The Correlation between Intersegmental Coordination Variability and Frontal Plane Hip Kinematics during Running in Persons with Patellofemoral Pain.

Background: Despite the existing evidence indicating altered hip kinematics as well as the studies showing altered movement coordination variability in persons with patellofemoral pain (PFP), there is no study investigating the correlation between hip joint kinematic and movement coordination variability in persons with patellofemoral pain (PFP). Objective: This study aims to evaluate the correlation between peak hip adduction and variability of thigh frontal-shank transverse coordination during running in persons with PFP. Material and Methods: In this cross-sectional correlational study, kinematic data were collected from 34 females (17 with and 17 without PFP) aged 18-35 years during treadmill running at preferred and fixed speeds, each for 30 s. The continuous relative phase method was used to calculate the coordination of thigh frontal-shank transverse. To calculate the deviation phase as the variability of intersegmental coordination, the standard deviation of the ensemble continuous relative phase curve points was averaged. The parameters of interest were peak hip adduction and coordination variability of thigh frontal-shank transverse. The Pearson Correlation Coefficient (r) was used to calculate the correlation between the variables. Results: The Pearson correlation coefficient showed a significant negative correlation between the peak hip adduction angle and variability of thigh frontal- shank transverse during running at both fixed (r=-0.553, P<0.05) and preferred (r=-0.660, P<0.01) speeds in persons with PFP while the control group showed a small nonsignificant correlation (r<0.29, P>0.05). Conclusion: The results indicated that greater adduction of the hip joint in persons with PFP during running is contributed to lesser variability of thigh frontal-shank transverse.

Investigating the lumbar proprioception and core muscles recruitment pattern while getting up from a chair with weight lifting in patients with chronic functional constipation: cross-sectional study.

INTRODUCTION AND HYPOTHESIS: Patients with chronic functional constipation have some problems such as weakness of pelvic floor muscles, and a lack of coordination of pelvic floor and abdominal muscles has been seen. The goal of this study was to investigate the lumbar proprioception and the core muscle recruitment pattern. METHODS: The study type is a cross-sectional case-control study. There were 30 participants (case, n = 15, and control, n = 15). Electromyography of the core muscles was recorded while the subjects were getting up from the chair accompanied by lifting a weight, to check the pattern of muscle recruitment. Moreover, the lumbar proprioception was evaluated by an isokinetic device in both groups. The study was analyzed using independent t test and Mann-Whitney U test, and a nonparametric Friedman test was performed followed by Bonferroni pairwise comparison. RESULTS: The comparison of muscle activity delay between the two groups showed that there was a significant difference between the two groups regarding the abdominal muscles, anal sphincter, and erector spinae (p < 0.05). However, there was no significant difference in the rectus femoris and gluteal muscles between the two groups (p > 0.05). Moreover, the proprioception of the lumbar region showed a significant difference (p < 0.05) between the two groups. CONCLUSIONS: The results of this study demonstrated that the lumbar proprioception sense was reduced in the case group. This result can be justified, based on the problems in constipation (lack of coordination of muscles, weakness of pelvic floor muscles). The coordination of core muscles changed in patients with chronic functional constipation during a functional task.

The relationship between physical activity pre COVID-19 pandemic with mental health, depression, and anxiety in COVID-19 patients: a cross-sectional study.

Purpose: Covid-19 pandemic has gained a growing trend and affected mental health in several aspects. Physical activity guidelines was strongly associated with a reduced risk for severe COVID-19 outcomes among infected adults. The purpose of this study was to evaluate the association between physical activity pre COVID-19 pandemic with mental health, depression, and anxiety in COVID-19 patients. Methods: 206 hospitalized patients diagnosed with covid-19 (140 male and 66 female, aged 34.5 ± 12) were selected and completed physical activity questionnaire (IPAQ) and hospital anxiety and depression questionnaire (HADS). For physical activity status assessment, a self-completed IPAQ questionnaire was taken and patients were divided into: (1) low active, (2) moderate active and (3) high active groups according to their physical activity experience. One-way ANOVA test was recruited and Tukey post hoc test was taken to assess difference among means. Pearson correlation was used to evaluate the association between physical activity level and mental health status (p < 0.05). Results: The results from this study showed that anxiety and depression was significantly higher in low active patients (p = 0.001) and there was a negative correlation between physical activity level and HADS (p = 0.001). However, patients with high physical activity pre COVID-19 pandemic have a lowest levels of anxiety and depression compare to other groups (p < 0.001). Conclusion: It seems that adequate physical activity as a part of a healthy lifestyle may have a beneficial effect on mental health during the current outbreak of covid-19. Therefore, it is suggested that we perform exercise training every day to preconditioning effects.

