azadeh shadmehr

Given the bone sensitivity to mechanical stimulus, bone-loading exercises and applying the Pulsed Electromagnetic Fields (PEMF(s)) are recommended for promoting bone strength. In this context, these two interventions 's effect on bone turnover markers (BTMs) in osteoporosis patients is yet to be clarified; consequently, an attempt is made in this study to compare the effect of these two interventions on bone turnover markers in women with Postmenopausal Osteoporosis (PMOP). This study is design as a randomized, single-center, three-arms, controlled trial. A total of 51 women with PMOP will be randomly assigned to three groups of 17, using opaque, sealed envelopes containing labels for A, B, and C groups. Group A) will receive bone-loading exercises, B) will follow the PEMF(s) and C) will be exposed to the combination of A and B. These three groups will require intervention for 24 sessions (2 sessions/week) next to their routine medical treatment (Alendronate+ Calcium+ Vitamin D). The primary outcome of this study is the serum biomarker of bone formation (bone-specific alkaline phosphatase, BSALP) and resorption (N-terminal telopeptide, NTX). The secondary outcomes consist of thoracic kyphosis angle, fear of falling, and quality of life. The outcomes are measured three times: at baseline, after 24 sessions of intervention, and at 12 weeks follow-up. A primary outcome will be measured and reported by a laboratory expert who is blinded to the participant grouping.  The trial has the code of ethics for research (IR.TUMS.FNM.REC.1401.126) and the code of Iranian Registry of Clinical Trials (IRCT) (IRCT20221202056687N1). Study results are expected to be available by mid-2024. This trial will provide new practical knowledge on the bone-loading exercises and PEMFS(s)’s effect on PMOP women. This knowledge is of the essence for physiotherapists, clinicians, other healthcare professionals, and policymakers in the healthcare system. Level of evidence: Not applicable

The study aimed to investigate the effects of deep neck flexor (DNF) and deep neck extensor (DNE) muscle exercises on pain, passive range of motion (PROM), craniovertebral angle (CVA), neck flexor endurance (NFE), neck extensor endurance (NEE), and the number of weekly painkiller usage (NWPKU) in chronic non-specific neck pain (CNNP) patients.

A total of 27 CNNP patients, incuding intervention group (n=15) and control group (n=12), were recruited for this study. Patients in the intervention group participated in 6 weeks of DNF and DNE exercises plus traditional physiotherapy. After 10 sessions (3 weeks), the exercise protocol was followed for 3 weeks of the home-based exercise form. Control group patients received traditional physiotherapy alone. The numeric pain rating scale (NPRS), PROM, CVA, NFE, NEE, and NWPKU were examined and compared between groups, at the baseline and after six weeks.

Numeric pain rating scale, PROM, CVA, NFE, NEE, and NWPKU improved significantly in both groups after treatment (P<0.001). The NPRS, passive flexion, passive extension, passive right-side bending, passive left rotation, CVA, NFE, NEE, and NWPKU differences were significant (P<0.05).

The study supports the positive effects of combination therapy (DNF and DNE exercises plus traditional physiotherapy) on pain, passive neck range of motion, neck lordosis posture, and neck muscle endurance in CNNP patients.

Forward head posture (FHP) is one of the most common positional deviations. Frequent users often exhibit incorrect posture because of the rising popularity of media devices, such as smartphones and computers. This posture leads to changes in muscle activity in cervical flexion and extension. It is defined by hyperextension of the upper cervical vertebrae and forward translation of the cervical vertebrae. This study evaluates the effect of dry needles as a new method in the upper trapezius muscle on the neck’s angles and range of motion (ROM) in individuals with FHP.

In this quasi-experimental interventional study, 18 women with FHP underwent a dry needle session. The photogrammetry of the cranio-vertebral angle measured the degree of FHP. Visual analog scale (VAS), pain pressure threshold (PPT), cranio-vertebral angle (CVA) and cranio-horizontal angles (CHA), ROM, scapular index (SI), and forward shoulder translation (FST) were assessed before and after the intervention.

The results demonstrated that after the intervention, right and left PPT, flexion, and proper neck rotation, right and left SI, CVA, and CHA were significantly improved (P<0.05).

The results showed that one session of dry needling with stretching exercises intervention could improve PPT, ROM, SI, CVA, and CHA and consequently improve FHP.

