CT-based comprehensive scoring system for assessing hip arthropathy in ankylosing spondylitis: feasibility study with clinical correlation.

OBJECTIVE: To develop a CT-based scoring system for assessment of hip arthropathy in AS. METHODS: All AS patients were prospectively recruited, consented, and underwent whole-body stereoradiographs and pelvis CT, which were assessed by two independent radiologists. Stereoradiographs were assessed according to Kellgreen-Lawrence and BASRI-h. For the Hip arthropathy CT score in AS (HACTSAS), joints were divided into 7 segments and scored for joint space, osteophytes, subchondral cysts/erosions. Patients were clinically assessed for range of motion (ROM), pain, and clinical scores (BASMI, BASFI, ASQol, BASDAI and ASDAS). Radiological scores correlations with clinical parameters were compared. ROM sensitivity and specificity for hip arthropathy (BASRI-h ≥ 2) were calculated. RESULTS: Sample included 112 patients, with 36/112 females and 76/112 males. Average age was 51.0 ± 11.2 years and mean duration of AS was 20.9 ± 9.6 years. ICC for HACTSAS, Kellgreen-Lawrence and BASRI-h were 0.89, 0.89 and 0.82 respectively. HACTSAS showed moderate absolute correlation with ROM (ρ=-0.41) and BASMI (ρ = 0.45), and weak with pain (ρ = 0.18) and BASFI (ρ = 0.25). BASRI-h and Kellgreen-Lawrence exhibited moderate correlation with ROM (ρ=-0.44 and ρ=-0.40, respectively), weak with pain (ρ=-.27and ρ=-0.23, respectively) and BASFI (ρ=-0.16 and ρ=-0.18, respectively), but only weak with BASMI (ρ=-0.34 and ρ=-0.36, respectively). Internal rotation <15°, abduction <31°, and intermalleolar distance <75cm were, respectively, 73%, 70% and 73% sensitivity and 81%, 65% and 68% specific for hip arthropathy. CONCLUSION: HACTSAS exhibited higher correlation with BASMI and BASFI when compared with BASRI-h, but less correlation with pain and ROM. Internal rotation was the best clinical discriminator for hip arthropathy.

Association of Knee Osteoarthritis and Flexion Contracture With Localized Tibial Articular Cartilage Loss: Data From the Osteoarthritis Initiative.

OBJECTIVE: To evaluate whether a knee flexion contracture (FC) was associated with localized tibial articular cartilage loss over a 1-year period using Osteoarthritis Initiative quantitative data. METHODS: Five hundred seventy-eight participants from a previously established nested case-control study of people with radiographic knee OA with or without progression, based on radiographs and symptoms, had their knee range of extension measured at baseline and received magnetic resonance imaging (MRI) at baseline and 1 year. The tibial articular cartilage of the medial and lateral condyles was segmented into anterior, center, and posterior regions. We tested for associations between knee FC (defined as lack of extension to 0°), and localized changes in tibial articular cartilage thickness or percent of denuded bone (0 mm thickness) after 1 year relative to baseline using ANOVA, controlling for baseline MRI outcomes and clinical factors. RESULTS: Knee FC was associated with denuded bone in the medial condyle center (ß 0.44, 95% CI 0.02-0.86) and preserved cartilage thickness in the medial condyle posterior (ß 0.01, 95% CI 0.002-0.03) regions. CONCLUSION: Knee FC unloading the tibial center region and loading the posterior region was associated with localized articular cartilage loss centrally and preserved articular cartilage posteriorly. These findings are consistent with knee FC negatively affecting unloaded tibial articular cartilage.

Validity and Reliability of Upper Limb Kinematic Assessment Using a Markerless Motion Capture (MMC) System: A Pilot Study.

