Is Adding Education to Trunk and Hip Exercises Beneficial for Patellofemoral Pain? A Randomized Controlled Trial.

OBJECTIVE: To investigate the effect of adding education to trunk and hip exercises in patients with patellofemoral pain (PFP). DESIGN: A randomized controlled trial. SETTING: Research laboratory. PARTICIPANTS: Sixty patients with PFP (N=60) were randomly assigned to either an experimental group (education followed by trunk and hip exercises, n=30) or a control group (trunk and hip exercises, n=30). INTERVENTIONS: Both groups received 8 weeks of trunk and hip exercises, while patients in the experimental group participated in 3 prior education sessions. MAIN OUTCOME MEASURES: The primary outcome was pain; secondary outcomes were pain catastrophizing, kinesiophobia, function, and muscle strength. Outcomes were assessed at baseline, after 8 weeks (post-intervention), and 3 months post-intervention (follow-up). RESULTS: No significant between-group differences were observed for pain outcome post-intervention. The experimental group showed superiority over the control group in the improvement of pain catastrophizing (mean difference: -2.32; 95% confidence interval [CI] -1.059 to 0.028) and kinesiophobia (mean difference: -3.56; 95% CI -1.067 to -0.035) at post-intervention. In the experimental group, improvements were maintained at follow-up assessment for all outcomes, except muscle strength. CONCLUSION: Adding education to trunk and hip exercises was associated with greater improvements in psychological outcomes than trunk and hip exercises alone after the intervention. Education can be incorporated when designing trunk and hip exercises for patients with PFP.

Examining the influence of pain neuroscience education followed by a Pilates exercises program in individuals with knee osteoarthritis: a pilot randomized controlled trial.

BACKGROUND: Knee osteoarthritis (OA) is a multifactorial form of rheumatic condition contributing to physical and psychological factors. Treatments have been provided solely and often compared with each other. An alternative view is that combined treatments addressing physical and psychological factors may result in more benefits. This study aimed to investigate the effect of pain neuroscience education (PNE) followed by Pilates exercises (PEs) in participants with knee OA, compared to PE alone. METHODS: In this two-arm assessor-blind pilot randomized controlled trial, fifty-four community-dwelling adults with knee OA were randomly assigned to the PNE followed by PEs and PEs groups (27 in each group). The study was conducted between early July 2021 and early March 2022 at the university's health center. Primary outcomes were Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) subscales of pain and physical limitation and secondary outcomes were Pain Catastrophizing Scale, Tampa Scale for Kinesiophobia, Pain Self-Efficacy Questionnaire, and Timed "Up & Go" test covering function. The primary and secondary outcomes were measured at baseline and eight weeks post-treatment. A general linear mixed model was used for between-group comparison with a statistical significance level of 0.05. RESULTS: Significant within-group differences were observed in all outcomes in both groups at post-treatment. There were no statistically between-group differences in pain (adjusted mean difference: -0.8; 95% CI -2.2 to 0.7; p = 0.288), physical limitation (adjusted mean difference: -0.4; 95% CI -4 to 3.1; p = 0.812) and function (adjusted mean difference: -0.8; 95% CI -1.8 to 0.1; p = 0.069) at eight weeks. For pain catastrophizing (adjusted mean difference: -3.9; 95% CI -7.2 to -0.6; p = 0.021), kinesiophobia (adjusted mean difference: -4.2; 95% CI -8.1 to -0.4; p = 0.032), and self-efficacy (adjusted mean difference: 6.1; 95% CI 0.7 to 11.5; p = 0.028) statistically between-group improvements were observed favoring PNE followed by PEs group after the treatment. CONCLUSIONS: Combining PNE with PEs could have superior effects on psychological characteristics but not on pain, physical limitation, and function, compared to PEs alone. This pilot study emphasizes the need to investigate the combined effects of different interventions. TRIAL REGISTRATION: IRCT20210701051754N1.

Comparing Functional Motor Control Exercises With Therapeutic Exercise in Wrestlers With Iliotibial Band Syndrome.