Flexibility or the ability of a muscle to increase in length is an integral part of musculoskeletal characteristics and is essential in preventing musculoskeletal injuries and increasing functional levels. Hamstring muscles rupture is a common injury. One of the important factors in the occurrence of this injury is poor hamstring muscle flexibility, which because of its stiffened structure, has less ability to quickly increase in length. Some researchers have recently suggested that the dry needling technique could reduce the number of treatment sessions for hamstring muscle tightness and bring faster and more effective results. Accordingly, this study aims to investigate the effect of the application of dry needling through an acupuncture technique on hamstring muscle flexibility.

The present study is a single-blinded randomized controlled trial in which 16 individuals with bilateral hamstring muscle shortness were randomly allocated into dry-needling and sham-needling groups. The sampling method was non-probability convenience. The outcome measures were the right and left active knee extension range of motion, assessed before and after the first, third, and fifth sessions of intervention. A 2-factor mixed analysis of variance was applied to determine the differences between and within the two groups.

Except for the group main effect, time main effect and interaction effect were statistically significant for the right and left active knee extension range of motion (P<0.001). There were differences in behavioral patterns in groups; accordingly, in the real dry-needling group, a significant difference was detected across times. However, in the sham dry-needling group, no significant difference was observed.

The application of dry needling into motor points of hamstring muscles in individuals with bilateral hamstring muscles shortness could improve flexibility and increase the range of knee extension after 3 and 5 sessions of intervention because of the therapeutic effects of the dry needling technique in improving the muscle flexibility.

The study was conducted to compare the immediate effect of high-power pain threshold ultrasound (HPPTUS) and deep transverse friction massage (DTFM) as a traditional technique on the treatment of upper trapezius active myofascial trigger points in male patients with mechanical neck pain.

In this parallel single-blind randomized clinical trial study, 60 men with mechanical neck pain (mean age: 30.57±6.19 years) who met the inclusion and exclusion criteria were randomly assigned to HPPTUS and DTFM as the control group. A visual analog scale (VAS), pain pressure threshold (PPT), and range of motion (ROM) of cervical lateral flexion (CLF) were assessed before and after treatment.

Analysis of pre- and post-treatment findings showed that the VAS (P<0.01), PPT (P<0.01), and ROM of CLF (P<0.01) improved significantly in both groups while ROM of CLF increased significantly more in the HPPTUS group. An indirect correlation was found between the pre-treatment ROM of CLF and ROM of CLF improvement in both groups. A significant indirect correlation was observed between pre-treatment VAS and ROM of CLF improvement in the HPPTUS group. In the DTFM group a significant indirect correlation was found between pre-treatment ROM of CLF and VAS improvement.

The results showed that HPPTUS can be used as an effective treatment for active trigger points (TP). It seems that this method is more effective than deep transverse friction massage.

The Objective Ankle sprains are among the most common injuries in athletes. One of the limitations of people with chronic ankle instability is the lack of postural control. Balance and coordination training are among the most common interventions for people with chronic ankle instability. Therefore, the aim of this study was to investigate the effect of balance training on postural control in athletes with chronic ankle instability.

Randomized clinical trials (RCTs) that examined the effects of balance training on postural control in athletes with chronic ankle instability were searched through the Scopus, PubMed, Cochrane and PEDro databases using keywords and concepts of postural control, balance training, and ankle instability from inception until April 2022. The quality of studies was assessed using the PEDro scale.

Eight RCTs were included in this study, based on inclusion and exclusion criteria. Balance exercises reduced postural sway, decreased the distribution of center of mass, improved the overall body balance index and anterior-posterior balance index in the Biodex balance system, increased the duration of balance maintenance, and reduced the number of errors in the foot lift test when checking static postural control, and improved the reaching distance in the star balance test when checking dynamic postural control.

Four to six weeks of balance training can improve postural control in both static and dynamic situations in athletes with chronic ankle instability.

This study investigated the effect of change in postural stability after applying static load during internal perturbation among professional athletes with and without anterior cruciate ligament (ACL) surgery.

The participants of the present study were 20 athletes with sixteen months post ACL reconstruction surgery and 20 healthy matched athletes. Each participant performed transitional tasks from double limb stance to single leg stance (SLS) and again to double limb stance on the force plate before and after the application of 10 minutes of constant loading. Area, fore-after range (the meaning of fore-after is anterior-posterior and in articles, this term has been used instead of anterior-posterior) range fore-after (Rfa), range sideway (Rsw), mean velocity (Mv) and confidence ellipse (Ce) of the center of pressure were measured.

Rsw (P=0.009) and area (P=0.009) in response to static loading in the healthy group showed a decrease and an increase of area (P=0.009) in response to static loading in the ACLR group was seen on the double limb stance phase. Mv (P<0.001) and area (P<0.001) were bigger in the ACLR group after static loaded on the integration phase.