OBJECTIVE: To investigate the validity and test-retest reliability of a customized markerless motion capture (MMC) system that used iPad Pros with a Light Detection And Ranging scanner at two different viewing angles to measure the active range of motion (AROM) and the angular waveform of the upper-limb-joint angles of healthy adults performing functional tasks. DESIGN: Participants were asked to perform shoulder and elbow actions for the investigator to take AROM measurements, followed by four tasks that simulated daily functioning. Each participant attended 2 experimental sessions, which were held at least 2 days and at most 14 days apart. SETTING: A Vicon system and 2 iPad Pros installed with our MMC system were placed at 2 different angles to the participants and recorded their movements concurrently during each task. PARTICIPANTS: Thirty healthy adults (mean age: 28.9, M/F ratio: 40/60). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The AROM and the angular waveform of the upper-limb-joint angles. RESULTS: The iPad Pro MMC system underestimated the shoulder joint and elbow joint angles in all four simulated functional tasks. The MMC demonstrated good to excellent test-retest reliability for the shoulder joint AROM measurements in all 4 tasks. CONCLUSIONS: The maximal AROM measurements calculated by the MMC system had consistently smaller values than those measured by the goniometer. An MMC in iPad Pro system might not be able to replace conventional goniometry for clinical ROM measurements, but it is still suggested for use in home-based and telerehabilitation training for intra-subject measurements because of its good reliability, low cost, and portability. Further development to improve its performance in motion capture and analysis in disease populations is warranted.

Effects of kinesiotaping during early post-operative rehabilitation in individuals who underwent a total knee arthroplasty: A systematic review and meta-analysis of randomized control trials.

OBJECTIVE: To report the treatment effects of early use kinesiotaping on pain, range of motion, mobility, and edema outcomes following total knee arthroplasty. DATA SOURCES: Cochrane Central Register of Controlled Trials, PubMED, SPORTDiscus, Biosis Citation Index, and the Cumulative Index to Nursing and Allied Health Literature were searched for potential randomized control trials from inception to 8 January 2024. REVIEW METHODS: Randomized control trials evaluating the effect of kinesiotaping published in English were included. Reference lists for relevant reviews were searched. Study quality was assessed using the Cochrane Risk of Bias 2 tool. Certainty of evidence was determined using the Grading of Recommendations Assessment, Development, and Evaluation approach. RESULTS: Seven articles totaling 534 participants were included for meta-analysis. Kinesiotaping with standard rehabilitation when compared to standard rehabilitation alone had very low certainty of evidence in pain and knee flexion range of motion. Kinesiotaping was favored at post-operative days two to four for pain (P = 0.03, standard mean difference = -0.77 [-1.45, -0.09]) and range of motion (P = 0.002, standard mean difference = -0.24 [-0.44, -0.03]). Kinesiotaping was favored at post-operative days six to eight for pain (P = 0.02, standard mean difference = -0.76 [-1.41, -0.12]) and range of motion (P = 0.04, standard mean difference = -0.63 [-1.22, -0.04]). Edema and mobility could not be meta-analyzed. CONCLUSION: The use of kinesiotaping early in post-operative rehabilitation could be a useful modality for reducing pain and increasing the range of knee flexion, however, the certainty of evidence is very low.

Acute effect of static stretching on non-muscular tissue stiffness and joint flexibility: a comparative study between older and young men.

PURPOSE: Non-muscular tissue stiffness is assumed to have a negative impact on joint flexibility, and a reduction in non-muscular tissue stiffness may be important, especially in older adults. The present study aimed to compare the acute effects of static stretching on non-muscular tissue stiffness between older and young adults and to investigate whether a decrease in tissue stiffness improves joint flexibility. METHODS: Twenty older (62-83 years) and 20 young (21-24 years) males participated. Ankle dorsiflexion static stretching (five sets of 90 s each) was performed, and before and after stretching, the ankle dorsiflexion range of motion (RoM), passive ankle joint stiffness, and shear wave speed (SWS) (an index of stiffness) of the sciatic nerve, tibial nerve, and posterior thigh fascia were measured. RESULTS: Stretching led to an increase in RoM and a decrease in passive joint stiffness in both groups (P < 0.001) with no significant between-group differences (P ≥ 0.055). The between-group difference in the effect of stretching on SWS was evident only for the sciatic nerve, and a decline in sciatic nerve SWS was only observed in the older adult group (pre-stretching: 2.5 ± 0.3 m/s; post-stretching: 2.3 ± 0.4 m/s; P = 0.027). A significant positive repeated-measures correlation was observed between the sciatic nerve SWS and passive joint stiffness (P = 0.014, rrm = 0.540). CONCLUSION: The reduction in sciatic nerve stiffness by stretching was noticeable in older men and led to improved joint flexibility. These findings may provide insight into tissue adaptation by stretching and may be used to explore effective exercises for improving joint flexibility in older adults.

The effects of static and dynamic stretching on deep fascia stiffness: a randomized, controlled cross-over study.

