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Background There is no consensus in the English-language literature regarding the best types or dosages of stretching to maximise muscle strength and functional performance. It is possible that primary research published in non-English languages provides different insights, and could add to the body of international knowledge. Purpose This systematic review aimed to identify and evaluate Japanese-language randomised controlled trials (RCTs) investigating acute effects of stretching on maximal strength and functional performance. Methods Three Japanese databases and five English databases were searched from inception to 24 March 2015. Only Japanese-language RCTs examining acute effects of stretching on maximal strength and/or functional performance were included. Risk of bias in included studies was assessed using Physiotherapy Evidence Database scale. GRADE (Grading of Recommendation Assessment, Development and Evaluation) approach was applied to evaluate the quality of evidence. Descriptive synthesis was attempted. Results Seven RCTs with variable methodological quality were included. No two studies were the same, thus meta-analysis was not possible. Descriptively, because of heterogeneity of interventions and outcome measures, it was not possible to identify consensus on the benefits of stretching. GRADE approach indicated low to very low quality evidence for this topic. Conclusion This review of Japanese-language RCTs provided no additional information to strengthen or challenge the current English-language evidence base on acute effects of stretching on maximal strength and performance. Future Japanese-language studies should address methodological flaws exposed in this review and incorporate functional outcome measures to strengthen the international evidence base.

Background: There is evidence that consistent sitting for prolonged periods is associated with upper quadrant musculoskeletal pain (UQMP). It is unclear whether postural alignment is a significant risk factor. Objective and design: The aim of the prospective study (2010-2011) was to ascertain if three-dimensional sitting postural angles, measured in a real-life school computer classroom setting, predict seated-related UQMP. Method: Asymptomatic Grade 10 high-school students, aged 15-17 years, undertaking Computer Application Technology, were eligible to participate. Using the 3D Posture Analysis Tool, sitting posture was measured while students used desk-top computers. Posture was reported as five upper quadrant angles (Head flexion, Neck flexion; Craniocervical angle, Trunk flexion and Head lateral bending). The Computer Usage Questionnaire measured seated-related UQMP and hours of computer use. The Beck Depression Inventory and the Multidimensional Anxiety Scale for Children assessed psychosocial factors. Sitting posture, computer use and psychosocial factors were measured at baseline. UQMP was measured at six months and one-year follow-up. Results: 211, 190 and 153 students participated at baseline, six months and one-year follow-up respectively. 34.2% students complained of seated-related UQMP during the follow-up period. Increased head flexion (HF) predicted seated-related UQMP developing over time for a small group of students with pain scores greater than the 90th pain percentile, adjusted for age, gender, BMI, computer use and psychosocial factors (p = 0.003). The pain score increased 0.22 points per 1° increase in HF. Conclusions: Classroom ergonomics and postural hygiene should therefore focus on reducing large HF angles among computing adolescents. Refereed/Peer-reviewed

Members of the Manipulative Physiotherapists Association of Australia (now Musculoskeletal Physiotherapy Australia) were surveyed to determine their use of cervical manipulation, compliance with and attitudes to the Australian Physiotherapy Association's (APA) Protocol for Pre-manipulative Testing of the Cervical Spine, and the incidence of adverse effects from cervical manipulation. The questionnaire was mailed to 740 members and returned by 480 members (65%). Cervical manipulation (84.5%) and passive mobilization (99.8%) were used by a high percentage of respondents. Most were familiar with the protocol with 63% supporting its continued endorsement. Adverse effects were reported at a rate of one per 1000 years of practice (or 0.003/week). The most common effects were symptoms potentially related to VBI (94.4% responses), with no reported major complications. Only 37.1% of respondents always informed the patient about potential dangers of cervical manipulation and consent was sought on every occasion by 33% of respondents. The results suggest that the use and interpretation of the protocol are variable among members of MPA. The risk of adverse effects from manipulative (musculoskeletal) physiotherapy practice, including cervical manipulation, appears to be very low. Recommendations for revision of the protocol were made on the basis of results of the survey and treatment diary, in addition to a review of the literature related to testing for vertebro-basilar insufficiency, adverse incidents related to cervical mobilizing and manipulative technique, differentiating features of VBI related dizziness and vertigo related to benign paroxysmal positional vertigo (BPPV) and current issues surrounding informed consent. Finally, a summary of the content of the new Clinical Guidelines for Pre-Manipulative Testing of the Cervical Spine (APA, 2000) is provided.