Effects of neurorehabilitation with and without dry needling technique on muscle thickness, reflex torque, spasticity and functional performance in chronic ischemic stroke patients with spastic upper extremity muscles: a blinded randomized sham-controlled clinical trial.

PURPOSE: Evaluation the effects of dry needling on sonographic, biomechanical and functional parameters of spastic upper extremity muscles. METHODS: Twenty-four patients (35-65 years) with spastic hand were randomly allocated into two equal groups: intervention and sham-controlled groups. The treatment protocol was 12-sessions neurorehabilitation for both groups and 4-sessions dry needling or sham-needling for the intervention group and sham-controlled group respectively on wrist and fingers flexor muscles. The outcomes were muscle thickness, spasticity, upper extremity motor function, hand dexterity and reflex torque which were assessed before, after the 12th session, and after one-month follow-up by a blinded assessor. RESULTS: The analysis showed that there was a significant reduction in muscle thickness, spasticity and reflex torque and a significant increment in motor function and dexterity in both groups after treatment (p < 0.01). However, these changes were significantly higher in the intervention group (p < 0.01) except for spasticity. Moreover, a significant improvement was seen in all outcomes measured one-month after the end of the treatment in the intervention group (p < 0.01). CONCLUSIONS: Dry needling plus neurorehabilitation could decrease muscle thickness, spasticity and reflex torque and improve upper-extremity motor performance and dexterity in chronic stroke patients. These changes were lasted one-month after treatment.Trial Registration Number: IRCT20200904048609N1IMPLICATION FOR REHABILITATIONUpper extremity spasticity is one of the stroke consequences which interfere with motor function and dexterity of patient hand in activity of daily livingApplying the dry needling accompanied with neurorehabilitation program in post-stroke patients with muscle spasticity can reduce the muscle thickness, spasticity and reflex torque and improve upper extremity functions.

Evaluation of the Effect of Reduction Mammoplasty on Body Posture in Patients with Macromastia.

Background: Breast hypertrophy is a significant health problem with both physiological and psychological impacts on the patients' lives. Patients with macromastia adopt a corrective posture due to the effect of the breast on the center of gravity and possibly in a subconscious effort to conceal their breasts. Objective: This study aimed to evaluate whether the posture of patients with macromastia changed after the reduction of mammoplasty. Material and Methods: In this prospective study, patients with breast cup sizes C, D, and DD were scheduled for reduction mammoplasty in 3 Shiraz University Hospitals. Age, weight, height, and preoperative cup sizes of the breasts were recorded for every patient, and all patients underwent posture analysis with forceplate before and after reduction mammoplasty. Finally, the preoperative and postoperative data were compared. Results: Mean age at the time of reduction mammaplasty was 43.57±9.1; the mean pre-operation, such as weight, height, and mean the body mass index (BMI) was 76.57±10 kg, 158.28±6 cm and 30.57±4.1, respectively. The average Anterior-posterior (AP) direction velocity before and after the surgery was 0.85±0.12 cm/s and 0.79±0.098, respectively. These values were 0.83±0.09 and 0.81±0.10 for the mediolateral direction. The Detrended Fluctuation Analysis (DFA) value for the AP direction was 1.63±0.3 and 1.60±0.2 for pre-and post-surgery, respectively, which was not statistically different. The DFA value for maximum likelihood (ML) direction was 1.65±0.2 and 1.48±0.2 in pre-op and post-op, respectively, which was statistically significantly different. Conclusion: Reducing the weight of enlarged breasts can correct disturbed sagittal balance and postural sway.

The effects of lavandula aromatherapy on pain relief after coronary artery bypass graft surgery: A randomized clinical trial.