AIM: Previous stretching studies mostly investigated effects on the skeletal muscle but comprehensive explorations regarding the role of the connective tissue are scarce. Since the deep fascia has been demonstrated to be sensitive to mechanical tension, it was hypothesized that the fascia would also respond to stretching, contributing to enhanced range of motion (ROM). METHODS: Forty (40) recreationally active participants (male: n = 25, female: n = 15) were included in the randomized controlled cross-over trial and allocated to different groups performing 5 min static (STAT) or dynamic (DYN) plantar flexor stretching or control condition (CC) in a random order. Pre- and immediately post-intervention, muscle and fascia stiffness, as well as muscle and fascia thickness were measured using high-resolution ultrasound and strain elastography. ROM was assessed in the ankle joint via the knee to wall test (KtW) and goniometer. RESULTS: STAT reduced both, muscle and fascia stiffness (d = 0.78 and 0.42, p < 0.001, respectively), while DYN did not reduce stiffness compared to the control condition (p = 0.11-0.41). While both conditions showed significant increases in the KtW (d = 0.43-0.46, p = 0.02-0.04), no significant differences to the CC were observed for the isolated ROM testing (p = 0.09 and 0.77). There was a small correlation between fascia stiffness decreases and ROM increases (r = - 0.25, p = 0.006) but no association was found between muscle stiffness decreases and ROM increases (p = 0.13-0.40). CONCLUSION: Our study is the first to reveal stretch-induced changes in fascia stiffness. Changes of fascia`s but not muscle`s mechanical properties may contribute to increased ROM following stretching.

In vivo segmental vertebral kinematics in patients with degenerative lumbar scoliosis.

PURPOSE: This study aimed to find a standard of the vertebra kinematics during functional weight-bearing activities in degenerative lumbar scoliosis (DLS) patients. METHODS: Fifty-four patients were involved into this study with forty-two in DLS group and twelve in the control group. The three-dimensional (3D) vertebral models from L1 to S1 of each participant were reconstructed by computed tomography (CT). Dual-orthogonal fluoroscopic imaging, along with FluoMotion and Rhinoceros software, was used to record segmental vertebral kinematics during functional weight-bearing activities. The primary and coupled motions of each vertebra were analyzed in patients with DLS. RESULTS: During flexion-extension of the trunk, anteroposterior (AP) translation and craniocaudal (CC) translation at L5-S1 were higher than those at L2-3 (9.3 ± 5.1 mm vs. 6.4 ± 3.5 mm; P < 0.05). The coupled mediolateral (ML) translation at L5-S1 in patients with DLS was approximately three times greater than that in the control group. During left-right bending of the trunk, the coupled ML rotation at L5-S1 was higher in patients with DLS than that in the control group (17.7 ± 10.3° vs. 8.4 ± 4.4°; P < 0.05). The AP and CC translations at L5-S1 were higher than those at L1-2, L2-3, and L3-4. During left-right torsion of the trunk, the AP translation at L5-S1 was higher as compared to other levels. CONCLUSIONS: The greatest coupled translation was observed at L5-S1 in patients with DLS. Coupled AP and ML translations at L5-S1 were higher than those in healthy participants. These data improved the understanding of DLS motion characteristics.

Effects of sustained natural apophyseal glides versus rocabado 6 × 6 program in subjects with cervicogenic headache.

BACKGROUND: Cervicogenic headache is designated as the most common type of secondary headache that results from conditions affecting the neck's bony components, muscles, and intervertebral discs rather than the head itself. OBJECTIVE: The purpose was to determine the effects of Sustained Natural Apophyseal Glides (SNAGs) versus the Rocabado 6 × 6 program in subjects with cervicogenic headaches. METHODS: This study was a randomized clinical trial. The sample size was 38, and participants aged 20-60 years (mean age 40.22 ± 9.66) suffering from cervicogenic headaches were randomly allocated using the lottery method into two groups with 19 participants in each group. Assessment of subjects was done before starting treatment and by the end of the 8th week for all the variables. Outcome measures were the Neck Disability Index (NDI), 6-item Headache Impact Test (HIT-6), Flexion-Rotation test (FRT) to assess the rotation range of motion at the level of C1-C2 (goniometer) and the Numeric Pain Rating Scale (NPRS) for the intensity of pain. Data analysis was done by SPSS (IBM) 25. To check the normality of the data the Shapiro-Wilk test was used. RESULTS: In the Shapiro-Wilk test p-value of all the testing variables i.e. NDI, HIT-6 score, FRT and NPRS was > 0.05, data was normally distributed and parametric tests were used. Group A showed a considerable improvement (p < 0.05) in all variables compared to Group B, while within-group analysis of both groups shows that all outcome measures show significant results (p < 0.05). CONCLUSION: It was concluded that both SNAGs and Rocabado's 6 × 6 exercises were effective for the treatment of cervicogenic headache but the effects of headache SNAG were superior and produced more improvement in intensity of headache, disability, frequency of headache, duration of headache as compared to Rocabado 6 × 6 exercises. TRIAL REGISTRATION NUMBER: This study was registered at ClinicalTrials.gov ID: NCT05865808 on date 19/05/2023.

