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Breast cancer represents the most common type of malignant neoplasm worldwide. Advances in diagnosis and treatment have increased the life expectancy of patients. However, the sequelae associated with the treatment of the disease such as chronic pain, kinesiophobia and loss of physical function in breast cancer survivors (BCS) are a long-term health problem. Therapeutic strategies are required for the treatment of chronic sequelae in this population. To evaluate the effectiveness of a pain neuroscience education (PNE) and therapeutic exercise (TE) for the treatment of chronic sequelae in BCS. Quasi-experimental repeated measures study. The intervention lasted 9 weeks, with 3 educational and 24 exercise sessions. Pain frequency and intensity (VAS scale), neuropathic pain (DN4), kinesiophobia level (TSK-11V), central sensitization (CSI-Sp), functionality of the affected arm (ULFI-Sp) and active joint range (ROM) with goniometry were measured at baseline, 3rd, 6th and 9th week. Statistical analysis included Friedman's test and ANOVA according to normality criteria. A total sample of 26 BCS participate in the study. Significant statistical changes were found from the 3rd week of treatment in the frequency and intensity of pain, kinesiophobia and neuropathic pain (p < 0.05). All variables had significant changes at the 9th week (p = 0.001). The results of the present investigation suggest that the combination of PNE and TE are effective in treating sequelae at short term in BCS with chronic pain. [ABSTRACT FROM AUTHOR]

Self-massage using a foam roller (foam rolling) is effective for increasing range of motion (ROM). However, the independent effects of pressure stimulation and voluntary movement during foam rolling remain unclear. This study investigated the effects of pressure stimulation and voluntary movement during the foam rolling intervention on ROM and its related parameters from the aspects of tissue mechanical properties and the central nervous system. This study set a randomised open-label controlled parallel group design involving active foam rolling with pressure stimulation and voluntary movement (A-FR), passive foam rolling with only pressure stimulation (P-FR), and sham rolling with only voluntary movement (SHAM) of the calf muscle. Twenty-seven healthy active adults (males: 16, females: 11) were analysed. Parameters of tissue mechanical properties (as measured by tissue stiffness and thickness) and systemic nervous adaptation (as measured by PPT, stretch tolerance, HRV, and mood states), as well as maximal ankle active/passive dorsiflexion ROM, were measured. A-FR significantly improved pressure pain threshold, stretch tolerance, and negative mood and increased active and passive ROM. P-FR significantly improved parasympathetic nervous activity and negative mood and increased passive ROM. However, SHAM did not affect any ROM or parameters of tissue mechanical properties and systemic neural adaptation except for some negative mood improvement. Voluntary movement does not independently affect ROM, whereas pressure simulation independently enhances ROM during the foam rolling intervention. Combining pressure stimulation and voluntary movement can enhance the ROM effect and influence parameters of tissue mechanical properties and the central nervous system. • Ankle range of motion (ROM) is crucial for basic movements. • Voluntary movement does not independently affect ROM. • Pressure simulation independently enhances ROM during the foam rolling intervention. • Combining pressure stimulation and voluntary movement enhances ROM. • This combination influences tissue mechanical properties and central nervous system. [ABSTRACT FROM AUTHOR]

Cupping therapy involves lifting and separating fascial tissue to facilitate stretching and promote blood flow. Although cupping is a common treatment modality for pain, various protocols exist and studies are inconsistent in regards to whether cupping improves outcomes such as range of motion. We aimed to determine the acute effect of different types of cupping therapy on ankle dorsiflexion. Thirty-five generally healthy adults (mean ± SD; age: 22.1 ± 4.52 y; baseline ankle ROM: 34.68 ± 4.22°) were randomly assigned to one of four cupping therapy treatment groups: static, dynamic, static sham, or dynamic sham. Ankle ROM was measured using a digital inclinometer pre- and immediately post-intervention. ANCOVA was used to determine whether ROM differed between groups post-treatment when controlling for baseline ROM and the minimal detectable change (MDC) was used to determine clinical meaningfulness of the changes. Baseline ROM was significantly associated with post-intervention ROM (post-ROM: 38.41 ± 4.95°; p <.001), indicating an overall increase in ROM regardless of the intervention received. There was no difference in ROM between therapy groups post-intervention after controlling for baseline ROM. The dynamic cupping group experienced a change in ROM (baseline ROM: 34.11 ± 4.62°, post-ROM: 39.19 ± 6.44°) above the MDC (5.08°). Our findings support cupping as a modality for improving ankle ROM in individuals with limited ROM. Dynamic cupping may be effective for improving ankle ROM due to the addition of functional movement. Clinicians may consider dynamic cupping as a potential intervention to address limited ankle ROM. Regardless of therapy received, all groups showed improvement in ankle dorsiflexion immediately post intervention. Dynamic cupping increased ROM above the MCD threshold, indicating functional movement with cupping may improve ROM more than other cupping techniques. Further investigation is warranted to explore the long-term effects of cupping therapy, as well as the underlying mechanisms that contribute to its therapeutic effects. [ABSTRACT FROM AUTHOR]

