Journal of Back and Musculoskeletal Rehabilitation - Volume 34, issue 6

Authors: Koltak, Cansu | Yurt, Yasin

Article Type: Research Article

Abstract: BACKGROUND: Low level laser therapy (LLLT) is known to be effective in tendinopathies. No study yet investigated the effect of LLLT on posterior tibial tendon dysfunction (PTTD) in comparison to orthotic treatment. OBJECTIVE: The aim was to compare the effects of LLLT and insole application on pain, function and muscle strength in subjects with stage 2 PTTD. METHODS: Fifty-two subjects with stage 2 PTTD were randomly assigned to the LLLT and insole groups. The foot pain, function and strength of invertor and evertor muscles of the subjects was evaluated before and after treatment, …and after 9 months. RESULTS: Significant improvement was observed in the foot function and pain (p < 0.05) in both groups after treatment, but in the 9-month follow-up, the insole group had better values. The increase in 180 ∘ .sec - 1 concentric invertor muscle strength was found significant after the treatment and in month-9 as compared to the initial values (p < 0.05). CONCLUSIONS: Both treatments are effective in reducing treating foot pain, as well as improving the function in subjects with stage 2 PTTD. However, at the end of the 9-month follow-up, it was seen that insoles were more effective. Neither method had a clinically important effect on muscle strength. Show more

Keywords: Low level laser therapy, foot orthoses, posterior tibial tendon dysfunction

DOI: 10.3233/BMR-200199

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 34, no. 6, pp. 1069-1078, 2021

Authors: Hussein, Hisham Mohamed | Morsi, Amal Ahmed | Abdelraoof, Neveen Abdellatif

Article Type: Research Article

Abstract: BACKGROUND: Low back pain (LBP) is a common musculoskeletal problem, which commonly affects balance. Sustained natural apophyseal glide (SNAG) is a successful treatment approach for LPB. However, its influence on balance problems has not been studied before. OBJECTIVE: To investigate the immediate effect of SNAG on postural stability and pain in individuals with flexion-dominant chronic low back pain (FCLBP). METHODS: Randomized placebo-controlled trial in which 64 participants with FCLBP were randomly allocated into two groups (SNAG and sham). SNAG group (n = 32) received central lumbar SNAG …on the symptomatic lumbar level(s). Sham group (n = 32) received sham SNAG. The outcome measures were postural stability indices; overall stability index (OSI), anteroposterior stability index (APSI), and mediolateral stability index (MLSI) in addition to pain intensity. Outcomes were assessed using the Biodex Balance System and visual analog scale respectively. Measures were taken before and immediately after interventions. RESULTS: There were statistical significance and high effect size (ES) in favor of the SNAG group regarding OSI, APSI, and pain (p < 0.01, cohen’s d ES = 1.3, 1.4, 1.1 respectively). MLSI showed moderate ES (cohen’s d = 0.7) but did not reach a statistically significant level (p = 0.05). CONCLUSION: Lumbar SNAG produces an immediate improvement in postural stability and pain in individuals with FCLBP. Show more

Keywords: Balance, immediate effect, low back pain, sustained natural apophyseal glide

DOI: 10.3233/BMR-200217

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 34, no. 6, pp. 1079-1086, 2021

Authors: Kim, Ji Young | Kim, Seong Yoel

Article Type: Research Article

Abstract: BACKGROUND: Hamstring flexibility plays a significant role in physiotherapy. Various stretching studies have been conducted to increase hamstring flexibility, but the effects of the Fascial Distortion Model (FDM) on hamstring flexibility have not yet been investigated. Moreover, no studies have compared the effects of FDM and static stretching. OBJECTIVES: To investigate the effects of the FDM on hamstring flexibility compared with static stretching. METHODS: Thirthy healthy adults were divided into two groups: static stretching and FDM groups. Static stretching was performed to hamstring in the supine position. The FDM was performed using trigger …band techniques that followed the hamstring in a longitudinal direction. Hamstring flexibility was measured using the active knee extension angle (KEA), passive straight leg raising (SLR), sit-and-reach (SR), and finger-floor distance (FFD) tests. A paired t -test and an independent t -test were performed to compare the hamstring flexibility measurements. RESULTS: Both groups showed significant differences (p < 0.05) in KEA, SLR, SR, and FFD before and after. However, no significant difference (p > 0.05) was found between the two groups. CONCLUSIONS: There was no difference in the effects of FDM and static stretching on hamstring flexibility. Show more