CONTEXT: Iliotibial band syndrome (ITBS) is a common overuse injury in runners with parallels to our findings of overuse in Greco Roman wrestlers. Despite research indicating coordination and movement-based factors about the hip, no studies were found using functional motor control (FMC) in runners or wrestlers with ITBS. Thus, we compared FMC exercises and therapeutic exercises (TEs) on pain, function, muscle strength, and range of motion (ROM) in national-level Greco Roman wrestlers with ITBS. DESIGN: Controlled laboratory study. METHODS: Sixty national-level Greco Roman wrestlers diagnosed with ITBS were randomly assigned to 8 weeks of FMC exercises, TE, and a control group (20 individuals for each group). Pain (visual analog scale), function (triple hop test for distance, single-leg vertical jump test, and agility T test), muscle strength (handheld dynamometer), and ROM (goniometer) were measured at baseline and 8 weeks after intervention as posttest. RESULTS: Although both interventions significantly reduced pain (P < .001, η2 = .87), improved function (triple hop test P = .004, η2 = .94; single-leg vertical jump P = .002, η2 = .93; and T test P < .001, η2 = .93) and strength (hip abduction (P < .001, η2 = .52), hip external rotation (P = .02, η2 = .95), knee flexion (P ≤ .001, η2 = .94), and knee extension (P < .001, η2 = .91) compared with the control group, FMC showed more significant improvements in comparison with TE. Significant differences (P = .001) were observed between FMC and TE compared with the control group in ROM outcome. However, TE was more effective than FMC in improving ROM hip abduction (P < .001, η2 = .93), hip adduction (P = .000, η2 = .92), hip internal rotation (P < .001, η2 = .92), and hip external rotation (P < .001, η2 = .93). CONCLUSION: FMC exercises were superior to TE in terms of pain, function, and muscle strength, whereas TE was more effective for improving ROM. FMC exercise is suggested as an effective intervention for improvement of the outcomes related to ITBS in national-level Greco Roman wrestlers.

Examining the Influence of Attentional Focus on the Effects of a Neuromuscular Training Program in Male Athletes.

ABSTRACT: Ghanati, HA, Letafatkar, A, Almonroeder, TG, and Rabiei, P. Examining the influence of attentional focus on the effects of a neuromuscular training program in male athletes. J Strength Cond Res 36(6): 1568-1575, 2022-Neuromuscular training programs that incorporate lower extremity strengthening, plyometric exercises, balance training, and movement retraining are recommended for anterior cruciate ligament injury prevention; however, there is a need to improve their effectiveness. The purpose of this study was to examine how athletes' attentional focus during training influences the effects of an 8-week neuromuscular training program on hip strength, single-leg landing mechanics, and hop performance. Sixty-six male athletes were randomly allocated to a group that trained with an internal focus, a group that trained with an external focus, or a control group. All athletes completed testing before (baseline) and after (posttesting) the 8-week period. Isokinetic hip strength, hip and knee kinematics and ground reaction forces during landing, and hop distance were examined as part of this study. Analysis of covariance was used to compare posttesting outcomes among the groups while accounting for group differences in baseline performance. The neuromuscular training program resulted in improved hip abduction strength, reduced hip adduction and internal rotation motion during landing, and increased hop distance for athletes who trained with an external focus. However, the program did not seem to influence hip strength, landing kinematics, or hop performance for athletes who trained with an internal focus. Our findings indicate that male athletes may benefit from completing a neuromuscular training program with an external focus vs. an internal focus. Trainers, coaches, and clinicians should consider using instructions that promote an external focus when implementing neuromuscular training programs with male athletes.

Comparing Pain Neuroscience Education Followed by Motor Control Exercises With Group-Based Exercises for Chronic Low Back Pain: A Randomized Controlled Trial.