Decreased capacity of passive structures to maintain postural stability against perturbation was observed due to positional change among athletes with a history of ACL reconstruction surgery.

Blood flow restriction (BFR) training, in which an inflatable cuff partially occludes blood flow around the proximal portion of a limb, coupled with low-load resistance exercise (LLRE) has resulted in gains comparable with traditional progressive resistive exercise in healthy populations. The use of BFR with LLRE may help people with supraspinatus tendinopathy through proximal effects to improve strength and muscle size. The purpose of this case report is to describe the proximal effect of the LLRE+BFR program on a patient with supraspinatus tendinopathy.

The patient was a 40-year-old man with a history of shoulder pain and weakness for the past months. He received an LLRE+BFR program for his right shoulder including rotator cuff and scapular strengthening exercises and lower limbs aerobic exercises based on protocols of strengthening and aerobic exercises of BFR. Outcomes measured at baseline and 4 weeks included the 4 items: 1) Strength of supraspinatus muscle and four scapular stabilizer muscles including serratus anterior strength, middle trapezius strength, and lower trapezius strength by dynamometer, 2) supraspinatus thickness by ultrasound, 3) pain pressure threshold of supraspinatus and deltoid muscles by algometer, and 4) pain reported bay in each session based on pain numeric scale.

After 6 weeks, the strength of supraspinatus and scapular stabilizers except for the lower trapezius increased. The supraspinatus thickness and pain pressure threshold in the supraspinatus and deltoid muscle also increased after 4 weeks. The mean of pain reported by the patient based on the pain numeric scale before and after each session was also decreased.

The patient had measurable improvements following the use of an LLRE+BFR program. LLRE+BFR program may be an option for strength training in people with supraspinatus tendinopathy; however, more research is needed to determine effectiveness across the population of people with supraspinatus tendinopathy.

Reaction time is an important indicator of good performance. Different types of exercises have been used by researchers to improve the reaction time of an individual. Other types of exercises still need more research to study their effect on simple reaction time, such as proprioceptive training. The purpose of this study is to examine the effect of a proprioceptive training program using the Huber machine on the simple reaction time.

Twenty-one participants from the medical staff were assigned to two groups including the experimental group (1) composed of 5 male and 5 female participants and a control group (2) including 5 male and 6 female participants. A simple reaction time (SRT) test was assigned to all participants. Only the experimental group performed a proprioceptive exercise protocol on Huber motion’s platform, while the control group was tested at identical periods without exercising before the training (T0), immediately post-exercise (T1), and twenty minutes after exercising (T2). The procedure was repeated for six sessions over two weeks.

The participants of the group (1) show a decrease in the mean of RT (-43 min) immediately after proprioceptive training (T1), but they reveal a little increase (at T2) in SRT after an interval of 20 minutes (-23 min). They still prove a retention effect, while few participants in the control group show improvement at T1 or T2. Paired sample t-test was significant for the group (1) at T1 and T2 (P<0.05) while it was not significant for the control group.

Proprioceptive training may have a positive influence on reaction time with a retention effect. Clinicians can use proprioceptive training to improve the reaction time of their patients.

Chronic neck pain (CNP) is of the most common symptoms of musculoskeletal disorder. Diaphragmatic exercises can reduce pain, and disability, improve proprioception, and correct forward head posture (FHP) in patients with CNP. The present study aims to determine the effect of combining diaphragmatic exercises with physiotherapy on pain, disability, and active range of motions of cervical and FHP in individuals with CNP.

Thirty women with CNP were randomly divided into two combined groups of diaphragmatic exercises and physiotherapy (DEPT) and PHYSIOTHERAPY ALONE (PT). Each person received ten sessions of treatment over two weeks. The results were assessed in the first and tenth sessions as well as two weeks later. Pain intensity was measured by visual analogue scale (VAS), disability by neck disability index (NDI), cervical active range of motions (CAROMs) by goniometry, and FHP by a lateral photograph.

The VAS, neck disability index (NDI), CAROMs, and FHP were improved after the tenth session and in a two-week follow-up (P<0.001). A significant difference was observed between the groups for average changes of VAS (P=0.04) and active extension (P<0.001) after the tenth session, while the average changes between the two groups of cervical active left lateral flexion (P=0.82) and left rotation (P=0.11) in the next two weeks was not significant.