The influence of gender and sport on popliteal angle and dorsiflexion in junior high school students.

BACKGROUND: The aim of the study was to assess factors affecting the popliteal angle and foot dorsiflexion, in particular gender. The subjects were 142 students from the 2nd and 3rd year of Poznan junior high schools. METHODS: The participants included 57 girls and 87 boys. Three raters examined each subject: a specialist in orthopaedics, a resident doctor and a physical therapy student. Foot dorsal flexion was tested in a supine position with lower limbs extended. Next, dorsal flexion was evaluated with the knee and hip in 90 degrees of flexion. Finally, a passive knee extension (PKE) test was carried out. The significance of the PKE test is that the lower the angle the more flexible the hamstrings. This is because the PKE measurement is the distance to the right angle, that is a full knee extension with the hip flexed. RESULTS: The non-parametric test (Mann-Whitney) and the Student's t-test showed differences between the female and male gender in the measurements of the popliteal angle (p < .05000). The correlation was negative, which means that the hamstrings are more flexible in girls. No differences were found between gender and passive foot dorsiflexion and dorsiflexion with a flexed hip and knee. No differences were found between the group with the extended PE curriculum and the group with the standard number of PE classes in the range of motion of foot dorsiflexion and the value of the popliteal angle. CONCLUSIONS: Girls between 13 and 15 years old have a significantly larger hamstring flexibility, which is confirmed by the tests of the popliteal angle. No differences were found in dorsiflexion between girls and boys who have not been trained using a training model.

Determining a relative total lumbar range of motion to alleviate adjacent segment degeneration after transforaminal lumbar interbody fusion: a finite element analysis.

BACKGROUND: A reduction in total lumbar range of motion (ROM) after lumbar fusion may offset the increase in intradiscal pressure (IDP) and facet joint force (FJF) caused by the abnormally increased ROM at adjacent segments. This study aimed to determine a relative total lumbar ROM rather than an ideal adjacent segment ROM to guide postoperative waist activities and further delay adjacent segment degeneration (ASD). METHODS: An intact L1-S1 finite element model was constructed and validated. Based on this, a surgical model was created to allow the simulation of L4/5 transforaminal lumbar interbody fusion (TLIF). Under the maximum total L1-S1 ROM, the ROM, IDP, and FJF of each adjacent segment between the intact and TLIF models were compared to explore the biomechanical influence of lumbar fusion on adjacent segments. Subsequently, the functional relationship between total L1-S1 ROM and IDP or total L1-S1 ROM and FJF was fitted in the TLIF model to calculate the relative total L1-S1 ROMs without an increase in IDP and FJF. RESULTS: Compared with those of the intact model, the ROM, IDP, and FJF of the adjacent segments in the TLIF model increased by 12.6-28.9%, 0.1-6.8%, and 0-134.2%, respectively. As the total L1-S1 ROM increased, the IDP and FJF of each adjacent segment increased by varying degrees. The relative total L1-S1 ROMs in the TLIF model were 11.03°, 12.50°, 12.14°, and 9.82° in flexion, extension, lateral bending, and axial rotation, respectively. CONCLUSIONS: The relative total L1-S1 ROMs after TLIF were determined, which decreased by 19.6-29.3% compared to the preoperative ones. Guiding the patients to perform postoperative waist activities within these specific ROMs, an increase in the IDP and FJF of adjacent segments may be effectively offset, thereby alleviating ASD.

Effects of manual therapy in addition to stretching and strengthening exercises to improve scapular range of motion, functional capacity and pain in patients with shoulder impingement syndrome: a randomized controlled trial.