BACKGROUND AND AIMS: Coronary artery bypass graft surgery (CABG) is a primary treatment in coronary artery disease (CAD). Patients experience pain after CABG. Pain may increase postoperative complications and decrease quality of life (QoL). This study aims to determine the lavandula aromatherapy effect on patients' pain after CABG. METHODS: 98 patients undergoing CABG were randomly assigned to intervention and placebo groups. The intervention group inhaled 5-drops of 20 % lavandula essential oil (LEO) and the placebo group was exposed to 5-drop of distilled water. LEO or distilled water were dropped into a sterile gauze converted to the form of a necklace. The subjects wore necklace for three consecutive days and intervention was performed each 24 h. The pain intensity, systolic blood pressure (SBP), and diastolic blood pressure (DBP) were measured before each intervention and 30 min after it. Also, the mean analgesic intake was recorded. SPSS version 16 was used to analyze the data. RESULTS: The mean pain score measured in the intervention group showed a more decrease than that obtained in the placebo group after the first and second interventions. Additionally, the mean pain score in the intervention group demonstrated a significant decrease than the placebo group after the second intervention (P=0.008). Moreover, mean SBP after the second intervention (P=0.046) and mean DBP after the first intervention (P=0.029) revealed a significant difference between two groups. Moreover, the intervention group received less analgesic than the placebo group. CONCLUSIONS: Lavandula aromatherapy can reduce pain and received analgesic dose after CABG.

Susceptibility and Severity of COVID-19 Are Both Associated With Lower Overall Viral-Peptide Binding Repertoire of HLA Class I Molecules, Especially in Younger People.

An important number of studies have been conducted on the potential association between human leukocyte antigen (HLA) genes and COVID-19 susceptibility and severity since the beginning of the pandemic. However, case-control and peptide-binding prediction methods tended to provide inconsistent conclusions on risk and protective HLA alleles, whereas some researchers suggested the importance of considering the overall capacity of an individual's HLA Class I molecules to present SARS-CoV-2-derived peptides. To close the gap between these approaches, we explored the distributions of HLA-A, -B, -C, and -DRB1 1st-field alleles in 142 Iranian patients with COVID-19 and 143 ethnically matched healthy controls, and applied in silico predictions of bound viral peptides for each individual's HLA molecules. Frequency comparison revealed the possible predisposing roles of HLA-A*03, B*35, and DRB1*16 alleles and the protective effect of HLA-A*32, B*58, B*55, and DRB1*14 alleles in the viral infection. None of these results remained significant after multiple testing corrections, except HLA-A*03, and no allele was associated with severity, either. Compared to peptide repertoires of individual HLA molecules that are more likely population-specific, the overall coverage of virus-derived peptides by one's HLA Class I molecules seemed to be a more prominent factor associated with both COVID-19 susceptibility and severity, which was independent of affinity index and threshold chosen, especially for people under 60 years old. Our results highlight the effect of the binding capacity of different HLA Class I molecules as a whole, and the more essential role of HLA-A compared to HLA-B and -C genes in immune responses against SARS-CoV-2 infection.

HLA-DRB1*04 may predict the severity of disease in a group of Iranian COVID-19 patients.

Human leukocyte antigen (HLA) genes with extreme diversity can make a contribution for individual variations to the immune response against SARS-COV-2 infection. This study aimed to explore the distributions of HLA class II alleles frequencies and their relations with disease severity in a group of Iranian COVID-19 patients. This prospective and case-control study was conducted on 144 COVID-19 patients including 46 cases with moderate form, 54 cases with severe and 44 cases with critical disease. HLA-DRB1 and -DQB1 allele families were determined by PCR-SSP method and compared between three groups of the patients and in comparison to 153 ethnic-matched healthy controls. The patients group showed lower frequencies of HLA-DRB1*15 (OR = 0.57, P = 0.06), DRB1*15 ~ DQB1*05 haplotype (P = 0.04) and DRB1*15/DRB1*04 genotype (P = 0.04) in compare with healthy controls. Moderate COVID-19 patients had higher frequencies of HLA-DRB1*04 (P = 0.03), HLA-DRB1*10 (P = 0.05) and DRB1*04/DRB1*11 genotype (P = 0.01). Also, a higher significantly frequency of HLA-DRB1*03 allele group was observed in the critical patients versus controls (P = 0.01). Multiple logistic regression analysis revealed that the presence of DRB1*04 allele group was negatively associated with development of severe and critical disease (OR: 0.289, P = 0.005). Our results indicate a possible contribution of some HLA class II alleles in disease severity and clinical features of COVID-19 disease.

Trunk, pelvis, and knee kinematics during running in females with and without patellofemoral pain.

