فرید بحرپیما

Background Understanding of shoulder muscles function in various dynamic tasks is effective to understand the underlying mechanism of the shoulder injuries in sport activities. The aim of this study was to identify the electrical activity of deltoid and supraspinatus muscles during the fast and slow shoulder abduction with and without an external load in healthy adolescent subjects.
Methods In 16 females (20-28 years old), using a surface EMG system (MA-300), the activity of deltoid (anterior, medial, and posterior portions), and supraspinatus muscles within 90º of shoulder abduction in slow (22.5 º /s) and fast (45 º /s) movements that were repeated with and without a dumbbell (equal to 5% of body mass) were registration. Repeated Measure ANOVA was used with SPSS-22 for statistics analysis having p=0.05.
Results In slow without load abduction, the intensity of the activity of anterior, medial, and posterior deltoid and supraspinatus Muscles were %18.22±1.92, %50.55±1.97, %50.60±17.50 and %39.49±3.78, microvolt respectively. In with and without load conditions, the posterior and middle deltoid muscles displayed significantly greater activity than the other muscles. Load factor significantly increased the muscle activity by1.19 times (P=0.0001). However, loading effect was greater in posterior deltoid than in other muscles. Speed factor displayed similar effect in all muscles.
Conclusion The cause of the higher activity of posterior deltoid than anterior deltoid could be specified by the mechanism of external rotation of the humerus during shoulder abduction. The strengthening of posterior deltoid should be noteworthy in rehabilitation shoulder exercises.

Background & Measurements of muscle activity in scoliosis has clinical importance. The aim of this study was to compare the effects of electrode placement method based on SENIAM with ultrasound method on the activation levels of erector spinae muscles in patients with adolescent idiopathic scoliosis.
10 female idiopathic scoliosis patients with double curvature participated in this study.
During superman, upper arm abduction, and quadrupt exercises, the activity of erector spinae muscles at T6, T10, and L3 levels were measured using a 16 channel BTS FREE EMG 300 EMG system with surface electrodes. In the first method, electrodes’ direction was placed based on SENIAM protocol, and then in the second method, they were based on the ultrasound images.
The differences between the directions of electrodes in two methods were 13.3º ± 8.22º. There was not any significant difference between methods on the amplitudes of the EMG activities of erector spinae muscles (p>0.05).
In both methods, the ipsilateral muscles to the arm movements displayed higher activity than the contralateral muscles.
The direction of electrodes in ultrasound method was significantly different from that of the SENIAM method. However, this difference did not alter the amplitudes of the EMG signals. It seems that the application of ultrasound in EMG measurements in scoliosis is not necessary. However, the effects of ultrasound technique on EMG parameters other than the amplitude need further analysis.

One of the most common complications of Diabetic Polyneuropathy (DPN) is decreased balance and Postural Control disorder. Balance has an important role in static and dynamic activities as a base of activities of daily living. The objective of this study was the evaluation and comparison of dynamic and functional balance in patients with DPN and healthy subjects.
In this study, dynamic and functional balance of 11diabetic patients with DPN (detected by Michigan questionnaire) and 11 healthy subjects were evaluated by Biodex Balance System (BBS) and Tandem Stance (TS) test in open and closed eyes conditions. The participants were matched by age and BMI. An independent t-test was used to compare balance parameters between patient and normal group. Furthermore, the correlation between dynamic balance parameters of BBS and TS tests were calculated using the Pearson’s Correlation Coefficient.
The results of BBS in patients with diabetic peripheral neuropathy were significantly higher than normal subjects (P Older adults with DPN have an impaired functional balance in comparison with matched control subjects and this may expose the patients to danger of falling during daily activities.

