73.6%), "local twitch response" (63, 48.8%), pain recognition (59, 45.7%), limited range of motion" (29, 22.5%), and "jump sign" (10, 7.8%). Twenty-three combinations of diagnostic criteria were identified. The most frequently used combination was "spot tenderness," "referred pain," and "local twitch response" (n=28 studies, 22%). CONCLUSIONS: A number of the included studies failed in properly reporting the MTrP diagnostic criteria. Moreover, high variability in the use of MTrP diagnostic was also observed. Spot tenderness, referred pain, and local twitch response were the 3 most popular criteria (and the most frequently used combination). A lack of transparency in the reporting of MTrP diagnostic criteria is present in the literature. REGISTRY: This systematic review was registered under the Centre for Reviews and Dissemination, PROSPERO number: CRD42018087420.

Physical Management of Scar Tissue: A Systematic Review and Meta-Analysis.

Objective: The aim of this systematic review with meta-analysis was to describe the status on the effects of physical scar treatments on pain, pigmentation, pliability, pruritus, scar thickening, and surface area. Design: Systematic review and meta-analysis. Subjects: Adults with any kind of scar tissue. Interventions: Physical scar management versus control or no scar management. Outcome measures: Pain, pigmentation, pliability, pruritus, surface area, scar thickness. Results: The overall results revealed that physical scar management is beneficial compared with the control treatment regarding the management of pain (p = 0.012), pruritus (p < 0.001), pigmentation (p = 0.010), pliability (p < 0.001), surface area (p < 0.001), and thickness (p = 0.022) of scar tissue in adults. The observed risk of bias was high for blinding of participants and personnel (47%) and low for other bias (100%). Conclusions: Physical scar management demonstrates moderate-to-strong effects on improvement of scar issues as related to signs and symptoms. These results show the importance of specific physical management of scar tissue.

Comparison of two skin temperature assessment methods after the application of topical revulsive products: Conductive iButton data logger system vs contact-free infrared thermometry.

BACKGROUND: Skin temperature assessments comprise conductive and contact-free techniques. Comparison between conductive data loggers and contact-free thermometry after the application of revulsive products is scarce. This study aimed to compare iButton data loggers with an infrared thermometer after the application of two revulsive products. Secondly, the relation between skin temperature kinetics with skin's perfusion of microcirculation was investigated. MATERIALS AND METHODS: Healthy females (n = 25) were randomly allocated to two groups, representing the products A and B. Skin temperature was measured with "iButtons" and an infrared pistol at baseline and up to 1 hour after application. Skin's perfusion of microcirculation was monitored with a laser speckle contrast imager. RESULTS: Baseline "iButton" temperature values were significantly lower compared with infrared pistol values in both groups. After application of the products, skin temperature decreased as recorded with both devices followed by an increase to baseline values when measured with the pistol. The results obtained by the "iButtons" reached values above baseline in both products towards the end of the follow-up period. A moderate correlation was found between infrared pistol and "iButton" system in product A, with a weak negative correlation between skin's perfusion of microcirculation and temperature devices. For product B, the correlation between the devices was moderate and between skin's perfusion and temperature devices weak and positive. CONCLUSION: Both devices produced similar kinetics, except at baseline, where they may differ as metallic loggers have been insufficiently adapted to skin temperature. Skin's perfusion of microcirculation could not explain skin temperature changes.

Partial-body cryotherapy (-135°C) and cold-water immersion (10°C) after muscle damage in females.