BACKGROUND: Different individualized interventions have been used to improve chronic low back pain (CLBP). However, their superiority over group-based interventions has yet to be elucidated. We compared an individualized treatment involving pain neuroscience education (PNE) plus motor control exercise (MCE) with group-based exercise (GE) in patients with CLBP. METHODS: Seventy-three patients with CLBP were randomly assigned into the PNE plus MCE group (n = 37) and GE group (n = 36). Both PNE plus MCE and GE were administered twice weekly for 8 weeks. Pain intensity (as measured using the VAS), disability (as measured using the Roland-Morris Disability Questionnaire), fear-avoidance beliefs (as measured using the Fear-Avoidance Beliefs Questionnaire), and self-efficacy (as measured using the Pain Self-Efficacy Questionnaire) were assessed at baseline and 8 weeks post-intervention. A 2 × 2 variance analysis (treatment group × time) with a mixed-model design was applied to statistically analyze the data. RESULTS: Both groups showed significant improvements in all the outcome measures, with a large effect size (P < 0.001, partial eta squared [ηp2 ] = 0.66 to 0.81) after the intervention. The PNE plus MCE group showed greater improvements, with a moderate effect size in pain intensity (P = 0.041, ηp2  = 0.06) and disability (P = 0.021, ηp2  = 0.07) compared to the GE group. No significant difference was found in fear-avoidance beliefs during physical activity and work, and self-efficacy (P > 0.05) between the 2 groups. CONCLUSION: PNE and MCE seem to be better at reducing pain intensity and disability compared to GE, while no significant differences were observed for fear-avoidance beliefs and self-efficacy between the 2 groups in patients with CLBP. With regard to the superiority of individualized interventions over group-based ones, more studies are warranted.

Comparing the effects of no intervention with therapeutic exercise, and exercise with additional Kinesio tape in patients with shoulder impingement syndrome. A three-arm randomized controlled trial.

OBJECTIVE: To investigate if adding Kinesio tape to therapeutic exercise is an effective treatment to improve clinical outcomes compared to therapeutic exercise alone and no intervention, in patients with shoulder impingement syndrome. DESIGN: Three-arm randomized controlled trial. SETTING: Outpatient setting. SUBJECTS: One hundred and twenty patients (mean (SD): age 37.8 (5.4)) with shoulder impingement syndrome. INTERVENTION: Patients were randomly assigned to eight-weeks therapeutic exercise alone, therapeutic exercise with Kinesio tape, and control group. MAIN MEASURES: Pain was measured with a numerical rating scale and disability and scapular kinematics were measured with a relative questionnaire and motion analysis software respectively, at baseline and after eight-weeks intervention. RESULTS: There was significant differences in therapeutic exercise with Kinesio tape group vs. therapeutic exercise alone and control group respectively for pain (d = -0.34, P = 0.042; and d = -1.53, P = 0.001), disability (d = -0.46, P = 0.024; and d = -2.18, P = 0.001), scapular upward rotation at sagittal plane (d = 0.33, P = 0.033; and d = 0.68, P = 0.001), scapular plane (d = 0.18, P = 0.045; and d = 0.43, P = 0.001), scapular tilt at sagittal plane (d = 0.55, P = 0.043; and d = 1.39, P = 0.001), and scapular plane (d = 0.29, P = 0.034; and d = 0.58, P = 0.001). Therapeutic exercise alone was superior over control group in all significant outcomes (P < 0.05). CONCLUSION: Although therapeutic exercises alone showed positive effect on clinical outcomes, adding Kinesio tape to therapeutic exercises had more significant effects with larger effect sizes. Adding Kinesio tape to therapeutic exercise may be of some assistance to clinicians in improving clinical outcomes in patients with shoulder impingement syndrome.

Effect of neuromuscular training augmented with knee valgus control instructions on lower limb biomechanics of male runners.

OBJECTIVE: To examine if combining neuromuscular training (NMT) with knee valgus control instructions (VCIs) can affect lower limb biomechanics and injury incidence in male novice runners and assess over 1-year follow-up. DESIGN: Controlled laboratory Study. SETTING: University research laboratory. PARTICIPANTS: 60 male novice runners randomly assigned into NMT (n = 20), NMT plus VCIs (n = 20), and sham (n = 20). MAIN OUTCOME MEASURES: Kinematic and kinetic were measured at pre- and post-test and 1-year follow-up. Injury incidence assessed at pre-test and 1-year follow up. RESULTS: There were significant between-group differences in kinetics after 6 weeks in NMT plus VCIs group. No significant differences were observed between NMT and NMT plus VCIs in kinematic variables. No significant change was seen in the sham in all variables. At 1-year follow-up, the minimal changes were seen in kinetic variables. Reduction reported running-related injuries were 31.58% in the NMT alone group, 65.52% in NMT plus VCIs group. In sham, it increased to 13.46%. CONCLUSIONS: NMT plus VCIs was effective to reduce kinetics and improve kinematics in novice runners. Also, it could reduce injury incidence. This protocol may be an option for both athletic trainers and coaches for preventing of lower limbs' injury in male runners.