Around 7% of world population is suffering from diabetes and its widespread complications. There are several studies discussing the beneficial effects of aerobic and resistance exercises on postural sway in type 2 diabetic patients. However, the effects of eccentric exercise on displacement and speed of displacement the center of pressure in these patients have not been studied yet. This study was designed to compare the effect of eccentric and concentric exercises on kinetic indices in type 2 diabetic patients. Patients with type 2 diabetes (n = 28) with a mean of 51.79 years of age (male and female), who referred to the neuromuscular rehabilitation research center of Semnan University of Medical Science, were assigned randomly in either of two experimental eccentric or concentric groups. Before and after intervention, displacement and speed of displacement the center of pressure in anteroposterior and mediolateral directions were measured. Eccentric exercise training significantly reduced displacement the center of pressure in anteroposterior (P = 0.016) and mediolateral (P = 0.005) directions and speed of displacement in anteroposterior (P = 0.020) and mediolateral (P = 0.037) directions, in compare to concentric exercise. Our findings suggest that eccentric exercise is more effective than concentric exercise in improving the postural sway in type 2 diabetic patients.

The aim of the present study was to examine the rate of central and peripheral contributions in circadian rhythms and gender differences after exhausted sub maximal exercise. 12 healthy male and female subjects (mean age of 23/5±1/37 years, height of 166/83±5/11cm, weight of 59/8±9/15 kg, vo2max of 33/14±4/71 lit.kg/min in male subjects and mean age of 23±6/32 years, height of 165/17±2/48, weight of 56±2/09 and vo2max of 29/05±2/89 lit.kg/min in female subjects) took part in this investigation. Central (Mvc, latency of H reflex, amplitude of H reflex and ratio of H reflex to M wave) and peripheral properties of fatigue (blood lactate and M wave) were recorded before and after an exhausted sub maximal exercise (Storer and Davies 1998) at two different times of day: 8 and 18 oclock which is separated by a week. The result showed that significant differences were found in HR, blood lactate and latency of H reflex before and after exercise. However differences between male and female in Mvc, amplitude of H reflex, ratio of H reflex to M wave and M wave was significant. As induced –exercise central and peripheral fatigue was higher in men in the morning, our results suggest designing suitable training program for men and women is preferred afternoon and morning respectively. However, more study is needed to confirm this result, especially it is recommended to use transcranial magnetic stimulation.

Balance dysfunction is one of the problems in diabetic patients so that peripheral neuropathy and decreased somatosensory sensitivity are the most important causes for it. One of the supposed theories for diabetic peripheral neuropathy is reduction in blood flow secondary to pathologies of peripheral neural arterioles. Intermittent Pneumatic Compression, regarding to its effect on vessels hemodynamics and perfusion improvements, has been considered in recent years. The aim of this study is to evaluate the effects of this method on improvement of neuropathy signs and symptoms improvement in patients with type 2 Diabetes and neuropathy. Also, regarding to the role of neuropathy on balance impairment, other aim of this study is to investigate the effect of this method on improvement of dynamic balance in diabetic patients. This study is a clinical trial study. 39 patients with diabetes type 2 and neuropathy divided into intervention (20 patients) and control (19 patients) groups. The intervention group underwent 10 sessions of IPC treatment, with 45 minutes for each session and one day interval between them. Neuropathy severity changes (by Valk and Michigan Questionnaires), Proprioceptive sensation (assessed by Diapason), and balance (by Biodex system), were evaluated in both groups in first and final sessions. Anterior-Posterior Stability Index and Overall Stability Index obtained from Biodex system in level 6 showed significant changes. Vibration sensation, and Valk and Michigan neuropathy questionnaires also showed significant improvements (P<0.05). This study showed that IPC treatment method has positive effects on improvement of neuropathy severity, Vibration sensation and dynamic stability (Biodex).

Type 2 diabetes mellitus results in vascular dysfunction and reduction of nitric oxide (NO) level. In this study the effect of electromagnetic field (EMF) on NO level, an effective factor in increasing blood flow, and on ankle brachial index (ABI) as a n index of lower extremity blood flow in type 2 diabetic patients, have been investigated. This study was a randomized controlled clinical trial carried out in Imam Khomeini hospital of Ardabil and Mehr physiotherapy center in 2013. Thirty diabetic patients after initial pilot study participated in this experiment based on inclusion and exclusion criteria. Then, they were randomly assigned into two equal groups, electromagnetic therapy and control. The baseline levels of ABI and NO of both groups were measured. Patients in electromagnetic group were exposed to 10 Hz EMF radiation (with intensity of 8 mT) together with scanning lower limbs (three sessions per week, and 40 minutes per session for 8 weeks). The control group did not receive any treatment. After eight weeks, the amount of ABI and NO level were recorded. For statistical analysis paired t-test and independent t-test were used in SPSS 19 software. Statistical analysis showed significant differences between pre (1.009±0.02) and post (1.052±0.02) measurement of ABI of diabetic patient after applying magnetic field (P = 0.013). However, there was no significant difference between p and after measurement of ABI and NO level in controlgroup and also NO level in magnet groups (P> 0.05). Difference between pre and post therapy of ABI in electromagnetic group (0.05±0.01) showed significant increase compared with control group (0.004±0.003) (P = 0.001). Increase in ABI after 8 weeks electromagnetic therapy could be considered as an accretion index in blood flow in lower extremity.