The ankle is one of the most commonly injured areas in people with active and sedentary lives. Achilles tendinopathy (AT) is characterized by pain and stiffness that limits daily living work. Myofascial release and eccentric training are believed to improve soft tissue circulation, strength, pain, ROM, and function. To compare the effects of myofascial release with and without eccentric resistance on pain, range of motion, and functional disability in patients with AT. This randomized clinical trial was conducted with a sample of 72 participants selected via a convenient sampling technique. Participants were divided into two groups, Group A was given myofascial release therapy, and Group B was given myofascial release with eccentric resistance. Numeric Pain Rating Scale (NPRS), Goniometer, and Foot ankle disability index (FADI) were outcome measure tools for pain, range of motion, and functional disability. The assessment was done at baseline, 2nd and 4th week. Mann-Whitney U Test and Friedman's ANOVA were applied to find between-group and within-group differences. P-value was set at ≤0.05. There was a significant difference in pain (p = 0.03), plantarflexion ROM (p = 0.008), and functional disability (p = 0.02) between the two groups. However, no significant difference was observed in dorsiflexion (p = 0.06). Within-group differences were also significant (p < 0.05). It is concluded that myofascial release with eccentric resistance was more effective than myofascial release without eccentric resistance in improving pain, range of motion, and functional disability in Achilles tendinopathy. [ABSTRACT FROM AUTHOR]

Volleyball and handball have typical overhead throwing motion that can generate adaptations in the athlete's kinetic chain predisposing to injuries and pain. Considering the importance of the trunk and shoulder in overhead throwing motion and the particularities of these action in different sports, this study aimed to compare the trunk and shoulder muscle strength and mobility in young female volleyball and handball athletes. Cross-sectional study with 70 female volleyball and handball athletes between 13 and 18 years old. Shoulder rotators, trunk extension and flexion with rotation strength was measured with a handheld dynamometer (MicroFET 2, Hoogan Health Industries, West Jordan, UT, USA). Shoulder and trunk range of motion was measured with a digital inclinometer (Acummar – model ACU001). Total range of motion deficit (TROM deficit), glenohumeral internal and external rotation of dominant (DOM) and non-dominant (NDOM) shoulder were also calculated. Handball athletes presented greater muscle strength of trunk flexors/rotators (DOM: 24.96%, effect size: 0.687; NDOM, 31.83%, effect size: 0.798) and dominant shoulder internal rotators (16.65%, effect size: 0.619). The groups showed no difference for trunk and shoulder range of motion and external rotators strength. A TROM (volleyball: 48%, handball: 35%) and a glenohumeral internal rotation deficit (volleyball: 28%, handball: 29%) was found in both groups. Young female handball athletes have greater strength of trunk flexors/rotators and dominant shoulder internal rotators compared to volleyball athletes. These differences may be related to the different demands required in the movement of these sports. • Handball female young athletes present greater trunk flexors/rotators and shoulder rotators strength. • Trunk and shoulder ROM are similar between young female handball and volleyball athletes. • High percentage of young female handball and volleyball athletes exhibit shoulder ROM. [ABSTRACT FROM AUTHOR]

