The impact of protrusion size on pain, range of motion, functional capacity, and multifidus muscle cross-sectional area in lumbar disc herniation.

OBJECTIVE: To investigate the effect of protrusion amount on pain, lumbar mobility, physical dysfunction, and the cross-sectional area of the multifidus muscle in patients with lumbar disc herniation. METHODS: 54 male patients aged 20 to 50 years were included in this study in 2 groups. The control group (n = 18) consisted of patients with disc herniation without nerve root compression, and the study group (n = 36) consisted of patients with lumbar disc herniation and nerve root compression in 3 subgroups according to the amount of protrusion. The multifidus muscle cross-sectional area and the amount of protrusion were measured using Magnetic Resonance Imaging. Pain intensity was measured using the Visual Pain Scale, physical dysfunction was measured using the Oswestry Disability Index, flexion-extension was measured with TiltMeter, and trunk rotation was measured with smartphone applications called iPhone Compass. RESULTS: There were no differences in pain levels (P > .05), mean trunk rotation movements of the affected and unaffected sides (P = .001, P = .001, P = .983, and P = .954, respectively), Oswestry Disability Index results (P = .967), or cross-sectional area sizes of the multifidus muscle (P = .866, P = .552, P = .787, respectively). There was a difference between the groups in terms of the mean trunk flexion and extension movement values (P = .001). The regression analysis indicated that there was no significant correlation between the binary variables, and the models exhibited a low explanatory rate for the dependent variable. CONCLUSION: A relationship has been identified between lumbar disc herniation and low back pain, lumbar movement limitation, and physical functionality. Nevertheless, subsequent to the regression analysis, it became evident that the binary variables did not exhibit a noteworthy relationship, leading to a decrease in the explanatory capacity of the models for the dependent variable. In forthcoming studies, it is advisable to contemplate the augmentation of the subject pool or the incorporation of multiple independent variables into the regression analysis as potential strategies to enhance the model capability in elucidating variations in the dependent variable.

Is plantar foot sensation affected in patients with gonarthrosis.

OBJECTIVE: The aim of this study was to compare pain, plantar foot sensation, postural control, fear of movement, and functional level between women patients with early-stage gonarthrosis and those with late-stage gonarthrosis. METHODS: A total of 62 women with gonarthrosis were included in the study. Patients were then divided into two groups: earlystage gonarthrosis group (31 women) and late-stage gonarthrosis group (31 women) according to Kellgren Lawrence criteria. Light touch-pressure sensation (Semmes Weinstein Monofilaments), two-point discrimination sensation (esthesiometer), and vibration sensation (128 Hz diapason) were used to evaluate plantar foot sensation. Pain intensity was assessed by the numeric rating scale, postural control by Berg balance scale, fear of movement by the Tampa kinesiophobia scale, functional mobility by the Timed Up and Go test and knee injury and osteoarthritis outcome score. RESULTS: Early-stage patients were found to have higher light-touch pressure sensation on 1st metatarsal head of dominant side, 5th metatarsal head of non-dominant side, heel of non-dominant side than late stage patients. Early-stage patients had a higher sensation of vibration than late stage patients. The patients in the early stage were found to have higher two-point discrimination sensation on middle of dominant side, heel of dominant side, trans-metatarsal of non-dominant side, middle of non-dominant side, heel of non-dominant side than late stage. Postural control of early-stage patients were found to be higher than late-stage patients. Early-stage patients had lower kinesophobia and higher functional levels than late-stage patients. CONCLUSION: The light touch sensation, vibration sensation, and two-point discrimination deteriorated by the progression of the disease should be important criteria in patients with gonarthrosis. LEVEL OF EVIDENCE: Level III, Therapeutic Study.

Scapular Dyskinesis, Shoulder Joint Position Sense, and Functional Level After Arthroscopic Bankart Repair.