Disabilities in upper limb due to stroke are the major problems in hemiplegic patients. Recently, joystick method as new method is applied for the improvment of upper limb disabilities. This study was carried out to compare the effect of joystick in compination verses routine rehabilitation and routine rehabilitation program on hand muscles stiffness in hemiplegic patients. In this clinical trial study, 12 hemiplegic patients were randomly divided into two control and interventional groups. Subjects in the control group were received rehabilitation program with placebo joystick. Patients in interventional group were received joystick treatment with routine rehabilitation program for 10 sessions, 3 times a week. Pre and post-treatment evaluation was performed based on Wrist Robo Hab method. Flextion and pronation muscle stiffness in control patients showed non significant improvement, but in the interventional group, significant improvement were observed (P<0.05). At the end of study, there was not any significant difference between control and interventional group. According to this finding, there was not any significant difference between the combination of joystick and rehabilitation treatment and routine rehabilitation program on the hand muscle function in hemiplegic patients.

Disabilities of the upper limbs due to stroke can lead to more prolonged functional problems in comparison to lower limb disabilities, and fewer numbers of investigations have been performed on this problem. Use of magnetic stimulation to produce induction currents in the brain for therapeutic purposes is a new method. The aim of this study was to determine the effects of rTMS plus routine rehabilitation on hand stiffness, and compare them with pure routine rehabilitation program in hemiplegic patients. Method and material: 12 hemiplegic patients were assigned randomly to two groups. Control group, received rehabilitation program with placebo magnetic stimulation, and experimental group, received magnetic stimulation with routine rehabilitation program, 3 times/week for 10 sessions. Using Wrist Robo Hab,we assessed joint stiffness during flexion-extension of the wrist, and supination-pronation of forearm before and after treatment. In the control group we did not find any significant decrease in the resistance of flexor (p=0.207) and pronator (p=0.291) muscles. But in the experimental group the resistance of flexor (p=0.009) and pronator (p=0.035) muscles decreased significantly. rTMS can decrease stiffness of the upper limb joints and can be used in chronic hemiplegic patients, when conventional treatments are not effective.

Some new methods of treatment focus on using magnetic stimulation as a means of induction currents in the brain to produce therapeutic effects. The aim of this clinical trial was to determine the effects of repetitive transcranial magnetic stimulation (rTMS) plus routine rehabilitation on hand grip and wrist motor function in hemiplegic patients. Twelve hemiplegic patients were assigned into the treatment group and received magnetic stimulation with routine rehabilitation program for 10 sessions, three times a week. Pre and post-treatment evaluations were done based on Barthel and Fugl-Meyer indexes and dynamometer. In the treatment group, significant improvement were observed in Barthel and Fugl Meyer indexes and dynamometer (-P =. 010, P =. 001 and P =. 007, respectively). Combination of rTMS with conventional treatment can improve hand muscle force and function in chronic hemiplegic patients.

Some new methods of treatment focus on using the Magnetic stimulation as a means of induction currents in the brain to produce therapeutic effects. The aim of this study is to determine the effects of rTMS plus routine rehabilitation on hand stiffness in hemiplegic patients، and compare them with pure routine rehabilitation program. Methods and materials: 12 hemiplegic patients were assigned randomly in two groups. Control group، received rehabilitation program with placebo magnetic stimulation، andexperimental group، received magnetic stimulation with routine rehabilitation program for 10 session، 3 times/week. Pre and post of treatment، evaluations done by Wrist Robo Hab. In control group، flextion and pronation muscle stiffness showed nonsignificant improvement (p=0. 291، p=0. 207) but in experimental group، showed significant improvement (p=0. 035، p=0. 009). rTMS can improve hand muscle force and function in chronic hemiplegic patients، when conventional treatment is not effective.