Measuring range of motion (ROM) is an important skill for clinicians because it can help in the accurate interpretation of a patient's condition. Recently, ROM tests using smartphone applications have been performed in clinical settings, with the tests demonstrating high reliability and validity. This study aimed to identify the usefulness of ROM tests conducted using smartphone applications by examining the reliability of straight leg raise (SLR) and hip extension (HE) tests. This cross-sectional observational study included 72 lower limbs of 36 participants (19 men and 17 women; mean age, 21.6 ± 0.8 years). Passive SLR-ROM and HE-ROM were measured in 1° increments using an iPhone goniometer (IG). Intra-rater and inter-rater reliabilities were calculated using intraclass correlation coefficients (ICCs). ROM test systematic error was confirmed using Bland–Altman analysis, and ROM measurement error was calculated. The ICCs of the IG ROM tests were 0.820 or higher. According to Bland–Altman analyses, SLR-ROM and HE-ROM did not acknowledge fixed and proportional biases. Thus, ROM measurement error was calculated as the minimal detectable change (MDC). The intra-rater and inter-rater MDC 95% confidence interval (MDC 95) values of SLR-ROM were 3.3° and 10.2°, respectively. The intra-rater and inter-rater MDC 95 values for HE-ROM were 3.9° and 9.6°, respectively. IG ROM tests were highly reliable, simple, and easy to perform. SLR-ROM and HE-ROM tests conducted using smartphone applications may be useful indices for clinical decision-making. • The values of ROM tests help to understand a patient's condition. • The iPhone goniometer ROM tests are highly reliable and the most suitable methods in clinical settings. • The MDC 95 obtained in this study has potential clinical utility in interpreting changes in ROM exercises. [ABSTRACT FROM AUTHOR]

According to the concept of biotensegrity, the whole body consists of fascial lines. The relationship between muscles and fascia is important to ensure full and proper range of motion. This study investigated the effect of hamstring flexibility on cervical range of motion and deep neck flexor muscle endurance. The aim was to explore the relationship between the hamstring muscles and neck region in the myofascial tensegrity network. Sixty healthy participants with a median age of 22.0 years (24 male, 36 female) were included. Hamstring flexibility was categorized as "normal (n = 31)" or "limited (n = 29)" according to hip flexion angle (HFA) using the passive straight leg raise (PSLR) test. Active cervical range of motion was measured by the Clinometer smartphone application, and the following movements were recorded: flexion, extension and lateral flexion. The craniocervical flexion test was performed to evaluate deep neck flexor endurance using performance index and highest-pressure score. The Mann-Whitney U test was used for statistical analysis. No significant differences in cervical range of motion were observed between the groups (p > 0.05). Participants with limited hamstring flexibility presented lower deep neck flexor muscle endurance scores (performance index and highest-pressure score) than participants with normal hamstring flexibility (p = 0.002, and p = 0.012, respectively). The results suggest that hamstring flexibility can influence deep neck flexor muscle endurance in healthy young adults. This preliminary clinical finding supports the hypothesis of a myofascial network between the hamstring muscles and neck region. • Limited hamstring flexibility can negatively affect deep neck flexor endurance. • No effect of hamstring flexibility on active cervical range of motion. • Preliminary clinical findings may support the hypothesis of a myofascial network between the hamstring and neck region. [ABSTRACT FROM AUTHOR]

Improving the understanding of shoulder function for badminton players would develop injury preventive programs. However, no studies on shoulder function reference parameters of badminton players when controlling for age and sex have been found. To examine the differences in shoulder function between elementary school-age badminton players and university badminton players using shoulder range of motion. Cross-sectional study. Testing at elementary school and university. 67 players (7-12 year-old players and 18-22 year-old players) without shoulder injury experience. Shoulder range of motion (ROM) included internal rotation (IR), external rotation (ER), and total ROM (TROM). Significant differences in shoulder IR of both sides (dominant: 97.67° vs 77.78°, p < 0.001; nondominant:104.70° vs 88.89°, p < 0.001), dominant ER (126.30° vs 115.98°, p = 0.013), TROM of both sides (dominant: 222.97° vs 193.76°, p < 0.001; nondominant: 222.90° vs 200.10°, p = 0.001), and TROM loss (-0.06° vs 6.34°, p = 0.047) existed between elementary school-age and university players. Significant differences in IR of both sides existed between male elementary school-age and university players (dominant: 98.38° vs 72.50°, p < 0.001; nondominant: 106.72° vs 83.99°, p < 0.001) as well as in female players (dominant: 95.25° vs 82.84°, p = 0.007; nondominant: 103.01° vs 93.57°, p = 0.035). Additionally, significant differences in IR of both sides (dominant: 72.50° vs 82.84°, p = 0.016; nondominant: 83.99° vs 93.57°, p = 0.012) and TROM of both sides (dominant: 188.24° vs 199.05°, p = 0.025; nondominant: 192.43° vs 207.44°, p = 0.002) existed between male and female university players. Compared with university badminton players, elementary school-age badminton players showed significantly greater shoulder IR and TROM of both sides and dominant ER while significantly smaller TROM loss. However, regardless of sex, no significant differences of bilateral deficit for glenohumeral rotation existed between elementary school-age and university badminton players. [ABSTRACT FROM AUTHOR]