BACKGROUND: Scapular kinesia is an important component of glenohumeral rhythm and shoulder stability. No studies have evaluated scapular dyskinesis and its relationship to shoulder proprioception in patients who have undergone arthroscopic Bankart repair (ABR). PURPOSE: To investigate scapular dyskinesis, proprioception, and functional level after ABR. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: This study included 13 male patients who underwent ABR (ABR group; mean age, 30 years; range, 24-36 years) and 13 sex- and age-matched healthy individuals (control group). The age, height, weight, and dominant side of all participants were collected. Scapular dyskinesis was evaluated using the lateral scapular slide test and the scapular dyskinesis test; proprioception was measured by the active angle reproduction test using a smartphone goniometer application, and functional level was assessed using the upper-quarter Y-balance test for dynamic stability as well as the Rowe score and Walch-Duplay score for quality of life and return to activities of daily living. RESULTS: The presence of static scapular dyskinesis in the neutral position, at 45° of abduction, and at 90° of abduction as well as the presence of dynamic scapular dyskinesis was higher in the ABR group compared with the control group (P ≤ .04 for all). Shoulder joint position sense (absolute error) at 40° and 100° of shoulder elevation and shoulder functional level according to the Rowe score were worse in the ABR patients compared with the healthy controls (P ≤ .02 for all). Dynamic scapular dyskinesis was negatively related to shoulder joint position sense at 40° of shoulder elevation (r = -0.64; P = .01). Static scapular movement as measured on the lateral scapular slide test was moderately related to the Rowe score (r = 0.58; P = .03). CONCLUSION: Scapular kinematics and proprioception should be evaluated after ABR. Treatment approaches to improve scapular control and proprioceptive sense should be included in the rehabilitation program for patients after ABR.

Acute effects of static stretching and massage on flexibility and jumping performance.

OBJECTIVE: The purpose of this study was to evaluate the effects of static stretching and the application of massage on flexibility and jump performance. METHODS: Thirty-five athletes studying Physical Education at University (mean age 23.6±1.3 years, mean height 177.8±6.3 cm and mean weight 72.2±6.7 kg) performed one of three different warm-up protocols on non-consecutive days. Protocols included static stretching [SS], combined static stretching and massage [SSM], and neither stretching nor massage [CONT]. The athletes performed flexibility, countermovement jump (CMJ) and squat jump (SJ) tests. RESULTS: SS and SSM protocols demonstrated 12% (p<0.05) and 16% (p<0.05) respectively greater flexibility than the CONT protocol. SJ and CMJ performances were significantly decreased 10.4% (p<0.05) and 5.5% (p<0.05) respectively after the SS protocol. There was no significant difference between SSM and CONT protocol in terms of SJ and CMJ performance. CONCLUSION: This research indicates that whereas static stretching increases the flexibility it decreases the jumping performance of the athletes. On the other hand, the application of massage immediately following static stretching increases flexibility but does not reduce jumping performance. Considering the known negative acute effects of static stretching on performance, the application of massage is thought to be beneficial in alleviating such effects.

Does the right or left hemisphere involvement affect swallowing in patients with hemiplegia?