Nowadays personal lifting assistive devices، in order to reduce the load applied from the lifted weight to muscles - in particular lower back muscles، become more widely used. The objective of our study is to analyze an empirical model of a Weight Lifting Aid Vest (WLAV) during anterior flexion (anteflexion) and studying its effects on reduction of loads on the muscles in particular back muscles. To analyze this، the intensity of signals captured from involved muscles، during the lifting in two case of with and without WLAV، was studied by the use of electromyography amplifier. In this process، 20 subjects who lifted 10-kilogram loads in semi-squatting position were participated. With the use of a tensile-compressive spring، embedded at the back of WLAV، the amount of body stretch and deflection of their hip and knees were measured. The influence of the WLAV on satisfaction during the lifting was studied. Data were collected from electromyography findings from eight involved muscles in back، stomach and feet. The results depicted that there are a overall reduction of 25. 12-percent in activation of all the muscles and particularly a reduction of 57%، 28% and 26. 5% in activation of external oblique، lateral hamstring، and erector spine، respectively. In contrast، there is 11% increase in activation of Gluteus Maximus in the case of usage of WLAV. WLAV can significantly mitigate the activation of back muscles and rate of load insertion on muscles) P<0. 005). It also clarified the tendency of the subjects towards users WLAV) P<0. 005).

Diabetes is assosiated with neuropatic disorders. It is related to vascular or ischemic disorders. Intermittent Pneumatic Compression (IPC) has been recomanded for treatment of peripheral circulatory disorders. IPC is based on phases of intermittent positive pressure. The purpose of this study was to determine the effect of IPC on diabetic peripheral neuropath. In this study، 17 subjects (13 men،4 women) with diabetic neuropathy، were studied. They received 60 mmhg of IPC for 45 minutes in10 sessions، three time weekly. Neuropathy was measured by electrodiagnostic testes. Data were analyzed by using Repeated Measures ANOVA. Nerve Conduction Velocity (NCV) of tibial، peronal and sural nerves significantly improved after the modally sessions. This study showed IPC therapy improwed diabetic neuropathy and increasing of NCV as a sign of improvement.

Patients with type 2 diabetes mellitus (T2DM) are subject to progressive reduction of muscle strength especially in the lower limb. But the rate of progression of weakness is not clear yet. The aim of the study was to compare the isometric and concentric peak torque of knee extension and flexion in the T2DM more and less than 10 years of disease with healthy subjects that matched to patients with regards to sex، body mass index (BMI)، ankle to brachial pressure index (ABI)، and physical activity index (PAI). 30 T2DM patients categorized based on duration of disease in the two groups consist of 18 subjects with T2DM less than 10 years and 12 subjects with T2DM more than 10 years. The patients were compared with 20 sex، BMI، ABI and PAI - matched health subjects. Two- way ANCOVA analyzed the main and interaction effect of grouping and sex on the isometric maximum peak torque (IMPT) and concentric MPT (CMPT) of knee extension and flexion recorded by isokinetic instrument. The age was considered as covariate. The results showed that both knee extensor and flexor IMPT and CMPT were significantly greater in the health subjects than both patient groups (P value<0. 02). The amount of CMPT had also negative correlation with HbA1c percent (P value < 0. 002). There was no significant interaction effect of sex and grouping and different between two diabetic groups in the all MPTs. the women were weaker than men (P value < 0. 002). it is demonstrated that the T2DM patients in the both sexes had less knee strength than health subjects. The effect of duration of diabetes on muscle strength was seem very slowly overtime.