Both groups showed improvement in neck pain, disability, CAROMs, and FHP. However, diaphragmatic exercises and physiotherapy (DEPT) seem to have more lasting effects. Therefore, it is recommended to evaluate and modify the breathing patterns in the first line of treatment programs for patients with CNP.

To demonstrate the effectiveness of extracorporeal shock wave therapy (ESWT) in treating active trigger points to relieve pain and increase range of motion (ROM) and improve the function of the cervical region in fewer sessions.

In this single-group, pretest-posttest study, 15 participants with active myofascial trigger points (MTrPs) in the upper trapezius muscle took part. Before and after each treatment, visual analog scale (VAS), pressure pain threshold (PPT), neck disability index (NDI) questionnaire, and range of active contra lateral flexion (CLF) were assessed. Participants were given three treatments over a week, with at least a two-day break between them, and then all outcomes were evaluated.

The general results of this study demonstrate a significant reduction in pain perception in terms of VAS (P=0.0001), increased pressure pain threshold (P=0.0001), increased CLF of ROM (P=0.0001), and improved neck function by reduction of NDI (P=0.0001), after the third session of ESWT intervention in participants with MTrP in the upper trapezius muscle.

It reveals that ESWT has positive effects on pain reduction, cervical range of motion, and cervical function in participants treated with MTrPs in the upper trapezius muscle.

We investigated the combined effect of Radial Shockwave Therapy (RSWT) and muscle energy technique (MET) on pain, range of motion (ROM), and neck function in people with active trigger points (ATrPs) of the upper trapezius muscle.

Fifty-four participants with ATrPs of the upper trapezius muscle were randomly divided into three groups. Group A (n=18) received only MET, group B (n=18) received only RSWT, and group C (n=18) received both RSWT and RSWT. Pain intensity using the Visual Analog Scale (VAS), pressure pain threshold (PPT), neck function using the Neck Disability Index (NDI) questionnaire, and lateral-flexion range of movement (LF ROM) were measured before and after the intervention. The participants were treated for three sessions in one week with at least two days of rest between sessions.

All three intervention groups showed pain reduction (p<0.001), an increase in PPT (p<0.001), counter-lateral flexion (CLF) (p<0.001), and also improvement in neck function (p<0.001). The combined group showed a more obvious improvement than the other two groups in PPT (p<0.001). There was no difference between the three groups in terms of VAS and NDI scores and CLF (p>0.05).

The results of this study showed that all three interventions used in the upper trapezius trigger points therapy were effective; however, the combined group showed a significant difference in PPT. Therefore, combined therapy is superior to MET and RSWT alone in improving pressure pain relief in individuals with upper trapezius trigger points.

This study aimed to investigate the immediate effect of kinesio taping (KT) over abdominal muscles with different tensions on the components of the lumbopelvic complex.

This is a single-blind randomized controlled clinical trial. Participants were 44 healthy male athletes aged 18-30 years with increased anterior pelvic tilt (PT). Three intervention groups underwent 15 minutes of KT over rectus abdominis and external oblique muscles with tensions of 100, 115, and 140%, respectively, and one group was considered as the control group with no KT. The PT and lumbar lordosis angles and iliopsoas and hamstring muscle lengths were measured before and after the KT. Repeated measures ANOVA was used to compare the means in the study groups before and after the intervention.

The mean of right and left PT and lumbar lordosis angles in groups with 115 and 140% tensions before and after the intervention were statistically different (P<0.05). Moreover, the mean of right and left PT and lumbar lordosis angles showed a significant difference between the groups after the intervention (P<0.05). There was a significant difference in active and passive hamstring lengths on both sides in the group received KT with 140% tension before and after the intervention (P<0.05).

Kinesio taping with high tension on rectus abdominis and external oblique muscles can reduce their PT angle and lumbar lordosis and increase hamstring muscle length in men with increased anterior PT. This issue should be considered in lumbopelvic complex physiotherapy.

The present study aimed to investigate the effects of Myofascial Release Therapy (MRT) on cardiorespiratory functions in patients with COVID-19.

A total of 36 patients with COVID-19 (intervention group=20, controls=16) were included in the present study. The patients in the intervention group participated in a single session of suboccipital, anterior thoracic and sternal, anterior cervical, and diaphragm myofascial release techniques, plus respiratory physiotherapy. The controls just received respiratory physiotherapy. Before-after assessments included recording heart rate, systolic and diastolic blood pressure, respiratory rate, blood oxygen saturation, chest expansion, and breathing comfort.