BACKGROUND: Stroke is one of the most important causes of swallowing difficulty. It is seen in one of every two patients with stroke. Although the swallowing function is controlled by both hemispheres, it is unknown which hemisphere is more dominant than another for controlling the swallowing function. However, the aspiration and pharyngeal phase dysfunction can be seen in right hemisphere involvement while oral phase dysfunction can be seen in left hemisphere involvement. OBJECTIVE: The aim of this study was to investigate whether water swallowing performance, deep cervical flexor muscle endurance, and maximum phonation time were affected in right handed patients with hemiplegia. STUDY DESIGN: The study was designed as a cross-sectional study. METHODS: Patients with unilateral strokes that damaged the right (Group I: n = 37) and left (Group II: n = 20) hemispheres were included. Swallowing difficulties were evaluated with the Turkish version of the Eating Assessment Tool. The water swallowing performance was measured with the 100 ml water swallow test. The muscle endurance (ME) of deep neck flexors was measured in the chin-tuck position. The laryngeal function was measured indirectly with maximum phonation time (MPT). RESULTS: The mean age of patients was 73.54±7.28 years in Group I and the mean age of patients was 73.15±6.94 years in Group II. There were no differences in maximum phonation time, water swallowing performance (swallow volume, capacity, and speed), and swallowing difficulty (p > 0.05). The neck flexor muscular endurance of patients with unilateral strokes that damaged the left hemisphere was better than the patients with unilateral strokes that damaged the right hemisphere (p < 0.05). There was a relationship between MPT and ME, MPT and swallowing difficulty, ME and swallowing difficulty (r:0.637, p:0.000; r:-0.465, p:0.004; r:-0.473, p:0.003 respectively) in the right hemisphere involvement patients. There was a relationship between swallowing difficulty to swallowing volume and swallowing capacity (respectively, r:-0.402 and p:0.014; r:-0.473 and p:0.003) in the patients with unilateral strokes that damaged the right hemisphere. There was no relationship between other parameters in Group I (p > 0.05). There was no relationship between all parameters in Group II (p > 0.05). CONCLUSIONS: This study is the first study to investigate whether water swallowing performance, deep cervical flexor muscle endurance, and maximum phonation time were affected in right handed patients with unilateral strokes that damaged the right or left hemispheres. In light of the findings of the study, it was thought that swallowing should be evaluated in detail especially in hemiplegic patients with right hemisphere involvement. There is a need for studies examining the results of swallowing rehabilitation on right or left hemisphere in hemiplegic individuals.

Swallowing difficulty and swallowing anxiety in patients with type-II diabetes mellitus.

BACKGROUND: Type-II Diabetes Mellitus (TII-DM) is the most common endocrine disorder in people who are over 65 years of age. It leads to a decrease in muscle strength and impaired muscle coordination. Ageing and weakness cause swallowing difficulty (SD). OBJECTIVE: The aim of this study was to evaluate the relationship between duration of disease, SD and swallowing anxiety (SA) in TII-DM patients. STUDY DESIGN: Prospective case-control study. METHODS: A total of 103 elderly individuals (74 females and 29 males) participated in this study. Fifty-two elderly patients (aged 70.27 ± 4.65 years) had a TII-DM and the duration of DM was 11.32 ± 10.03 years (minimum: 0-40 years). Fifty-one patients without diabetes mellitus (69.35 ± 3.58 years) were included in the control group. SD was determined using the EAT-10 Questionnaire. SA was evaluated with the Swallowing Anxiety Scale developed in the Turkish population. Handgrip strength was evaluated with a Jamar dynamometer on the dominant side. RESULTS: There was a significant difference in SD (p : 0.042), SA (p : 0.001), and handgrip strength (p : 0.039) between groups. There was a relationship between SD and SA in the control and DM groups (r : 0.577; p : 0.000 and r : 0.663; p : 0.000, respectively). There was no relationship between the other parameters (age, SD, SA, and handgrip strength) in the control group (p < 0.05). There was a positive moderate relationship between SA and duration of disease in the TII-DM group (r : 0.472; p : 0.000). There was no relationship between other parameters (age, SD, SA, handgrip strength, and duration of disease) in the DM group (p < 0.05). CONCLUSION: In elderly individuals with TII-DM and without DM, there were differences in SD, SA, and handgrip strength. Although there was a relationship between SD and SA in both groups, this relationship was found to be higher in elderly patients with TII-DM. In addition, there was a relationship between the duration of diagnosis and SA. In elderly individuals, evaluating SD with SA was thought to be helpful in the prevention or early rehabilitation of swallowing disorders.

Is the proprioceptive neuromuscular facilitation technique superior to Shaker exercises in swallowing rehabilitation?