Effect of therapeutic exercise routine on pain, disability, posture, and health status in dentists with chronic neck pain: a randomized controlled trial.

PURPOSE: To investigate the effect of therapeutic exercise (TE) on pain, disability, posture, and health status in female dentists suffering from chronic neck pain (NP). METHODS: 48 female dentists (40-45 years) suffering from NP were randomly divided into two experimental (n = 24) and control (n = 24) groups. Experimental group received 8 weeks of TE aimed to improve (1) muscle coordination and proprioception, (2) muscular endurance, and (3) muscle strength. Control group received no specific exercises. The pain, disability, posture (forward head and protracted shoulder angles), and health status were assessed at baseline and after an 8-week TE by visual analogue scale (VAS), neck disability index (NDI), photogrammetry, and self-rated general health questionnaire, respectively. Wilcoxon and Mann-Whitney non-parametric tests were used for statistical analysis. RESULTS: There were significant between-group differences in neck pain [p = 0.003, 0.86 (0.09-1.65)], disability [p = 0.009, ES (95% CI) = 0.78 (0.020-1.37)], forward head angle [p = 0.039, ES (95% CI) = 0.61 (0.034-1.19)], protracted shoulder angle [p = 0.031, ES (95% CI) = 0.64 (0.062-1.22)], and health status [p = 0.022, ES (95% CI) = 0.68 (0.102-1.26)] favoring the corrective exercise group. There were significant within-group changes in pain, disability, posture, and health status in the experimental group. However, there were no within group changes in the control group. CONCLUSIONS: TEs successfully alleviated pain, disability, posture, and health status in female dentists suffering from chronic NP. Considering the extremely large effect size of TEs, this intervention was recommended to neck pain treatment in patients suffering from chronic NP, poor posture, and health problem.

Long-term efficacy of conditioning training program combined with feedback on kinetics and kinematics in male runners.

This study was aimed to compare the effects of 8-week conditioning training (CT) programs with and without feedback on lower limbs' biomechanics and injury incidence in free-injury male runners and assess their effectiveness across a 1-year observation. A total of 49 healthy male runners were randomly assigned to one of three groups of CT (n = 16), CT with feedback (n = 17), and placebo (n = 16) group. Kinematic and kinetic measurements were conducted at pre-intervention, 8 weeks post-intervention, and 1-year follow-up stage. Injury incidence was also measured at pre-intervention and follow-up stage. As a result, significant improvement was found in within-group differences in CT and CT with feedback groups. Moreover, significant difference in CT with feedback group was observed in the kinetic outcome improvement after 8 weeks as compared to CT group. On the other side, there were no significant differences between the CT and CT with feedback groups in kinematic outcomes. However, the percentage of changes in kinematic outcomes were higher in CT with feedback group than those in the CT group. No significant change was observed in the placebo group in all the variables. There was comparative between-group difference between CT with feedback group and the placebo one, favoring the former group. At 1-year follow-up, the injury incidence was reduced by 32% for CT group, 64.6% for CT with feedback group, and 15.5% for placebo. Thus, the CT with feedback was effective in improving biomechanics and reducing injury incidence. Improvements were generally maintained through 1 year, indicating potential for long-term changes. This study demonstrates the applicability of using feedback with CT to enhance safer movement patterns in runners and may subsequently help prevent or reduce injury risks.

EFFICACY OF PERTURBATION-ENHANCED NEUROMUSCULAR TRAINING ON HAMSTRING AND QUADRICEPS ONSET TIME, ACTIVATION AND KNEE FLEXION DURING A TUCK-JUMP TASK.