To investigate the effect of instrument-assisted soft tissue mobilization technique on pain, joint range of motion, functionality and quality of life in patients with lumbar disc herniation. This is a double blinded, randomized controlled trial. A total of 60 patients were randomly allocated to either an experimental group [n = 30, age = 46.33 ± 12.96 years] or a control group [n = 30, age = 57.03 ± 9.64 years]. The experimental group received instrument-assisted soft tissue mobilization [3 consecutive days a week for 4 weeks] in addition to conventional physiotherapy [five days a week for 4 weeks]. The control group only received the conventional physiotherapy [five days a week for 4 weeks]. Pain intensity, range of motion of the lumbar spine (flexion, extension, lateral flexion), functional disability related to low back pain and quality of life were assessed at the beginning and end of the study. The experimental group showed statistically significant improvements in the range of motion in lumbar area (flexion, extension and lateral flexion values) compared to that shown in the control group (p < 0.05). The mean differences in Oswestry disability index were significantly better in experimental group than in the control group (p < 0.05). There were no significant differences between the two groups in terms of pain and quality of life (p > 0.05). Instrument-assisted soft tissue mobilization, in addition to conservative treatment, can improve range of motion in lumbar area and reduce functional disability in patients with Lumbar Region Disc Herniations. [ABSTRACT FROM AUTHOR]

The Constant-Murley Score (CMS) uses universal goniometry (UG), and the Shoulder Functional Reach Score (SFRS) uses visual estimation (VE). The CMS has validity challenges, and the SFRS has been critiqued for using VE. This study sought to determine the reliability and concurrent validity of VE when compared to the UG for shoulder flexion and abduction. Differences between symptomatic and asymptomatic shoulder and expert and novice raters were also explored. Participants were included if they were at least 18 years old with unilateral, symptomatic shoulder pain, with no post-surgical contraindications. All conditions were randomized, and raters were blinded. The intertester reliability for UG had Intraclass Correlation Coefficient (ICC) values of 0.76–0.91 at visit one. VE had ICC values that ranged from 0.87 to 0.92 at visit one. VE test-retest reliability had ICC values from 0.81 to 0.94. At visit one, concurrent validity was demonstrated by rho values from 0.84 to 0.89. There were statistically significant differences between the shoulders (P ≤ 0.0448), and there were no differences between the raters (P ≥ 0.0960). UG and VE of active shoulder flexion and abduction are reliable and concurrently valid. Additionally, there were differences between symptomatic and asymptomatic shoulders, and there were no differences between novice and expert raters. The SFRS may be reliable and valid for measuring shoulder motion using VE within and between treatment sessions. Future research should examine this in larger, more diverse participant populations. [ABSTRACT FROM AUTHOR]

myofascial pain syndrome (MPS) is associated with reductions in range of movement (ROM), decrease in physical function and performance and increase in pain in different populations. Elucidating the best prevention and treatment strategies for MPS has been one of the main goals in the last decade. The objective of the present study was to compare the acute effects of self-myofascial foam rolling release (SFR) and dry-needling (DN) techniques on ankle dorsiflexion ROM, soreness post-needling and performance through countermovement jump (CMJ) height. a prospective crossover design composed by 12 active adults, aged 23.41 ± 1.68 years (weight: 78.33 ± 9.02 Kg; height: 1.79 ± 0.088 m) with active ankle dorsiflexion restriction was performed. Participants were randomized into the SFR and DN techniques to analyze its effects on ankle dorsiflexion ROM, muscle soreness and jump height at pre, post and 24 h post-intervention. significant improvements were found by DN on ankle dorsiflexion at 24 h post intervention and muscle soreness by SFR at the same time point. No significant differences were found between conditions. Both SFR and DN are effective in improving ankle dorsiflexion and performance in young adults without producing an acute effect in muscle soreness. [ABSTRACT FROM AUTHOR]