Balance and gait disorders are common motor complications after stroke. Studies have revealed that conventional physiotherapy cannot manage these disorders efficiently, so more studies addressing causes of these complications and presenting efficient treatment protocols are crucial. Concerning the significant effect of Constraint Induced Movement Therapy on treatment of upper limbs motor impairments in hemiparetic patients, the goal of this study is to assess the effect of “Constraint Induced Movement Therapy” on symmetry of spatiotemporal gait parameters and velocity of gait in hemiparetic patients. Thirty hemiparetic patients (aged from 40 to 60 years) participated in this study. Patients were divided randomly into 2 groups. They received constraint induced movement therapy (group1) and mass practice (group 2) for 3 weeks. Experimental assessments of patients included stride velocity and symmetry of spatiotemporal gait parameters (spatial step symmetry, temporal stance symmetry, temporal swing asymmetry, overall temporal asymmetry) that were recorded and compared before and after treatment. In addition, the amount of weight bearing asymmetry was assessed via dual force platform. In both groups, stride velocity increased (p=0.03, p=0.01). In group A, spatial step symmetry increased (p=0.02).Temporal swing asymmetry and overall temporal asymmetry decreased (p=0.01). In group B, only temporal swing asymmetry decreased (p=0.02). Physical therapy by “constraint induced movement therapy” can improve symmetry of spatiotemporal gait parameters efficiently through overcoming the “learned non use “phenomenon and improving the somatosensory deafferentation to motor controller centers.

Disability of upper extrimity from stroke are often permanent. Despite numerous functional problems، there is less attention to upper exterimity disabilitis than lower limbs. Some new methods of treatment focuses on using the magnetic stimulation as a means brain currents to produce therapeutic effects. This study was done to evalute the effect of low frequency repeatitive transcranial magnetic stimulation to improve motor function and grip force of upper limb in hemiplegic patients. This clinical trial study was done on 12 stroke hemiplegic patients in Firoozgar hospital in Tehran، Iran during 2009-10. Patients in group I، recieved rehabilitation program with placebo magnetic stimulation، and patients in group II، received magnetic stimulation with routine rehabilitation program for 10 session، 3 times in week. Pre and post were evaluated by Barthel and Fugl-Meyer indeces and dynamometer. Data were analyzed using SPSS-15، Kolmogorov-Smirnov، paired t-test، independent t-test and Wilcoxon signed tests. According to Barthel and Fugl-Meyer indeces both groups I، II showed significant improvement (P<0. 05). Using dynamometer، it was demenstrated that grip force of upper limb in group I was not significant but this index in group II was significant after intervention (P<0. 05). This study showed that low frequency repeatitive truscrianial magnetic stimulation has therapuetic effect on grip force of upper limb.

Adiponectin is an adipocyte-secreted hormone. Low levels of Adiponectin may indicate the insulin resistance and development of diabetes. The regular exercise therapy induces insulin resistance to be reduced. Glucose uptake increase in muscles، increased adiponectin levels and decreased of HbA1c in diabetic patients. This study was designed to evaluated the effect of down-hill and up-hill running exercises on the adiponectin and serum glucose in type-2 diabetic patients.

This clinical trial study was conducted on 28 patients (13 male and 15 female)، age 40 to 60 years، with type-2 diabetes، in neuromuscular rehabilitation research center، Semnan، Iran during 2009. Participants were assigned randomly in one of the two experimental groups، eccentric or concentric exercise using treadmill. Before and after control and intervention period، glucose، HbA1c and adiponectin serum were measured in both groups. Data were analyzed using SPSS-18، Kolmogorov-Smirnov، Repeated Measures ANOVA، Tukey and independent t tests.

Eccentric and concentric exercise significantly decreased glucose، HbA1c and also increased adiponectin levels (P<0. 05) in type-2 diabetic patients. However، eccentric exercise also significantly reduced glucose and HbA1c and increased adiponectin levels compared to the concentric exercise (P<0. 05).

This study showed that eccentric exercise are more effective than concentric exercise to reduce and control the blood glucose level and improve serum adiponectin in type-2 diabetes mellitus patients.