This randomized controlled trial examined the effects of cold-water immersion (CWI), partial-body cryotherapy (PBC), or a passive control (CON) on physiological and recovery variables following exercise-induced muscle damage (EIMD, 5 × 20 drop jumps) in females. Twenty-eight females were allocated to PBC (30 seconds at -60°C, 2 minutes at -135°C), CWI (10 minutes at 10°C), or CON (10 minutes resting). Muscle oxygen saturation (SmO2 ), cutaneous vascular conductance (CVC), mean arterial pressure (MAP), and local skin temperature were assessed at baseline and through 60 minutes (10-minute intervals), while delayed onset of muscle soreness (DOMS), muscle swelling, maximum voluntary isometric contraction (MVIC), and vertical jump performance (VJP) were assessed up to 72 hours (24-hour intervals) following treatments. SmO2 was lower in PBC (Δ-2.77 ± 13.08%) and CWI (Δ-5.91 ± 11.80%) compared with CON (Δ18.96 ± 1.46%) throughout the 60-minute follow-up period (P < .001). CVC was lower from PBC (92.7 ± 25.0%, 90.5 ± 23.4%) and CWI (90.3 ± 23.5%, 88.1 ± 22.9%) compared with CON (119.0 ± 5.1 and 116.1 ± 6.6%, respectively) between 20 and 30 minutes (P < .05). Mean skin temperature was lower from CWI vs PBC (between 10 and 40 minutes, P < .05). Mean skin temperature was higher in CON compared with CWI up to 60 minutes and compared with PBC up to 30 minutes (P < .05). DOMS was lower following both PBC and CWI compared with CON through 72-hour (P < .05), with no difference between groups. No main group differences for swelling, MVIC, and VJP were observed. In conclusion, CWI elicited generally greater physiological effects compared with PBC while both interventions were more effective than CON in reducing DOMS in females, but had no effect on functional measures or swelling.

Acute Injuries in Male Elite and Amateur Mountain Bikers: Results of a Survey.

Together with the growing popularity of mountain biking, the number of riders at risk for an acute injury has increased. A cross-sectional observational study was performed to describe the prevalence of acute injuries among elite and amateur riders and to determine predictive factors leading to a severe injury. A retrospective questionnaire was created comprising questions aiming on demographics, training volume, injury events and wearing of protective gear items. The survey was conducted during the Swiss Epic Mountain Bike Event in 2017. Complete data sets of male mountain bikers were used to determine prevalence. To evaluate injury related factors, only data sets reporting one or more injuries were included in the final analysis. Ninety-nine questionnaires were included to calculate the injury prevalence of 74% for elites and 69% for amateurs (p = 0.607). For the analysis of injury related factors 56 questionnaires were processed. Elites were significantly younger (p = 0.004) and had a significantly higher exposure time per year as amateurs (p < 0.001). The groups did not differ in number of injuries (p = 0.437) and number of severe injuries (p = 0.225). No predictive factors for a severe injury event were found. Both groups wore an equal amount of protective gear items (p = 0.846). A significant medium, respectively small correlation was found in both groups for mean hours of training per week and number of races per year (elites: r = 0.597, p = 0.023; amateurs: r = 0.428, p = 0.005). An equal prevalence of acute injuries was found in elite and amateur mountain bikers. Elites are at higher risk for an injury event due to their exposure time but do not suffer more or more severe injuries than amateurs.

Home-Based Virtual Reality-Augmented Training Improves Lower Limb Muscle Strength, Balance, and Functional Mobility following Chronic Incomplete Spinal Cord Injury.

Key factors positively influencing rehabilitation and functional recovery after spinal cord injury (SCI) include training variety, intensive movement repetition, and motivating training tasks. Systems supporting these aspects may provide profound gains in rehabilitation, independent of the subject's treatment location. In the present study, we test the hypotheses that virtual reality (VR)-augmented training at home (i.e., unsupervised) is feasible with subjects with an incomplete SCI (iSCI) and that it improves motor functions such as lower limb muscle strength, balance, and functional mobility. In the study, 12 chronic iSCI subjects used a home-based, mobile version of a lower limb VR training system. The system included motivating training scenarios and combined action observation and execution. Virtual representations of the legs and feet were controlled via movement sensors. The subjects performed home-based training over 4 weeks, with 16-20 sessions of 30-45 min each. The outcome measures assessed were the Lower Extremity Motor Score (LEMS), Berg Balance Scale (BBS), Timed Up and Go (TUG), Spinal Cord Independence Measure mobility, Walking Index for Spinal Cord Injury II, and 10 m and 6 min walking tests. Two pre-treatment assessment time points were chosen for outcome stability: 4 weeks before treatment and immediately before treatment. At post-assessment (i.e., immediately after treatment), high motivation and positive changes were reported by the subjects (adapted Patients' Global Impression of Change). Significant improvements were shown in lower limb muscle strength (LEMS, P = 0.008), balance (BBS, P = 0.008), and functional mobility (TUG, P = 0.007). At follow-up assessment (i.e., 2-3 months after treatment), functional mobility (TUG) remained significantly improved (P = 0.005) in contrast to the other outcome measures. In summary, unsupervised exercises at home with the VR training system led to beneficial functional training effects in subjects with chronic iSCI, suggesting that it may be useful as a neurorehabilitation tool. TRIAL REGISTRATION: Canton of Zurich ethics committee (EK-24/2009, PB_2016-00545), ClinicalTrials.gov: NCT02149186. Registered 24 April 2014.