A prevalent musculoskeletal condition that has a substantial socioeconomic impact and causes considerable morbidity is chronic shoulder pain (CSP). CSP may result from a dysfunction of the upper quarter region's (UQR) myofascial continuum (MC), which is connected by deep fascia. Fascial Manipulation® (FM), proposed by Luigi Stecco, involves deep kneading performed at specific points on the deep fascia. FM is considered to reinstate the gliding of the fascial layers, thus may aid in the reduction of pain and improvement of shoulder function. This study aims to determine the influence of FM on shoulder pain, passive range of motion (PROM), and function in participants with CSP. Single group, pretest-posttest design. Eighteen individuals with CSP aged 18–45 years were recruited. FM was applied to the painful and densified centre of coordination (CC) points on the MC of the UQR based on Stecco's FM method. The therapist performed the baseline, post-treatment, and numerical pain rating scale (NPRS) at rest and during activity, PROM, and pressure pain threshold (PPT). The follow-up measurements were done after seven days following the FM intervention. Also, the baseline and follow-up measurements of disability of arm, shoulder, and hand (DASH) score were performed. A considerable improvement in all shoulder PROM (p < 0.01), DASH score (p = 0.01), and pain reduction (p = 0.01) following FM were observed. However, the PPT showed no differences following FM (p > 0.05). FM may be an effective treatment strategy in reducing pain and improving shoulder range of motion and function in patients with CSP. [ABSTRACT FROM AUTHOR]

Effects of a 4-Week Passive Stretching Program on Flexibility and Range of Motion in Older Adults. JEPonline 2024;27(5):43-49. The purpose of this study was to evaluate the effects of a passive stretching exercise program on flexibility and range of motion in older adults. Forty elderly farmers 60 to 75 years of age who live in Ban Mad Community, Sam Phrao Subdistrict, Mueang District, Udon Thani Province in Thailand were divided into the Experimental Group (n = 20) that performed a passive stretching program and the Control Group (n = 20). The Experimental Group worked out 3 times·wk-1, 30 min·d-1 for 4 weeks. Their flexibility (evaluated by the Back Extension Test and Sit and reach Test) and their range of motion in the hips and shoulders (goniometer) were measured before and after 4 weeks. The findings indicate that several variables in flexibility and range of motion were statistically significantly different between the Experimental Group and the Control Group. The older adults in the Experimental Group had greater improvement in their back flexibility as well as their hip and shoulder range of motion. Thus, the findings indicate that the passive stretching program resulted in an increase in flexibility and range of motion in the older adults. [ABSTRACT FROM AUTHOR]

Breast cancer is the most commonly diagnosed cancer among women globally, with significant impacts on physical, emotional, and functional well-being. Traditional rehabilitation methods may not fully address the multifaceted challenges faced by breast cancer survivors (BCSs), prompting exploration into innovative approaches such as Virtual Reality (VR) technology. The present review aims to assess the effectiveness of VR in alleviating pain, improving Range of Motion (ROM), enhancing muscle strength, and augmenting the overall quality of life in patients undergoing breast cancer rehabilitation. A comprehensive review of existing literature was conducted, focusing on studies investigating the use of VR in breast cancer rehabilitation. PubMed, Scopus, PEDro and Google scholar were searched for articles addressing VR interventions targeting pain management, ROM improvement, muscle strength enhancement, and quality of life enhancement in breast cancer patients. Findings yielded total 12 articles matching the selection criteria. VR technology has shown promising results in addressing the multifaceted needs of breast cancer patients. VR also serves as a distraction tool, positively impacting psychological well-being and mitigating negative psychological symptoms associated with the disease. VR represents a non-pharmacological approach to pain management and rehabilitation in breast cancer patients. Its ability to engage emotional, cognitive, and attention processes contributes to its effectiveness in enhancing overall quality of life. Further research is warranted to elucidate the long-term benefits and optimal utilization of VR technology in breast cancer rehabilitation programs. [ABSTRACT FROM AUTHOR]