Disabilities of upper extremities, as a sequel of stroke, often result in permanent functional complications which have received less attention in comparison to lower limb disabilities. Magnetic stimulation is a new therapeutic method which is used for induction of currents in the brain. The aim of this study was to compare the effect of magnetic stimulation on the wrist and elbow joints movements and grip force with that of routine rehabilitation. 12 hemiplegic patients were assigned to two groups. Patients in group I, received routine rehabilitation with placebo magnetic stimulation, and patients in group II, received magnetic stimulation with routine rehabilitation for 10 sessions, 3 times a week. Pre and post treatment evaluations were performed by use of Barthel index, Fugl-Meyer Motor Impairment Scale and dynamometer. In group I, Barthel and Fugl-Meyer indexes showed significant improvement, but no significant improvement noted in the rate of grip force. Group II, showed significant improvement in Barthel and Fugl-Meyer indexes and rate of grip force. When conventional treatment is not effective, rTMS can improve force and function of hand muscles in chronic hemiplegic patients.

About 7% of world populations suffer from diabetes disease and its widespread complications. There are several studies about the beneficial effects of aerobic and resistance exercises on blood glucose and lipids levels, insulin sensitivity in type 2 diabetic patients. However, there is no study to investigate the effects of eccentric exercise in these patients. This study was designed to compare the effect of eccentric and concentric exercises on some of the blood biochemical parameters in type 2 of diabetic patients.

28 type 2 diabetic patients were assigned randomly in one of the two experimental eccentric and concentric groups. Before and after control and also after intervention, blood sugers, HbA1c, lipids and body mass index were measured.

The results showed that eccentric and concentric exercises result in a significant decrease in blood sugar, HbA1c, and blood lipids. Eccentric exercise training also significantly reduced blood sugar levels and HbA1c compared to the concentric exercise (P<0.0001). Moreover, no significant changes were found in blood lipids levels in regard to the type of exercise.

Our findings show that eccentric exercise is more effective than concentric exercise with respect to reducing and controlling blood glucose levels in type 2 diabetic patients.

Knee osteoarthritis is one of the most common disabilities, which may lead to some limitations in physical activity. This study aimed to evaluation of grade one mobilization in improvement of physical function. In this single blind clinical trial with a randomized sampling method, 30 patients of grade two or three, knee osteoarthritis were assigned into three groups: group one mobilization + exercise therapy, group two exercise therapy and group three mobilization. Ultrasound with the intensity below 0.2 w/cm2 in three minutes was used for all groups as placebo. The duration of treatment was 10 sessions for three weeks. Outcome was measured by WOMAC questionnaire form (Likert type) before and one week after treatment. Physical function showed no significant difference between before and after treatment and between before treatment and follow up among the groups (P>0.05). The difference of physical function after treatment compared to before treatment was significant in all groups.

Standing balance deficits are common in hemiplegic patients after stroke. One method to treat these deficits is to provide the patient with visual feedback while balance activities are performed. The purpose of this research was to investigate the effects of using visual biofeedback with conventional physical therapy on static postural stability following stroke.

This randomized clinical trial included 32 patients (11 females and 21 males) with hemiplegia secondary to stroke. These patients were randomly assigned in two groups; control and experimental groups. These groups were matched for age, weight and height. Patients were tested using Equitest (amplitude of postural sway) and two digital weight scales (symmetry) before, 6 sessions and 12 sessions after physical therapy intervention. The trained group received visual biofeedback from Biodex Balance System combined with conventional physical therapy whereas the control group performed conventional physical therapy without biofeedback.

Significant improvements in static stroke balance measurements were found in trained group. In trained group, symmetry of weight bearing was increased (P = 0.008) and postural sway was decreased (P = 0.03).

This study revealed that visual biofeedback training with conventional physical therapy improved proprioception and decreased hemineglect effects in stroke patients. Improved proprioception resulted in symmetry and decreased sway, subsequently increased static balance in stroke patients.