BACKGROUND: The current study aimed to measure the effectiveness of manual therapy in addition to stretching and strengthening exercises in patients with shoulder impingement syndrome to improve functional capacity, pain, and scapular range of motion. METHODS: This is a single-blinded randomized controlled trial. Thirty-two participants with chronic shoulder impingement syndrome were randomly allocated into two groups. Both groups received stretching and strengthening exercises while the treatment group was given manual therapy additionally. Treatment was started after the patients signed an informed consent form. The data were collected from the University of Lahore Teaching Hospital between March 2022 and December 2022. The study aimed to measure pain using a numeric pain rating scale, functional capacity was assessed by the disability of the arm and shoulder, and goniometry was used for scapular ranges, i.e., scapular protraction and upward rotation. Each treatment session lasted 45 min for the treatment group and 30 min for the control group. The treatment comprised five days a week for four weeks, after which post-intervention measurements were taken. RESULTS: Thirty-two participants were enrolled in the study, and 16 were divided into each group. The mean age of the participants in the treatment group was 38.19 ± 7.31 while the comparison group was 35.69 ± 7.98. An independent sample t-test was run on the data with a 95% confidence interval, statistically significant results were obtained, i.e., p-value < 0.05, post-intervention in the treatment group. Both groups have significantly improved functional capacity and scapular protraction (p < 0.005), however, pain and scapular upward rotation were not found statistically significant in the control group (p > 0.05). CONCLUSION: The addition of manual therapy along with exercise therapy showed clinical and statistical significant results for pain, functional capacity, and scapular range of motion. It demonstrated superior effects than exercise therapy alone for the chronic condition of SIS. TRIAL REGISTRATION: The trial was registered in the Iranian Registry of Clinical Trials ( https://www.irct.ir/ ) with the registration number: IRCT20230526058291N1, (Date: 12/08/2023).

A new role for joint mobility in reconstructing vertebrate locomotor evolution.

Reconstructions of movement in extinct animals are critical to our understanding of major transformations in vertebrate locomotor evolution. Estimates of joint range of motion (ROM) have long been used to exclude anatomically impossible joint poses from hypothesized gait cycles. Here we demonstrate how comparative ROM data can be harnessed in a different way to better constrain locomotor reconstructions. As a case study, we measured nearly 600,000 poses from the hindlimb joints of the Helmeted Guineafowl and American alligator, which represent an extant phylogenetic bracket for the archosaurian ancestor and its pseudosuchian (crocodilian line) and ornithodiran (bird line) descendants. We then used joint mobility mapping to search for a consistent relationship between full potential joint mobility and the subset of joint poses used during locomotion. We found that walking and running poses are predictably located within full mobility, revealing additional constraints for reconstructions of extinct archosaurs. The inferential framework that we develop here can be expanded to identify ROM-based constraints for other animals and, in turn, will help to unravel the history of vertebrate locomotor evolution.

The effectiveness of instrument-assisted soft tissue mobilization on range of motion: a meta-analysis.

BACKGROUND: To evaluate the effectiveness of instrument-assisted soft tissue mobilization (IASTM) on range of motion (ROM). METHODS: We performed a literature search of the PubMed, Embase, Web of Science, and Cochrane Library databases from inception to December 23, 2023. Randomized controlled trials that compared treatment groups receiving IASTM to controls or IASTM plus another treatment(s) to other treatment(s) among healthy individuals with or without ROM deficits, or patients with musculoskeletal disorders were included. The Cochrane risk of bias tool was used to assess the risk of bias. RESULTS: Nine trials including 450 participants were included in the quantitative analysis. The IASTM was effective in improving ROM in degree in healthy individuals with ROM deficits and patients with musculoskeletal disorders (n=4) (MD = 4.94, 95% CI: 3.29 to 6.60), and in healthy individuals without ROM deficits (n=4) (MD = 2.32, 95% CI: 1.30 to 3.34), but failed to improve ROM in centimeter in healthy individuals with ROM deficits (n=1) (MD = 0.39, 95% CI: -1.34 to 2.11, p=0.66, I2 = 88%). CONCLUSIONS: IASTM can improve ROM in degree in healthy individuals with or without ROM deficits, or in patients with musculoskeletal disorders (with very low to low certainty). TRIAL REGISTRATION: The PROSPERO registration ID is CRD42023425200.