Reverse shoulder arthroplasty (RSA) is a common procedure for treating a variety of shoulder pathologies. However, many patients struggle with postoperative internal rotation (IR) deficits, which often hinder their activities of daily living. The conjoint tendon provides an anatomic barrier that can impede the postoperative IR of the shoulder, and this study aims to evaluate the effect of a conjoint tendon lengthening on the glenohumeral range of motion (ROM) following RSA. This study used ten fresh-frozen cadaver specimens of the upper extremity. An RSA was implanted using a standard deltopectoral approach, and the ROM was assessed postimplantation. Following this, the conjoint tendon was identified and lengthened using a tendon sheath z-plasty, and the ROM was rerecorded. Statistical significance for the ROM gains after conjoint tendon lengthening was determined with a significance level of P <.05. Following the lengthening of the conjoint tendon, there were statistically significant improvements in all ROMs (P <.05). Subjects demonstrated a notable gain in IR to the back by 10.3 cm (P <.01), and all ROMs increased by at least 10°, except for forward flexion, which increased by 6° (P <.001). This study suggests that lengthening the conjoint tendon improves postoperative ROM of the glenohumeral joint after RSA, offering a potential solution to considerable IR deficits that are commonly encountered post-RSA. Subsequent clinical and biomechanical studies should assess the stability of the shoulder joint following conjoint tendon lengthening. [ABSTRACT FROM AUTHOR]

Computer simulation has indicated a significant effect of scapulothoracic orientation and posture on range of motion (ROM) after reverse total shoulder arthroplasty (RTSA). We analyzed this putative effect on the clinical and radiologic outcome post-RTSA. We retrospectively assessed 2-year follow-up data of RTSA patients treated at our clinic between 2008 and 2019. Patients were categorized into posture types A, B, and C based on an established method using scapular internal rotation on preoperative cross-sectional imaging. We compared differences in clinical ROM, pain, Subjective Shoulder Value, Constant Score, Shoulder Pain and Disability Index (SPADI), quality of life (EuroQol–5 Dimensions–5 Level utility index), and radiologic outcomes between posture types using linear regression analyses. Of 681 included patients, 225 had type A posture, 326 type B, and 130 type C. Baseline group characteristics were comparable, although the type C group had a higher proportion of females (60% [A], 64% [B], 80% [C]) with lower abduction strength (0.7 kg [A], 0.6 kg [B], 0.3 kg [C]) and a slightly higher proportion with a Grammont design RTSA (41% [A], 48% [B], 54% [C]). There were significant adjusted differences in mean (±standard deviation) active flexion (A: 137° ± 21°; B: 136° ± 20°; C: 131° ± 19°) and passive flexion (A: 140° ± 19°; B: 138° ± 19°; C: 134° ± 18°), active (A: 127° ± 26°; B: 125° ± 26°; C: 117° ± 27°) and passive abduction (A: 129° ± 24°; B: 128° ± 25°; C: 121° ± 25°), SPADI (A: 81 ± 18; B: 79 ± 20; C: 73 ± 23), and pain (A: 1.2 ± 1.7; B: 1.6 ± 2.2; C: 1.8 ± 2.4) between posture types at 2 years (P ≤.035). A higher distalization shoulder angle was associated with better abduction in type C patients (P =.016). Type C patients showed a trend toward a higher complication rate (3.9% vs. 1.1% [A], 3.2% [B]) (P =.067). Type C posture influences the 2-year clinical outcome of RTSA patients in terms of worse flexion, abduction, SPADI, and pain. Scapulothoracic orientation and posture should be considered during the patient selection process, preoperative planning, and implantation of an RTSA. [ABSTRACT FROM AUTHOR]