Anthropometric and performance characteristics of the German rugby union 7s team.

BACKGROUND: Somatotyping is advantageous in sports for the optimal development of performance level and injury prevention. The aim of this study was to describe the anthropometric and physical performance characteristics of the German national rugby union 7s team. Seventeen male rugby players, classified as forwards (N.=9; 24.2±2.1 years) and backs (N.=8; 24.3±5.05 years) were assessed. METHODS: Anthropometric measurements included: body height, weight, height to weight ratio (H/W), five skinfolds, biepicondylar humerus and femur breadth, upper arm- and calf girth, estimated lower body fat percentage and determination of the individual and mean somatotype. The physical performance tests included: sit-and-reach, handgrip strength, one minute of sit-ups, one minute of push-ups, vertical jump performance, peak power performance, bent arm hanging, 40-m sprint, and the Yo-Yo Intermittent Endurance Test. RESULTS: The forward players were significantly taller (P=0.003), heavier (P=0.001) with a smaller H/W (P=0.009) compared to the backs. Humerus and femur bone breadths (P<0.05) and flexed upper arm and calf girths (P<0.05) were significantly different between the groups. Handgrip strength left (P=0.04), one minute of sit-ups (P=0.03), and peak power output (P=0.015) were also significantly different between the groups. CONCLUSIONS: The data indicate that German forward and back players have a similar somatotype and performance level. However, a higher body mass of forward players could be advantageous in that their playing position is much more body contact intensive, and requires a significant amount of tackling. The nominative data of this study may assist coaches to detect weak links in rugby specific athletic performance.

Evolution of the methodological quality of controlled clinical trials for myofascial trigger point treatments for the period 1978-2015: A systematic review.

BACKGROUND: The methodological quality of controlled clinical trials (CCTs) of physiotherapeutic treatment modalities for myofascial trigger points (MTrP) has not been investigated yet. OBJECTIVES: To detect the methodological quality of CCTs for physiotherapy treatments of MTrPs and demonstrating the possible increase over time. DESIGN: Systematic review. METHODS: A systematic search was conducted in two databases, Physiotherapy Evidence Database (PEDro) and Medicine Medical Literature Analysis and Retrieval System online (MEDLINE), using the same keywords and selection procedure corresponding to pre-defined inclusion criteria. The methodological quality, assessed by the 11-item PEDro scale, served as outcome measure. The CCTs had to compare at least two interventions, where one intervention had to lay within the scope of physiotherapy. Participants had to be diagnosed with myofascial pain syndrome or trigger points (active or latent). RESULTS: A total of n = 230 studies was analysed. The cervico-thoracic region was the most frequently treated body part (n = 143). Electrophysical agent applications was the most frequent intervention. The average methodological quality reached 5.5 on the PEDro scale. A total of n = 6 studies scored the value of 9. The average PEDro score increased by 0.7 points per decade between 1978 and 2015. CONCLUSIONS: The average PEDro score of CCTs for MTrP treatments does not reach the cut-off of 6 proposed for moderate to high methodological quality. Nevertheless, a promising trend towards an increase of the average methodological quality of CCTs for MTrPs was recorded. More high-quality CCT studies with thorough research procedures are recommended to enhance methodological quality.