There was a significant reduction in the heart rate and ease of breathing in the intervention group (P=0.04, P=0.02; respectively); also, the diastolic blood pressure increased significantly in the control group (P=0.02). Compared to the controls, the ease of breathing decreased significantly in the intervention group (P=0.03).

Myofascial release techniques of the neck, thoracic, and diaphragm, along with respiratory physiotherapy, could immediately affect heart rate and ease of breathing and prevent increasing diastolic blood pressure. If a patient with COVID-19 is stable, pulmonary physiotherapists may consider using these techniques while monitoring cardiopulmonary function.

The present study aimed to investigate the immediate effects of two types of Kinesio taping on the temporal and spatial variables of gait initiation in individuals with and without Functional Ankle Instability (FAI).

Thirty semi-professional athletes (15 with and 15 without FAI [control]) were recruited for this study. The gait initiation task was examined before and after the two types of Kinesio taping on a force plate. Temporal (Reaction Phase [RP], Anticipatory Postural Adjustment Phase [APAP]), and spatial variables were recorded and compared between Groups, before and after the tape application.

The results of multiple repeated-measure analyses of variance showed no significant differences for “factor” and “Group by factor” interaction effects for any outcome measure (P>0.05). There were no significant differences for Group effects except for the APAP (F=10.27, P=0.003). The APAA was 71.95 ms longer in the FAI Group (476.95±15.87 ms) compared to the control Group (405.04±15.87 ms).

Kinesio taping application does not influence any of the gait initiation parameters on the force plate. Participants with FAI demonstrated longer APAP which might be due to recurrent injury and instability during sports or physical activity.

Many changes occur in postpartum period in the body and soul of mothers that may lead to mothers' feeling fatigue. The use of reflexology has been well established as a branch of complementary medicine in the promotion of health care, especially in the field of maternal and neonatal health. Therefore, this study was performed with aim to investigate the effect of foot reflexology on postpartum fatigue in primiparous women.

This clinical trial study was performed on 70 primiparous women referred to the healthcare centers in the south of Tehran in 2018. The subjects were divided into two groups of control and reflexology. The mothers of the control group received postpartum routine care and the reflexology group received massage for 3 consecutive days for 30 minutes (15 minutes per leg). Both groups completed the fatigue assessment-visual questionnaire before and after the intervention (immediately and one week after completion). Data were analyzed by SPSS statistical software (version 21) and parametric inferential statistical tests such as analysis of variance with repeated measures and non-parametric measures (Chi-square). Also, independent t-test was used to determine the significant difference between the mean of some social demographic characteristics with the treatment outcome. p < 0.05 was considered statistically significant.

Demographic characteristics and severity of fatigue before the intervention were the same in both reflexology and control groups. Immediately after the intervention (p <0.001) and one week after the intervention, the severity of fatigue between the two groups of reflexology and control showed a statistically significant difference (p <0.001).

Supportive and rehabilitation measures such as foot reflexology can be effective in reducing fatigue of primiparous mothers after normal delivery.

The most critical clinical presentation in myofascial pain syndrome is trigger points. Trigger points are the main problem in 30% of the patients presenting to general internal medicine practice. One of the treatments used for trigger points is ultrasound therapy. The high-power pain threshold ultrasound (HPPTUS) technique is one of the therapeutic ultrasound modifications used to treat trigger points. The present randomized clinical trial aimed to investigate the immediate effect of high-power pain threshold ultrasound on treating active trigger points of the upper trapezius muscle in men with mechanical neck pain.

Fourteen men with mechanical neck pain (Mean±SD age: 34.50±5.24 years) who met the inclusion and exclusion criteria participated in this study. The visual analog scale (VAS), pressure pain threshold (PPT), and range of motion of cervical lateral flexion (CLF) were assessed before and after the treatment. The ultrasound probe was placed on the trigger point. The frequency was set to 1 MHz, and the intensity increased from 0.5 to 2 until the patient reported an unpleasant sensation. The probe was held there for 4 seconds. Then, the intensity was reduced by 50%, and the probe was moved over and around the trigger point. This process was done several times for three minutes.

Analysis of pre-treatment and post-treatment findings showed that the VAS (P<0.001), PPT (P=0.001), and CLF (P<0.001) improved significantly after applying the HPPTUS to trigger points.

Ultrasound significantly improved the muscular symptoms of the trigger points.

Flexibility is an essential component of muscle function, and insufficient muscle flexibility may lead to muscle injuries. Decreased hamstring flexibility is one of the frequently reported risk factors for a hamstring strain and diminished athletic performance. Stretching is a commonly used intervention for increasing muscle length. There is a lack of evidence concerning the possible effects of hamstring stretching in balance and gait biomechanics. So, this study was designed to investigate the potential effects of static hamstring stretching on the range of motion (ROM), dynamic balance, and biomechanical variables of gait in athletes with hamstring tightness.