Superior augment use may help avoid superior tilt while minimizing removal of inferior glenoid bone. Therefore, our goal was to compare superior augments vs. no-augment baseplates in reverse shoulder arthroplasty (RSA) for patients with rotator cuff dysfunction and no significant superior glenoid erosion. A multicenter retrospective analysis of 145 patients who underwent RSA with intraoperative navigation (Equinoxe GPS; Exactech) and 3-year follow-up (mean 32 months' follow-up, range 20-61 months) who had preoperative superior inclination less than 10° and retroversion less than 15°. Patient demographics, radiographic measurements, surgical characteristics, patient-reported outcomes at preoperative and postoperative visit closest to 3 years, and adverse events at final follow-up were obtained. Operative time, planned inclination, and planned version of the baseplate were obtained. χ2 test was used to compare categorical variables, and Student t test was used to compare the augment and no-augment cohorts. The study population consisted of 54 superior augment patients and 91 no-augment patients. The augment cohort had lower body mass index (27.2 vs. 29.4, P =.023) and higher native superior inclination (5.9° vs. 1.4°, P <.001). No difference between the augment and no-augment cohorts was found regarding age (P =.643), gender (P =.314), medical comorbidities (P >.05), surgical indication (P =.082), and native glenoid version (P =.564). The augment cohort had higher internal rotation score (4.6 vs. 3.9, P =.023), and all remaining range of motion (ROM) and patient-reported outcomes (PROs) preoperatively were not significantly different. At final follow-up, active ROM in all planes was not different between the cohorts. Regarding PROs, the postoperative Shoulder Arthroplasty Smart score was significantly higher (78.0 vs. 73.6, P =.042), and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form score trended toward higher (83.6 vs. 77.5, P =.063) in the augment cohort. The augment cohort had a significantly lower proportion of patients who planned to have superior baseplate tilt (1.9% vs. 14.3%, P =.012) and had greater mean inclination correction (6.3° vs. 1.3°, P <.001), compared with the no-augment cohort. Adverse events were rare, and there was no significant difference found between the augment and no-augment cohorts (5.6% vs. 3.3%, P =.509). Superior augmented baseplate in RSA with minimal superior glenoid erosion is associated with similar ROM and adverse events with somewhat improved postoperative PROs compared with nonaugmented baseplates at the 3-year follow-up. Additionally, superior augments resulted in a greater proportion of baseplates planned to avoid superior tilt, and trended toward shorter operative times. Further investigation of long-term glenoid baseplate loosening is imperative to fully understand the cost-effectiveness of superior augments in the setting of minimal glenoid deformity. [ABSTRACT FROM AUTHOR]

Metacarpal fractures produce significant hand disability, and non-operative management of these fractures can produce satisfactory functional outcomes with few complications. However, most studies assessing non-operative outcomes of metacarpal fractures revolves around metacarpals I and V, which possess different anatomy. Therefore, further investigation into outcomes after non-operative treatment of metacarpals II-IV is required to inform management decisions and allow modification of the rehabilitation protocols to specific fracture patterns. All records for 76 non-operative patients presenting with fractures of metacarpals II-IV to our tertiary centre in the year 2019 were retrospectively reviewed. Patients were treated with thermoplastic splinting or fibreglass casting with a rehabilitative exercise programme. Range of motion (ROM) of the Metacarpophalangeal (MCPJ), Proximal Interphalangeal (PIPJ), and Distal Interphalangeal joints (DIPJ), return to work time, and complications were assessed at 12 weeks post-treatment. Mean return to work time was 5.4 weeks, and patients did not report any serious adverse events; the main complication reported was tenderness on palpation (20%). The MCPJ exhibited the poorest ROM (9° flexion reduction relative to the healthy hand). Metacarpal II fractures were associated with significantly worse MCPJ flexion than metacarpal III (p = 0.022) and metacarpal IV (p = 0.049) fractures. Fractures of the metacarpal base were associated with superior MCPJ flexion (p = 0.004) but longer return to work time (p = 0.042) than head fractures. Spiral fractures were associated with shorter return to work time (p = 0.043) and superior ROM results (p = 0.041). In conclusion, outcomes of the non-operative treatment of metacarpal II-IV fractures are highly dependent on the location and pattern of the fracture, and this should be considered during clinical decision making. [ABSTRACT FROM AUTHOR]