BACKGROUND: Females are two times more likely to develop patellofemoral pain (PFP) than males. Abnormal trunk and pelvis kinematics are thought to contribute to the pathomechanics of this condition. However, there is a scarcity of evidence investigating proximal segments kinematics in females with PFP. RESEARCH QUESTION: The purpose of this study was to investigate whether females with PFP demonstrate altered trunk, pelvis, and knee joint kinematics compared with healthy controls during running. METHODS: Thirty-four females (17 PFP, 17 controls) underwent a 3-dimensional motion analysis during treadmill running at preferred and fixed speeds, each trial for 30 s. Variables of interest included magnitudes of peak angles for trunk (forward flexion, ipsilateral trunk lean), pelvis (anterior tilt, contralateral drop), knee (flexion, valgus, internal rotation), range of motion (RoM) of trunk and pelvis in sagittal and frontal planes and RoM of knee joint in the three cardinal planes of motion. Kinematic data were compared between groups using mixed model repeated measure analysis of variance with the trial as the repeated measure. RESULTS: The PFP group displayed significantly less pelvis frontal plane RoM, greater knee frontal plane RoM, and less knee sagittal plane RoM during running compared with controls, irrespective of running trial. No differences were found in peak kinematic variables between PFP and healthy groups. SIGNIFICANCE: These results may suggest a rigid stabilization strategy at the pelvis, which the body has adapted to prevent further frontal plane knee malalignment. Less knee sagittal plane RoM may be indicative of another protective strategy in the PFP group to avoid patellofemoral joint reaction force. Clinical assessments and rehabilitative treatments may benefit from considering a global program with focus on pelvis kinematics in addition to the knee joint in females with PFP.

Evaluation of scapular mobilization and comparison to pectoralis minor stretching in individuals with rounded shoulder posture: A randomized controlled trial.

BACKGROUND: Rounded shoulder posture (RSP) is a common postural condition which can alter scapular position. Although, there is no consensus on the relationship between posture and musculoskeletal dysfunction, some evidence suggests a significant relationship between RSP and shoulder dysfunction. Therefore, treatment of this postural condition is important. Various treatment methods are used to correct RSP. However, the effectiveness of scapular mobilization, (SM) as a method which can alter scapular kinematics, has not been investigated. OBJECTIVE: To evaluate the effects of SM on scapular resting position in individuals with RSP, and to compare this technique to pectoralis minor self-stretching (PMS), and combined SM + PMS. METHODS: 52 healthy students (18 men and 34 women; mean age 23.67 ± 6.73 years) with RSP were randomly assigned to four groups (SM, PMS, combined SM + PMS, control). The mobilization group received SM, the stretching group performed self-PMS, and the combined group received SM + PMS. The control group received no treatment. Kinematics data to measure scapular protraction (cm), anterior tilt (°), internal rotation (°), and downward rotation (°) were captured with a motion analysis system before and after 5 sessions of group intervention. RESULTS: All variables decreased significantly post-intervention compared to baseline values (P < 0.05). Internal rotation and downward rotation decreased significantly in the intervention groups compared to the control group (P < 0.05). No significant differences were observed between the intervention groups. CONCLUSION: SM appears to be an effective technique to change scapular resting position in individuals with RSP. However, this technique was not superior to PMS or a combination of SM + PMS.

Effectiveness of Low-Level Laser Irradiation in Reducing Pain and Accelerating Socket Healing After Undisturbed Tooth Extraction.

Introduction: This study aimed to determine the effect of low-level laser therapy (LLLT) on reducing complications following tooth extraction. Methods: This randomized clinical trial consisted of 40 subjects who underwent lower molar extraction. The patients were randomly assigned to 4 groups. Group 1 was irradiated with a 660 nm laser (200 mW, 30 seconds radiation to lingual, buccal and occlusal surfaces of the socket, 6 J/area). In group 2, an 810 nm laser was applied similar to group 1. In group 3, a combination of 660 and 810 nm lasers was used. The patients in group 4 served as a placebo group. LLLT was performed after 0.5-1 hour of extraction and 2 days later. The participants were asked to record pain degree using a visual analogue scale (VAS) over 7 days. The amount of wound healing was evaluated on the third and seventh days. Results: There was no significant difference in pain scores among the groups at any of the assessment intervals (P >0.05). The between-group differences in wound healing scores were small and insignificant (P >0.05). Conclusion: LLLT with 660 nm or 810 nm lasers or their combination had no greater effect than the placebo laser for reducing the complications of tooth extraction.