This study is a single-group, pretest-posttest clinical trial performed on semi-professional female athletes. Twelve female athletes aged 20 to 35 years with bilateral hamstring tightness received a single session of unilateral static hamstring stretching on their randomly selected side. All subjects were assessed for straight leg raise, popliteal angle (using standard goniometry), perceived hamstring tightness (using a visual analog scale). They completed single-leg standing and 15-m walking and running tasks before and immediately after the intervention. The biomechanical parameters, including gait-line length, swing duration, and stance duration in walking tasks, maximum total force and mean total force in running task, and center of pressure (COP) displacement and standard deviation during balance task were measured using OpenGo sensor insole system. The pre-post values were compared using the paired sample t-test, and the level of significance was 0.05.

The values for straight leg raise and popliteal angle significantly increased (P<0.05) compared with the baseline, while perceived tightness significantly decreased following stretching (P<0.001). The amplitude (P₌0.006) and standard deviation (P₌0.016) of COP displacement in the mediolateral direction during the single leg stance balance task were significantly decreased after the intervention. Stance duration in slow walking (P₌0.004), as well as stance duration (P₌0.012) and swing duration (P<0.001) in fast walking, were significantly decreased (P<0.05) after stretching. No change was observed in gait biomechanical variables during the running test (P>0.05).

The results of this study indicate that static hamstring stretching can be a promising intervention not just for increasing hamstring flexibility but also for improving balance ability.

Until now, a variety of techniques have been introduced to address the adverse effects of NS-CLBP, including spinal manipulation technique (SMT) and muscle energy technique (MET). However, most of these techniques have focused on pain assessment and disability. In other words, the intermuscular synchronization between the co-contracting muscles was not considered, and hence, the effectiveness of these techniques on the corticospinal tract function was not studied.

This study aimed to compare the effects of SMT and MET on corticospinal tract function during four phases of standing, flexion, relaxation, and extension in flexion-extension task (F-ET) in NS-CLBP using pair-wise coherence of Beta-band intermuscular coherence (Bb-IMC).

Twenty volunteer healthymale subjects and twenty-fourmale subjects with NS-CLBP (20 - 45 years of age) participated in this work. The patients had continuous or recurrent symptoms for three months or more without any referral pain to the lower extremities. The patients were randomly assigned to two equal intervention groups (SMT and MET), and the techniques were applied as described by Greenman. Surface electromyography (sEMGs) from lumbopelvic muscles was recorded for all participants (i.e., healthy group and the patient groups), while they performed three trials of F-ET, and the pair-wise coherence for all muscles was calculated using Bb-IMC analysis. Besides, in the patient’s groups, sEMGs from the muscles were recorded before and after the interventional techniques (i.e., SMT and MET), while they performed three trials of F-ET, and the pair-wise coherence was calculated. Multivariate analysis of variance test was used to compare the healthy subjects and patient groups before the interventions in A and B muscle cross at different phases of F-ET task. Furthermore, in the NS-CLBP patients, comparisons were made before and after the interventions in each group (i.e., SMT and MET groups) as well as between the two groups in A and B muscle cross at different phases of the F-ET task.

In the standing phase of F-ET, there were no significant differences in the SMT and MET group before and after the intervention in PWC of A muscle cross and B muscle cross (P < 0.05). Considering the flexion phase, there were significant differences in the SMT group in all pair muscles as PWC (M1-M4), PWE (M1-M6), PWC (M4-M6) (P < 0.05), whereas there was one significantly in PWC (M4-M6) in the MET group (P < 0.05). In the relaxation phase, the SMT had significantly in PWC (M2-M5), whereas there was one significantly in PWC (M4-M6) in MET group (P < 0.05). In the extension phase, although the SMT was not significant (P < 0.05) in the MET intervention group, there were significant differences in the PWC (M2-M3) and PWC muscles (M2-M5).

This study provided some pieces of evidence about the effects of one of the common manual therapy techniques on the primary motor cortex and corticospinal drive in the NS-CLBP patients. The results showed that, by increasing the pair-wise coherence in all phases of FE-T, SMT intervention was more effective than MET intervention. Therefore, the pair-wise coherence of Bb-IMC can be considered an approach for clinicians when designing the rehabilitation protocol to ensure optimal treatment.