Goniometry and fleximetry measurements to assess cervical range of motion in individuals with chronic neck pain: a validity and reliability study.

PURPOSE: To assess the test-retest and inter-rater reliability of goniometry and fleximetry in measuring cervical range of motion in individuals with chronic neck pain. METHODS: A reliability study. Thirty individuals with chronic neck pain were selected. Cervical range of motion was measured by goniometry and fleximetry at two time points 7 days apart. To characterize the sample, we used the numerical pain rating scale, Pain-Related Catastrophizing Thoughts Scale, and Neck Disability Index. Intraclass correlation coefficient (ICC), standard error of measurement (SEM) and minimum detectable change (MDC) were calculated. Correlations between goniometry and fleximetry measurements were performed using Spearman's correlation coefficient (rho). RESULTS: For goniometry, we found excellent test-retest reliability (ICC ≥ 0.986, SEM ≤ 1.89%, MDC ≤ 5.23%) and inter-rater reliability (ICC ≥ 0.947, SEM ≤ 3.91%, MDC ≤ 10.84%). Similarly, we found excellent test-retest reliability (ICC ≥ 0.969, SEM ≤ 2.71%, MDC ≤ 7.52%) and inter-rater reliability (ICC ≥ 0.981, SEM ≤ 1.88%, MDC ≤ 5.20%) for fleximetry. Finally, we observed a strong correlation between the goniometry and the fleximetry for all cervical movements (rho ≥ 0.993). CONCLUSION: Goniometry and fleximetry measurements are reliable for assessing cervical range of motion in individuals with chronic neck pain.

Hip biomechanics in patients with low back pain, what do we know? A systematic review.

BACKGROUND: Biomechanical alterations in patients with low back pain (LBP), as reduced range of motion or strength, do not appear to be exclusively related to the trunk. Thus, studies have investigated biomechanical changes in the hip, due to the proximity of this joint to the low back region. However, the relationship between hip biomechanical changes in patients with LBP is still controversial and needs to be summarized. Therefore, the aim of this study was to systematically review observational studies that used biomechanical assessments in patients with non-specific LBP. METHODS: The search for observational studies that evaluated hip biomechanical variables (i.e., range of motion, kinematic, strength, and electromyography) in adults with non-specific acute, subacute, and chronic LBP was performed in the PubMed, Embase, Cinahl and Sportdiscus databases on February 22nd, 2024. Four blocks of descriptors were used: 1) type of study, 2) LBP, 3) hip and 4) biomechanical assessment. Two independent assessors selected eligible studies and extracted the following data: author, year of publication, country, study objective, participant characteristics, outcomes, and results. The methodological quality of the studies was assessed using the Epidemiological Appraisal Instrument and classified as low, moderate, and high. Due to the heterogeneity of the biomechanical assessment and, consequently, of the results among eligible studies, a descriptive analysis was performed. RESULTS: The search strategy returned 338 articles of which 54 were included: nine articles evaluating range of motion, 16 evaluating kinematic, four strength, seven electromyography and 18 evaluating more than one outcome. The studies presented moderate and high methodological quality. Patients with LBP, regardless of symptoms, showed a significant reduction in hip range of motion, especially hip internal rotation, reduction in the time to perform functional activities such as sit-to-stance-to-sit, sit-to-stand or walking, greater activation of the hamstrings and gluteus maximus muscles and weakness of the hip abductor and extensor muscles during specific tests and functional activities compared to healthy individuals. CONCLUSION: Patients with LBP present changes in range of motion, task execution, activation, and hip muscle strength when compared to healthy individuals. Therefore, clinicians must pay greater attention to the assessment and management of the hip during the treatment of these patients. SYSTEMATIC REVIEW REGISTRATION: International Prospective Register of Systematic Reviews (PROSPERO) (CRD42020213599).

An observational study of quality of motion in the aging cervical spine: sequence of segmental contributions in dynamic fluoroscopy recordings.