Comparison of Maximum Oxygen Uptake and Rating Perceived Exertion in Woman's Kabaddi Athletes (Without Breathy Voice to Severe Breathy Voice).

OBJECTIVE: There is limited research on voice problems of athletes, especially Kabaddi athletes who use their voice during Kabaddi exercises and may damage their vocal folds and impair their voice quality. The present study aimed to compare maximum oxygen uptake (VO2max) and rating perceived exertion (RPE) in Woman's Kabaddi athletes without breathy voice (BV) to severe BV. MATERIALS AND METHODS: Seventy woman's Kabaddi athletes (mean age of 20.5 ± 2.7 years, height of 163 ± 3.6 cm, weight of 61.4 ± 5.4 kg) at the club and national team level (without BV to severe BV) were compared in this study. Data were collected by imaging the larynx by a stroboscopic device (there is gap and asymmetry between vocal folds, presence of mass on vocal folds, muscle tension dysphonia, hoarseness, and harshness), evaluating the voice parameters by Vocal Assessment software (mean F0 (Hz), F0SD (Hz), jitter (%), shimmer (%), Normal Noise Energy (NNE) (dB)), and calculating VO2max by Bruce treadmill test. RPE was calculated by a 15-point (6-20) Borg test. RESULTS: The results showed that 39 (55.17%) subjects had moderate and high BV symptoms and 31 (44.28%) had no symptoms of BV and low BV. The mean fundamental frequency in the group with moderate and severe BV was equal to 2.59 Hz opposite the mean fundamental frequency in the group without BV and low BV was equal to 0.65 Hz, and in contrast, the jitter (0.47%) opposite (0.19%) and the shimmer was equal to (6.64%) opposite (0.67%) and the NNE was equal to (-3.08 dB) In front of (-11.95 dB). There was no significant difference between VO2max in two groups of Woman's Kabaddi athletes as well as RPE in two groups of Woman's Kabaddi athletes at significant level of P ≤ 0.05. CONCLUSIONS: Severe BV is affected by voice abuse. Voice abuse during Kabaddi is negatively affecting the quality of voice. After Kabaddi sport, athletes are complained from obstruction, hoarseness, and harshness due to disturbances in vocal folds and throat dryness. According to the data obtained from this study, abuse has a negative effect on vocal folds, which is followed by BV in various degrees in Kabaddi athletes.

Comparison of the trunk-pelvis and lower extremities sagittal plane inter-segmental coordination and variability during walking in persons with and without chronic low back pain.

Inter-segmental coordination can be influenced by chronic low back pain (CLBP). The sagittal plane lower extremities inter-segmental coordination pattern and variability, in conjunction with the pelvis and trunk, were assessed in subjects with and without non-specific CLBP during free-speed walking. Kinematic data were collected from 10 non-specific CLBP and 10 non-CLBP control volunteers while the subjects were walking at their preferred speed. Sagittal plane time-normalized segmental angles and velocities were used to calculate continuous relative phase for each data point. Mean absolute relative phase (MARP) and deviation phase (DP) were derived to quantify the trunk-pelvis and bilateral pelvis-thigh, thigh-shank and shank-foot coordination pattern and variability over the stance and swing phases of gait. Mann-Whitney U test was employed to compare the means of DP and MARP values between two groups (same side comparison). Statistical analysis revealed more in-phase/less variable trunk-pelvis coordination in the CLBP group (P<0.05). CLBP group demonstrated less variable right or left pelvis-thigh coordination pattern (P<0.05). Moreover, the left thigh-shank and left shank-foot MARP values in the CLBP group, were more in-phase than left MARP values in the non-CLBP control group during the swing phase (P<0.05). In conclusion, the sagittal plane lower extremities, pelvis and trunk coordination pattern and variability could be generally affected by CLBP during walking. These changes can be possible compensatory strategies of the motor control system which can be considered in the CLBP subjects.

Effects of Plantar Flexor Muscle Static Stretching Alone and Combined With Massage on Postural Balance.