Balance and gait disorders are common motor complications after stroke. Studies have revealed that conventional physiotherapy cannot manage these disorders efficiently; so more studies addressing the causes of these complications and presenting efficient treatment protocols are crucial. Thirty hemiparetic patients (age range 40-60 years old) participated in this experimental study. Patients were randomly divided in to 2 groups. One group received Constraint Induced Movement Therapy (CIMT) (group1) and the other Mass Practice (group 2) for 3 weeks. Experimental assessments included stride velocity and kinetic parameters of gait (amplitude and velocity of center of pressure sways of paretic and non-paretic limbs in sagittal and frontal planes) that were recorded and compared before and after treatment. For statistical analysis of data, if distribution of data was normal, parametric tests of t and pair t-tests were used. If distribution of data was not normal, non parametric tests of Wilcoxon and Mann-Whitney were used. SPSS V.11.5 was also used for data analysis. In both groups, stride velocity increased (p=0.03, p=0.01). In CIMT group, COP sway for paretic and non-paretic limbs decreased in frontal plane (p=0.03, p=0.008). COP sway velocity for paretic limb decreased in both planes (p=0.01, p=0.03). For mass practice group, only COP sway amplitude for non-paretic limb decreased in sagittal plane (p=0.03). Physical therapy based on “Constraint Induced Movement Therapy” can more efficiently manage dynamic balance gait disorders by overcoming "learned non-use" phenomena and improving somato-sensory deafferentation to central motor controllers.

Knee osteoarthritis is one of the most common disabilities and has caused a lot of limitations in human. There are many methods proposed for its treatment. The aim of this study was to assess the effect of grade one mobilization of patellofemoral joint on reducing the pain and joint stiffness and improving the physical function in knee osteoarthritis patients. This study was one side blind clinical trial which was carried out in physical therapy department of Sarcheshmeh copper town polyclinic. The patients were selected randomly. Outcome instrument was WOMAC index (sum of data resulted from WOMAC questionnaire form) and measurements were done before and after treatment nearly one week after final treatment session. 30 patients with diagnosis of knee osteoarthritis, grade two or three, were divided into 3 groups randomly: Group 1: Mobilization + Exercise therapy, Group 2: Exercise therapy and Group 3: Mobilization. The ultrasound with the intensity below 0.2 w/cm2 in three minutes was used for all groups as placebo. The duration of treatment was 10 sessions for 3 weeks. To analyze the data, nonparametric tests were used at the significance level of 0.05. In group one, WOMAC index decreased from 61.5+9.69 before treatment to 49.7+11.88 after treatment (P=0.005). In group two, WOMAC index decreased from 56.7+17.24 before treatment to 45.2+19.90 after treatment (p=0.022), and in group three, WOMAC index decreased from 59.6+16.51 before treatment to 47.7+19.72 after treatment (p=0.059). The difference of WOMAC index at the follow-up session, in comparison with the one before treatment, was significant only in group one which decreased to 50.1+11.73 (p=0.005). This study showed that grade 1 mobilization of patellofemoral joint can cause the effect of exercise therapy on reducing the pain and joint stiffness and improving the physical function in patients with grade 2 or 3 knee osteoarthritis continue at least for about one week.

Knee osteoarthritis (OA) is one of the common disabling conditions in human. Joint mobilization is a passive rhythmic accessory movement therapy that is used in the treatment of OA. In this study, the effect of grade one mobilization, on pain reduction of knee OA has been investigated. This study was an unidirectional blind clinical trial with random sampling from patients admitted to sarcheshme physiotherapy clinic in 2007. Thirty participants were divided into 3 groups randomly: group 1: Mobilization + Exercise therapy, group 2: Exercise therapy and group 3: Mobilization. Ultrasound with the intensity below 0.2 W/Cm2 was used for all groups as placebo. The treatment was done in 10 sessions during 3 weeks. Outcome was measured using was WOMAC questionnaire form (Likert Type). Measurements were done before and after treatment and one week after final treatment session. Friedman, Wilcoxon and Kruskal-Wallis tests were used for data analysis included. Comparison of pain between before and after treatment showed significant differences in group 1 (P=0.01) and group 3 (P=0.04) but was not significant in group 2 (P=0.135). The difference of pain at follow up visit was significant only in group 1 in comparison to before treatment (P=0.007). Pain reduction between before and after treatment (P=0.504) and before treatment and follow up session (P=0.18), showed no significant differences, between 3 groups. This study showed that grade 1 mobilization can decrease the pain of knee OA. If exercise therapy is used combined with mobilization, the effect of treatment will continue at least for about one week.