The aim of the study was to investigate the reliability and agreement of the Beta-band intermuscular coherence (Bb-IMC) as a clinical assessment tool for Non-Specific Chronic Low back pain (NS-CLBP) patients and healthy subjects by studying four phases of flexion-extension task; standing, flexion, relaxation and extension phases (F-ET).

Twenty-four men with NS-CLBP and 20 healthy subjects voluntarily participated in this study. All those subjects performed three trials of F-ET while the sEMG was recorded from the lumbar erector spinal, gluteus maximus and hamstring muscles of both sides. Beta-band intermuscular coherence analysis was used to calculate the pool coherence and the pairwise coherence for all mentioned muscles. Afterward, the intra-class correlation coefficient (ICC), standard error of measurement (SEM), and minimal detectable change (MDC) for four phases of F-ET were also used to analyze the intrarater reliability and agreement of the measurements.

The investigation of ICC, SEM and MDC showed that the reliability was moderate to a high level of reliability for pool and pairwise coherence of Bb-IMC in all mentioned muscles for four phases of flexion-extension task in NS-CLBP patients and healthy subjects. Yet, the agreement was low because the measurement error was relatively large.

Up until now, no studies have used the Bb-IMC method to study Low back pain which are carried out in our study to check the reliability of this new method. Our findings revealed that pool and pairwise coherence obtained during F-ET are moderate to a high level of reliability for using Bb-IMC and could be considered as a tool for the NS-CLBP patients’ assessment. Although the small sample size investigated, in clinical practice the using this measure to conclude the interaction of corticospinal in NS-CLBP and healthy subjects should help to improve the analysis. This requires including larger sample sizes in addition to studying other circumstances and functional movements such as lifting weight. Furthermore, more research appears to be warranted by the observed effectiveness of a particular intervention in modulation mechanisms of corticospinal tract function by Bb-IMC in NS-CLBP.

Muscle energy technique (MET) is one of the alternatives for the treatment of joint dysfunctions. Previous studies investigated this technique without considering the kind of dysfunctions. Therefore, the aim of this study was to evaluate the therapeutic effects of MET by considering the type of dysfunction and the direction of the corrective maneuver in women with iliosacral joint dysfunctions.

This randomized controlled clinical trial included 60 women with anterior innominate or posterior innominate dysfunctions and were randomly divided into the treatment group (n=30) receiving a session of MET and the control group (n=30). The range of flexion and extension of the lumbar, visual analogue scale (VAS), active straight leg raising (ASLR), and pressure pain threshold (PPT) at five points were measured before, after, and 24 hours after MET.

Before, after, and 24 hours after the intervention, the mean change of the range of lumbar flexion and extension showed an increase. However, the mean change of the level of VAS and ASLR decreased significantly (P<0.05) in the treatment group with corresponding 95% confidence intervals.

According to the results of this study, using MET by considering the kind of dysfunction may more efficiently improve a patient’s symptoms.

 Sacroiliac Joint Dysfunction (SIJD) is considered an origin of low-back pain. It can change the motor control strategy and postural control (PC).

 We aimed to find any probable differences in PC between subjects with and without SIJD and determine the effects of the pelvic belt (PB) on PC.

 Thirty-eight subjects were assigned into two equal groups with and without SIJD. They started to walk from the place marked on a force plate for 10 seconds after hearing an auditory signal and performed three attempts for each foot. They repeated six more ones with PB. Raw data were imported to an excel software (version 2007) spreadsheet to calculate the reaction time (RT) and anticipatory postural adjustment (APA) as the components of PC.

 Our results showed a significant difference in RT between the SIJD-affected and non-affected sides (P = 0.035), but there was no significant difference in APA (P = 0.057). There were significant differences in RT and APAs between the control and SIJD-affected side groups (P = 0.001 and P = 0.010, respectively). The PB application showed a significant difference in RT and APAs of the SIJD-affected side (P = 0.001 and P = 0.047, respectively).

 It seems pain could lead to the postural sway into instability and change the motor control strategy. The proprioception signals from the neuromuscular system of SIJ improved after PB. Therefore, PB, as a feasible tool, can be recommended for PC improvement.

 The current study aimed to compare between the chronic non-specific low back pain (CNSLBP) and healthy subjects during four phases of the trunk flexion-extension task (standing, flexion, relaxation, and extension phases) by using pool coherence as well as pairwise coherence of Beta band Intermuscular coherence (Bb-IMC) and flexion relaxation phenomena.