BACKGROUND: The term 'physiological motion of the spine' is commonly used although no proper definition exists. Previous work has revealed a consistent sequence of cervical segmental contributions in 80-90% of young healthy individuals. Age has been shown to be associated with a decreased quantity of motion. Therefore, it is of interest to study whether this sequence persists throughout aging. The aim of this prospective cohort study is to investigate if the consistent sequence of cervical segmental contributions in young asymptomatic individuals remains present in elderly asymptomatic individuals. METHODS: In this prospective cohort study, dynamic flexion to extension cinematographic recordings of the cervical spine were made in asymptomatic individuals aged 55-70 years old. Individuals without neck pain and without severe degenerative changes were included. Two recordings were made in each individual with a 2-to-4-week interval (T1 and T2). Segmental rotation of each individual segment between C4 and C7 was calculated to determine the sequence of segmental contributions. Secondary outcomes were segmental range of motion (sRoM) and sagittal alignment. RESULTS: Ten individuals, with an average age of 61 years, were included. The predefined consistent sequence of segmental contributions was found in 10% of the individuals at T1 and 0% at T2. sRoM and total range of motion (tRoM) were low in all participants. There was no statistically significant correlation between sagittal alignment, degeneration and sRoM in the respective segments, nor between cervical lordosis and tRoM. CONCLUSIONS: This study shows that aging is associated with loss of the consistent motion pattern that was observed in young asymptomatic individuals. The altered contribution of the cervical segments during extension did not appear to be correlated to the degree of degeneration or sagittal alignment. Trial registration clinicaltrials.gov NCT04222777, registered 10.01.2020.

Randomized controlled trial of compressive cryotherapy versus standard cryotherapy after total knee arthroplasty: pain, swelling, range of motion and functional recovery.

BACKGROUND: After total knee arthroplasty (TKA), patients have limited knee range of motion (ROM), trophic changes and pain. Cryotherapy and compression are recommended in the literature, but no study has shown that cryotherapy and compression combined leads to better results than cryotherapy alone. The primary objective was to compare knee ROM after 21 days of rehabilitation post-TKA between patients who underwent rehabilitation with compressive cryotherapy with those who had cryotherapy alone. The secondary objectives were to compare other trophic, pain and functional outcomes. METHODS: Forty patients were randomized into two groups: Standard Cryotherapy (SC = 20, median age 77 years), which applied cold packs along with their rehabilitation; and Compressive Cryotherapy (CC = 20, median age 76 years), which received cold compression. Knee joint's passive and active ROM (primary outcome) were measured with a goniometer. Knee's circumference, fluctuation test, pain at rest and during activity, 6-minute walking test (6MWT) and KOOS questionnaire were secondary outcomes. The groups were compared on D1 (baseline) and D21 of rehabilitation. A survival analysis has compared the groups on D1, D8, D15, D21. RESULTS: All subjects had a significant improvement in all the parameters on D21 relative to D1 (p < .05), except for pain at rest (p = .065 for CC and p = .052 for SC). On D21, the CC group had a significantly larger improvement in the joint effusion (p = .002), pain during activity (p = .005), 6MWT (p = .018) and KOOS (p = .004) than the SC group. Based on the survival analysis, the CC group had significantly faster improvement in the joint ROM (p = .011 for flexion and p = .038 for extension) and knee circumference (p = .013) than the SC group. CONCLUSIONS: Both cryotherapy methods improved joint ROM, trophic changes, pain and function. Adding dynamic compression to a cryotherapy protocol provided further benefits: a significantly faster improvement in passive knee flexion ROM, a greater reduction of swelling, and pain during activity. Similarly, walking distance and KOOS questionnaire were significantly better for CC. TRIALS REGISTRATION: The study was registered in the ClinicalTrials.gov database on 14/09/2023 (identifier: NCT06037824).

Effects of manual lymphatic drainage on total knee replacement: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Total knee joint replacement (TKR) is an effective method for the treatment of severe knee osteoarthritis. With an increasing number of surgeries, complications such as lower limb edema, pain, and limited mobility have caused a heavy burden. Manual lymphatic drainage (MLD) may be a solution to solve the problem. The study aims to evaluate the efficacy of MLD in reducing knee edema, pain, and improving range of motion (ROM) in patients after TKR. METHODS: A search was conducted in PubMed, Embase, Cochrane Library, Web of Science, CNKI, VIPs, WanFang database, and Google Scholar from inception to June 2023. Only randomized controlled trials (RCTs) that compared the effects of MLD and non-MLD (or another physiotherapy) on improving knee edema, pain, and ROM after TKR were included. Stata 16.0 was used for meta-analysis. GRADE was used to assess the quality of evidence. RESULTS: In total, 7 RCTs with 285 patients were identified. There were no significant differences found in the ROM of knee flexion (standardized mean difference (SMD) = 0.03, 95% confidence interval (CI): -0.22, 0.28, P = 0.812) and the ROM of knee extension (SMD= -0.30, 95%CI: -0.64, 0.04, P = 0.084). No differences were observed in the lower extremity circumference after TKR (SMD= -0.09, 95%CI: -0.27, 0.09, P = 0.324). For postoperative pain, there was no significant advantage between the MLD and non-MLD groups (SMD= -0.33, 95%CI: -0.71, 0.04, P = 0.083). CONCLUSIONS: Based on the current evidence from RCTs, manual lymphatic drainage is not recommended for the rehabilitation of patients following total knee replacement.