PURPOSE: This prospective study was planned to investigate whether the combined isotonic technique of proprioceptive neuromuscular facilitation (PNF) is superior to Shaker exercises in improving the function of swallowing muscles. METHODS: Fifty individuals (30 females and 20 males; mean age 68 ± 3.89 years) with swallowing difficulties were separated into two groups randomly. The treatment groups were Shaker and PNF groups, which performed these exercises three times in a week for6 weeks. Swallowing difficulties were determined with the Turkish version of the eating assessment tool (T-EAT-10). The 100 ml-water swallow test was used to measure capacity, volume, and speed of swallowing. Contraction amplitude changes used as a universal measurement of motor unit activity during the muscle action were measured with superficial electromyography. RESULT: After 6 weeks of exercise training, T-EAT-10 scores decreased in both groups (p < 0.001). Water swallowing capacity and volume improved in both groups (p < 0.001). There was no change in swallowing speed in both groups (p > 0.05). Maximal voluntary contraction values of suprahyoid muscles were higher in PNF than the Shaker group (p < 0.05). CONCLUSION: Both the types of exercise can be used in the rehabilitation of swallowing difficulties. However, the PNF technique increased the contraction amplitude values that occur during maximum contraction more than the Shaker exercises. Different functional evaluations are needed to determine the effectiveness of PNF on swallowing difficulty.

Evaluation of Plantar Foot Sensation, Balance, Physical Performance, and Fear of Movement in Substance Use Disorders.

BACKGROUND: Neuropathologic changes may occur in the nervous system due to long-term substance use, leading to functional disability with altering of balance. We know little about substance-related mechanisms that can cause movement disorders. This study investigated the effects of plantar foot sensation and balance on physical performance as an effect of substance use in detoxified patients. METHODS: Twenty-three users of cannabis, volatile agents, or narcotic/stimulant agents alone or in combination for at least 1 year (mean age, 27.6 years) and 20 healthy volunteers (mean age, 24.6 years) were included. Participant evaluations were implemented immediately after the detoxification process with psychiatrist approval. Depression, state-trait anxiety, and fear of movement levels were evaluated with the Beck Depression Inventory, State-Trait Anxiety Inventory, and Tampa Scale for Kinesiophobia, respectively. Plantar foot sensations were evaluated with light touch, two-point discrimination, and vibration examinations. Balance was assessed with balance software and a balance board and force platform. Balance path, balance path distance, and center of pressure were recorded. Physical performance was evaluated with the Timed Up and Go (TUG) test in the final step. RESULTS: There was a significant difference in two-point discrimination of patients versus controls (P < .05). Significant differences were also found in balance values, particularly in the sagittal direction (P < .05). TUG test results of patients compared with controls showed a negative influence on physical function (P < .05). CONCLUSIONS: Detailed examination should be performed to understand movement disorders in substance users. Herein, substance users had impaired two-point discrimination and sagittal balance reciprocally. Thus, customized physiotherapy approaches to substance users should be considered to improve their movement disorders.

Effects on Lower Extremity Neuromuscular Control Exercises on Knee Proprioception, Muscle Strength, and Functional Level in Patients with ACL Reconstruction.

OBJECTIVE: The purpose of this study was to determine the effects of lower extremity motor control exercises on knee proprioception, muscle strength, and functional level in patients with anterior cruciate ligament reconstruction (ACL-R). MATERIALS AND METHODS: Thirty-two of the 57 patients with ACL-R using tibialis anterior allografts were divided into two groups. Group I: lower extremity motor control exercises were added to the standard rehabilitation program. Group II: standard rehabilitation program was applied. Effects of lower extremity motor control exercises on quadriceps and hamstring muscles strength, knee joint position sense, and hop test were evaluated. RESULTS: There were no differences in muscle strength and endurance of the quadriceps and hamstring between the operative and nonoperative sides in Group I (p > 0.05) while there were significant differences in strength of the quadriceps and hamstring between the operative and nonoperative sides in Group II (p < 0.05). There were significant differences in the endurance of the quadriceps and hamstring and knee joint position sense at 15°, 45°, and 75° between the operative sides of the patients in both groups (p < 0.05). CONCLUSIONS: The neuromuscular control exercises program was found to be more effective in reducing the difference in strength while the standard program was found to be more effective in reducing the difference in endurance between the operated knee and the other knee. This study revealed that neuromuscular control exercises should also be used to improve knee proprioception sense following ACL-R.