OBJECTIVE: To evaluate and compare the effects of stretching and combined therapy (stretching and massage) on postural balance in people aged 50 to 65 years. METHODS: Twenty-three subjects participated in this nonrandomized clinical trial study. Each participant randomly received plantar flexor muscle stretching (3 cycles of 45 seconds with a 30-second recovery period between cycles) alone and in combination with deep stroking massage (an interval of at least 30 minutes separated the two interventions). The data were recorded with a force platform immediately after each condition with eyes open and closed. The center of pressure displacement and velocity along the mediolateral and anteroposterior axes were calculated under each condition. The data were analyzed with multiple-pair t-tests. RESULTS: The center of pressure displacement and velocity along the mediolateral axis increased after both stretching and the combined intervention. There were significant differences in both values between participants in the stretching and combined interventions (p<0.05). CONCLUSION: Plantar flexor muscle stretching (for 45 seconds) combined with deep stroking massage may have more detrimental effects on postural balance than stretching alone because each intervention can intensify the effects of the other.

Comparison of manual therapy and exercise therapy for postural hyperkyphosis: A randomized clinical trial.

OBJECTIVE: To compare the efficacy of a manual therapy and an exercise therapy program in improving postural hyperkyphosis among young adults. METHODS: Forty-six women between the ages of 18 to 30 years with thoracic kyphosis diagnosed by flexicurve ruler were randomly assigned to either an exercise therapy or a manual therapy group. The exercise therapy program focused on stretching and strengthening exercises in 15 sessions over 5 weeks. The manual therapy group received 15 sessions of manual techniques including massage, mobilization, muscle energy and myofascial release. Kyphosis angle and back extensor muscle strength were measured with a motion analysis system and a dynamometer at the baseline and after treatment. The data were analyzed with paired and independent t-tests. RESULTS: After treatment, the angle of thoracic kyphosis was smaller and back extensor muscle strength was significantly greater in both the exercise and manual therapy groups (p < 0.001). We found no significant differences between groups in the changes in kyphosis angle or muscle strength after treatment (p > 0.05). CONCLUSION: Manual therapy was as effective as exercise therapy in reducing kyphosis angle and increasing back extensor muscle strength in young women with postural hyperkyphosis.

Assessment of functional parameters and comfort of a new computer mouse as compared with other types of input devices.

BACKGROUND: This study was conducted to assess functional parameters and comfort of a new computer mouse (Ergomice) as compared with three other input devices. MATERIALS AND METHODS: Functional parameters (i.e., task completion time and error rate) of each device were assessed by 10 participants using standardized software based on Standard No. ISO 9241-9:2000. Comfort evaluation was also undertaken for each device using the visual analogue scale technique. Statistical analysis including the Wilcoxon signed-rank test and the Friedman test was performed using SPSS version 16. RESULTS: The functional parameters of the standard mouse were better than those of the other devices. However, no significant difference was observed between this mouse and Ergomice. Overall comfort evaluation showed that the standard mouse and Ergomice were more comfortable to work with. The comfort level of hand/wrist posture in the Ergomice was higher than that of the other three devices. CONCLUSION: The design features of Ergomice could improve its functional properties. Hand/wrist posture comfort of Ergomice was judged to be high compared with that of the other devices.

Comparison between massage and routine physical therapy in women with sub acute and chronic nonspecific low back pain.

OBJECTIVE: The aim of this study was to investigate the comparison of massage therapy and routine physical therapy on patients with sub acute and chronic nonspecific low back pain. METHODS AND MATERIALS: Thirty volunteer female subjects with a sub acute or chronic nonspecific low back pain were randomly enrolled in two groups, massage therapy and routine physical therapy. After massage application, the hamstring and paravertebral muscles stretching and also stabilizing exercises were prescribed. In the routine physical therapy group, TENS, US and vibrator were used besides exercises. Pain intensity according to Numerical Rating Scale, functional disability level in accordance to Oswestry Disability Index, and modified Schober test, for measurement of flexion range of motion, before and after ten sessions of treatment were used to evaluate the effectiveness of the treatment. RESULTS: Pain intensity, Oswestry Disability Index and flexion range of motion had shown significant differences before and after intervention in both groups (p<0.001). The statistical analysis revealed that the massage therapy had significantly improved the pain intensity and Oswestry Disability Index compared to routine physical therapy (p=0.015, p=0.013 respectively), but the range of motion changes were not significant between two groups (p=1.00). CONCLUSION: It can be concluded that both massage therapy and routine physical therapy are useful for sub acute and chronic nonspecific low back pain treatment especially if accompanied with exercise. However, massage is more effective than other electrotherapy modalities, and it can be used alone or with electrotherapy for the treatment of patients with low back pain.