BACKGROUND: Deficits in dynamic neuromuscular control of the knee may contribute to the higher incidence of the anterior cruciate ligament (ACL), specifically in female athletes. Little is known about the effects of preventive training programs on muscle onset time and activation during functional tasks. PURPOSE: The purpose of this study was to evaluate the efficacy of perturbation-enhanced neuromuscular training on hamstring and quadriceps onset time and activation, and knee flexion angle in female athletes with quadriceps dominance (QD) deficit during a tuck-jump (TJ) task. STUDY DESIGN: Quasi-experimental study. METHODS: Thirty-one collegiate female athletes with neuromuscular quadriceps dominance deficit randomly divided into experimental (n=16) and control (n=15) group. The experimental group performed a six-week perturbation training (18 sessions). Electromyograhic (EMG) assessment of quadriceps and hamstring activation and knee flexion angles during a TJ task were completed at baseline and after six weeks. RESULTS: A significant decrease in the preparatory(p=0.003) and reactive (p=0.013) quadriceps-hamstring (Q/H) co-activation ratio was found in the experimental group. Perturbation training markedly decreased latency in medial hamstring (MH) (p=0.001), vastus medialis (VM) (p=0.004) and lateral hamstring (LH) (p=0.031), while latency increased for rectus femoris (RF) (p=0.001) and vastus lateralis (VL) (p=0.023) during a TJ task. The experimental group had average increases of 41.1%, 40.8%, and 39.5% in initial knee flexion, peak knee flexion and knee flexion displacement angle during the TJ task, respectively. CONCLUSION: Increased preparatory VM and MH activities and decreased Q/H co-activation ratio, decreased VM and MH latency represent preprogrammed motor strategies learned during the perturbation training. This observed neuromuscular adaptation during TJ task could potentially reduce the risk for non-contact ACL injury. LEVEL OF EVIDENCE: 2.

The effects of selective Pilates versus extension-based exercises on rehabilitation of low back pain.

INTRODUCTION: Chronic non-specific low back pain (LBP) may lead to functional impairment and physical disability. The aim of this study was to compare the effects of selective Pilates (SP) and extension-based (EB) exercises on pain, lumbar spine curvature, lumbar forward flexion range of motion (ROM), and physical disability in such individuals. MATERIALS AND METHODS: In this randomized clinical trial, Forty-seven patients with chronic non-specific LBP (Mean of age: 39.7 years) were randomly allocated into either SP (N = 16), EB (N = 15), or control (N = 16) groups. The measurements included pain intensity, physical disability, lumbar forward bending ROM, and lumbar spine curvature at the baseline, after receiving the 6-week interventions, and also following one month of cessation of the exercises The analysis of co-variance (ANCOVA) and Post-hoc Bonferroni tests were administered to compare the three groups after the interventions and one month later (P < 0.05). RESULTS: More significant improvement was observed in SP group compared to the subjects receiving EB exercises in terms of pain, ROM, and physical disability (P < 0.001), however, there was no significant difference between the two experimental groups for lumbar curvature (P > 0.05). Furthermore; in follow-up, the patients in SP group significantly achieved a higher level of pain intensity improvement and lumbar flexion ROM than the EB exercises (P < 0.001). CONCLUSIONS: It is estimated that core muscles activation and improving lumbopelvic rhythm in SP training may play a role in decreasing pain and physical disability in chronic LBP patients. Further high-quality studies are required to investigate the details of this mechanism.

The comparison of the effectiveness of conventional therapeutic exercises and Pilates on pain and function in patients with knee osteoarthritis.

The aim of this study was to investigate the effectiveness of two different interventions on pain and disability in patients with knee osteoarthritis (KOA). Forty-one individuals (Mean ± SD: Age 52.1 ± 8.9 years, Height 172.8 ± 6.6 cm, Weight 80.2 ± 6.9 kg) with KOA were randomly allocated into Pilates (N = 14), conventional therapeutic exercise (CTE) (N = 14), and control (N = 13) groups. Joint position sense (JPS), functional performance, pain, and disability were examined using Biodex system, aggregate time of four daily activities, and Lequesne Index. One-Way ANOVA, and Post Hoc Scheffe test were administrated to analyze the data (P < 0.05). There was a significant (P < 0.001) difference between the experimental groups in all measured outcomes compared to the control. While, regarding pain and disability, more significant (P = 0.003) improvement was observed in participants following Pilates training compared to CTE. It seemed that Pilates training was more effective than the CTE to improve pain and disability in individuals with KOA.