 Twenty-four men with CNSLBP and 20 healthy men voluntarily participated in this study. All subjects performed three tests of Flexion-extension task (F-ET) while the surface electromyography (sEMGs) were recorded from the right erector spinal muscle of the lumbar region “1”, left erector spinal muscle of the lumbar region “2”, right gluteus maximus muscle”3”, left gluteus maximus muscle”4”, right hamstring muscle”5” and left hamstring muscle”6”. Accordingly, group A contains muscles 1, 4, and 6 and group B consists of muscles 2, 3, and 5. The pool coherence (PC) and the pairwise coherence (PWC) for all the above-mentioned muscles were calculated using Beta-band intermuscular coherence analysis. Thereafter, the mean pool coherence (mPC) was considered for group A and group B for four phases of F-ET in three groups as following: CNSLBP patients group, healthy subjects group and the third group included all subjects that participated in this study, whether patients or healthy and it was called the general group. Moreover, the mean pairwise coherence (mPWC) among each pair of group A and B muscles was calculated for four phases of F-ET using Bb-IMC in CNSLBP patients and healthy subjects.

 These results indicated a high value of A mPC in the general group and healthy subjects in the flexion phase, whereas the same A mPC in CNSLBP patients was high in all phases of F-ET. On the other hand, while B mPC was high in the general group and healthy subjects in the extension phase; it was high in all phases of F-ET in CNSLBP patients; B mPC in CNSLBP patients was high in extension, standing, and flexion phases. A mPWC and B mPWC were not significantly different between CNSLBP patients and healthy subjects in all phases of F-ET. However, only A mPWC “1 - 4” and the A mPWC “4 - 6” were significantly smaller in CNSLBP patients compared to the healthy subjects in the relaxation and flexion phases, respectively. Hence, we suggest pool coherence of Bb-IMC, not pairwise coherence of Bb-IMC, to compare CNSLBP patients and healthy subjects.

 According to the present findings, we suggest using the pool coherence of Bb-IMC in the clinical examination for CNSLBP patients and studying the probable cortical effects and the effectiveness of various treatments on corticospinal tract function in CNSLBP.

This study aimed to investigate the foot function, range of motion, plantar pressure, and plantar contact area in the distance runners with normal, pronated, highly-pronated, supinated, and highly-supinated foot posture groups during static standing.

In this comparative cross-sectional study, a total of 75 distance runners were divided into 5 groups using the foot posture index. The foot function and knee and foot range of motion were assessed using the Foot And Ankle Ability Measure questionnaire (FAAM) and the goniometer, respectively. The mean of the plantar pressure percentage and the mean of the contact area on the forefoot and rearfoot were investigated during static standing. One-way ANOVA was used to compare the outcomes between the groups.

Among the groups, the normal foot group showed the highest scores in the activities of daily living subscale and sport subscale. Compared with the other groups, the highly-pronated foot group had a significantly greater range of motion in the ankle plantar flexion (P<0.002), and the normal foot group showed more range of motion in the first metatarsophalangeal extension (P<0.0001). In all groups, the mean plantar pressure percentage on the rearfoot was greater than the mean plantar pressure percentage on the forefoot. Of the groups, the highly-supinated foot group showed the highest plantar pressure percentage on the rearfoot (P<0.0001). However, the highly-pronated foot group showed the highest plantar pressure percentage and the largest contact area on the forefoot (P<0.0001) and the rearfoot (P>0.0001), respectively.

Based on the results of this study, the foot posture is an important option that could affect function and range of motion of foot and ankle and distribution of the plantar pressure and plantar contact area.

Musculoskeletal disorders are among the main causes of disability in modern life. Myofascial trigger points are very common among musculoskeletal disorders and may occur through ordinary common activities. This study aimed to determine the combined effects of laser therapy and Ischemic Compression (IC) on the treatment of Myofascial Trigger Points (MTrPs) at the upper trapezius muscle.

Twenty men with at least one active trigger point at their upper trapezius muscle voluntarily participated in this study. Trigger points were under treatment of laser irradiation (6 Joules per point) and also ischemic compression. Treatment approaches were applied over the pain point every other day for 5 sessions in 10 days. Neck disability index, pain intensity by visual analog scale, pressure pain threshold by algometry, and cervical lateral flexion by goniometer were assessed and recorded before the intervention, and immediately after the last session.

At the end of treatment, statistically significant improvements were seen in the neck disability index, VAS value, pressure pain threshold, and cervical lateral flexion. VAS values of the treatment and control groups were compared with the baseline (P<0.001).

Application of combined laser and compression therapy was effective on the pain and level of disability of patients with trigger points in the upper trapezius muscle.