Keywords: Static stretching, fascial distortion model, FDM, hamstring, flexibility

DOI: 10.3233/BMR-200219

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 34, no. 6, pp. 1087-1092, 2021

Authors: Kısacık, Pınar | Tunay, Volga Bayrakcı | Bek, Nilgün | Atay, Özgür Ahmet | Selfe, James | Karaduman, Aynur Ayşe

Article Type: Research Article

Abstract: BACKGROUND: Patellofemoral pain (PFP) is a common knee problem. The foot posture in a relaxed stance is reported as a distal factor of PFP. However, the effects of short foot exercise (SFE) on the knee and functional factors have not yet been investigated in patients with PFP. OBJECTIVE: This study aimed to investigate the additional effects of SFE on knee pain, foot biomechanics, and lower extremity muscle strength in patients with PFP following a standard exercise program. METHODS: Thirty patients with a ‘weak and pronated’ foot subgroup of PFP were randomized into …a control group (ConG, n = 15) and a short foot exercise group (SFEG, n = 15) with concealed allocation and blinded to the group assignment. The program of ConG consisted of hip and knee strengthening and stretching exercises. SFEG program consisted of additional SFE. Both groups performed the supervised training protocol two times per week for 6 weeks. Assessment measures were pain visual analog scale (pVAS), Kujala Patellofemoral Score (KPS), navicular drop test (NDT), rearfoot angle (RA), foot posture index (FPI), and strength tests of the lower extremity muscles. RESULTS: Both groups displayed decreases in pVAS scores, but it was only significant in favor of SFEG. NDT, RA, and FPI scores decreased in SFEG whereas they increased in ConG. There was a significant group-by-time interaction effect in hip extensor strength and between-group difference was found to be significantly in favor of SFEG. CONCLUSIONS: An intervention program consisting of additional SFE had positive effects on knee pain, navicular position, and rearfoot posture. An increase in the strength of the hip extensors may also be associated with improved stabilization by SFE. Show more

Keywords: Patellofemoral pain, short foot exercises, foot core, foot posture

DOI: 10.3233/BMR-200255

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 34, no. 6, pp. 1093-1104, 2021

Authors: Lee, Jihoon | Park, Chanhee | Cha, Youngjoo | You, Joshua (Sung) H.

Article Type: Research Article

Abstract: BACKGROUND: Although the instrument-assisted manual (IM) technique has been widely utilised to improve soft tissue and joint mobility, its therapeutic benefits and underlying neuromechanical mechanisms remain unknown compared to those of conventional static stretching (SS) and hold-relax (HR) manual techniques. OBJECTIVE: This study aimed to compare the effects of the SS, HR, and IM techniques on muscle activity, kinematics, and strength during deep squatting in limited ankle dorsiflexion (DF) syndrome. METHODS: This was a cross-sectional randomised controlled study including 39 adults divided into three groups: SS group: 13, HR group: 13, IM group: …13. Outcome measures were the tibialis anterior (TA): gastrocnemius (GCM) balance ratio and ankle, knee, hip and thoracolumbar junction angles. TA muscle strength was analysed to evaluate the limited ankle DF. Analysis of variance was performed, with P < 0.05. RESULTS: The TA:GCM balance ratio, ranges of motion of ankle DF and knee flexion, and TA muscle strength in the IM group improved significantly compared to that in either the SS group or HR group (P < 0.05). CONCLUSIONS: Our novel results demonstrated that IM was most effective in normalising TA:GCM balance, ankle DF range of motion, and TA muscle strength during deep squatting in adults with limited ankle DF. Show more

Keywords: Ankle dorsiflexion, deep squatting, hold-relax, static stretching, manual technique

DOI: 10.3233/BMR-200257

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 34, no. 6, pp. 1105-1112, 2021