Comparative Analysis of Thoracic Rotation Exercises: Range of Motion Improvement in Standing and Quadruped Variants.

There have been few investigations into the effectiveness of thoracic spine exercises for improving thoracic range of motion (ROM) in any plane. This study assessed the effectiveness of two thoracic spine exercises: one in the quadruped position and one in the thoracic standing position. We determined how these exercises affect thoracic spine mobility ROM over a 2-week intervention period. Thirty-nine healthy participants were enrolled and assigned to a Quadruped Thoracic Rotation group (n=17 participants: 9 females and 8 males) or Flamenco Thoracic Spine Rotation group (n=22: 14 females and 8 males). All participants were administered a KOJI AWARENESSTM screening test, and the initial thoracic spine ROM before intervention exercise was measured in a laboratory setting. Quadruped Thoracic Rotation was performed as the quadruped exercise and Flamenco Thoracic Spine Rotation as the standing exercise. The KOJI AWARENESSTM thoracic spine test and ROM were evaluated on the day after the first exercise session and again after the program. Despite their different approaches to thoracic mobility, the quadruped exercise and standing exercise achieved equivalent improvement in thoracic ROM after 2 weeks. Practitioners have a range of exercise options for enhancing thoracic mobility based on their environmental or task-specific needs.

The effect of high-intensity laser therapy on pain and lower extremity function in patellofemoral pain syndrome: a single-blind randomized controlled trial.

Patellofemoral pain syndrome (PFPS) is a set of symptoms that negatively affect the daily life activities of the individual, leading to functional disability and significant loss of labor, especially in young adults. PFPS is usually due to weakness of the vastus medialis obliquus (VMO) resulting in abnormal patellar tracking and pain. Our study aims to compare the efficacy of high-intensity laser therapy (HILT) on pain and lower extremity function in the treatment of PFPS with different electrophysical agents (EPAs). The study was designed as a single-blind randomized controlled trial. Forty-five people with PFPS (aged 25-45 years) were included in the study. The patients were randomly divided into three groups and a total of ten sessions of treatment were administered to all three groups for 2 weeks, 5 days a week. High-intensity laser (HILT) and exercise program were applied to group 1. Ultrasound (US), transcutaneous electrical nerve stimulation (TENS), and exercise program were applied to group 2. In group 3, US, interferential current (IFC), and exercise program were applied. Both groups underwent three evaluations: pre-treatment, post-treatment, and 12 weeks after treatment. Outcome measures included the visual analog scale for pain severity (VAS), knee flexion range of motion (FROM), Q angle, pain threshold, muscle strength of quadriceps and hamstring, Kujala patellofemoral scoring, lower extremity functional scale (LEFS), and Timed Up and Go Test (TUG). The ANOVA was used for comparing the data of the groups, and two-way repeated measure ANOVA was used to compare at the pre-post and post-intervention 3rd month. The LSD and Bonferroni post hoc tests were also used to identify the between-group differences. Groups 2 and 3 were statistically effective in pain and functionality (p < 0.05). Group 1 was found to be statistically more effective than other groups in reducing pain (95% confidence interval (CI), 0.000/0.000; p = 0.000), increasing knee flexion angle (95% CI, 127.524/135.809; p = 0.000), and increasing lower extremity function (95% CI, 75.970/79.362; p = 0.000). This study indicated that high-intensity laser therapy was found to be a more effective method in the treatment of patellofemoral pain syndrome after 3 months of follow-up compared to US-TENS combination and US-interferential current combination treatments. Also, HILT can be used as an effective method in combination with an appropriate exercise program including vastus medialis strengthening to reduce pain and increase functionality in the patients with PFPS.