Purpose: Improvements in breast cancer management continue to increase survival and life expectancy after treatment. Yet the adverse effects of treatment may persist long term, threatening physical, psychological, and social wellbeing, leading to impaired quality of life (QOL). Upper-body morbidity (UBM) such as pain, lymphoedema, restricted shoulder range of motion (ROM), and impaired function are widely reported after breast cancer treatment, but evidence demonstrating its impact on QOL is inconsistent. Therefore, the aim of the study was to conduct a systematic review and meta-analysis evaluating the effect of UBM on QOL following primary breast cancer treatment. Methods: The study was prospectively registered on PROSPERO (CRD42020203445). CINAHL, Embase, Emcare, PsycInfo, PubMed/Medline, and SPORTDiscus databases were searched for studies reporting QOL in individuals with and without UBM following primary breast cancer treatment. Primary analysis determined the standardised mean difference (SMD) in physical, psychological, and social wellbeing scores between UBM + /UBM − groups. Secondary analyses identified differences in QOL scores between groups, according to questionnaire. Results: Fifty-eight studies were included, with 39 conducive to meta-analysis. Types of UBM included pain, lymphoedema, restricted shoulder ROM, impaired upper-body function, and upper-body symptoms. UBM + groups reported poorer physical (SMD = − 0.99; 95%CI = − 1.26, − 0.71; p < 0.00001), psychological (SMD = − 0.43; 95%CI = − 0.60, − 0.27; p < 0.00001), and social wellbeing (SMD = − 0.62; 95%CI = − 0.83, − 0.40; p < 0.00001) than UBM − groups. Secondary analyses according to questionnaire showed that UBM + groups rated their QOL poorer or at equal to, UBM − groups across all domains. Conclusions: Findings demonstrate the significant, negative impact of UBM on QOL, pervading physical, psychological, and social domains. Implications for Cancer Survivors: Efforts to assess and minimise the multidimensional impact of UBM are warranted to mitigate impaired QOL after breast cancer. [ABSTRACT FROM AUTHOR]

Due to the simplicity, low cost and benefit of avoiding long-term joint immobilization, extension block pinning could be a suitable option for treating the volar base fractures of the middle phalanges. The aim of the present study was to evaluate the outcomes of using extension block pinning in chronic volar base fractures of the middle phalanges. In total, 26 patients with chronic closed volar base fractures of the middle phalanges were included our study. The mean age was 37 years (SD 11.59), and the mean follow-up time was 35 months (SD 19.41). The mean active range of motion (ROM) after surgery was 93° (SD 12.9). There was a negative correlation between the age and the ROM of the injured proximal interphalangeal joint after surgery. ROM did not correlate with the articular surface involvement or the interval between injury and surgery. We obtained a satisfactory result from extension block pinning for volar base fractures of the proximal interphalangeal joint in patients with chronic injuries. Level of evidence: IV [ABSTRACT FROM AUTHOR]

Purpose: Understanding relationships between blood flow and muscle inflexibility in the lower leg can support improved healthcare competency. Sports medicine practitioners might use the reference ranges and knowledge of relationships among these variables to support effective health screenings among their competitive runners. These variables have been linked in other areas of the body where inflexibility in the pectoralis minor and scalene muscles have been associated with diminished blood flow to the upper limb. No studies, however, have examined the relationship between vascular and mobility characteristics in the lower legs of runners. Therefore, the purpose of this study was to examine the relationship between blood flow in the posterior tibial artery and ankle range of motion (ROM) among competitive runners. Methods: Blood flow in the posterior tibial artery and ankle ROM were measured bilaterally on twenty-five, asymptomatic collegiate track athletes (15 males, 10 females, age = 20.0±1.2 years, height = 171.5±10.2 cm, mass = 66.7±13.7 kg) using diagnostic ultrasound and standard goniometry, respectively. Pearson correlation analysis was used to analyze the relationship between blood flow in the posterior tibial artery and ROM of the ankle joint. Results: Findings revealed no significant relationship between blood flow in the dominant leg's posterior tibial artery and dorsiflexion (r=.14, P=.52, CI95% = -0.27 - 0.51) or plantar flexion (r=-.32, P=.12, CI95% = -0.63 - 0.09) and no significant relationship between blood flow in the non-dominant leg's posterior tibial artery and dorsiflexion (r=-.02, P=.93; CI95% = -0.41 - 0.38) or plantar flexion (r=-.02, P=.92; CI95% = -0.41 - 0.38). Conclusion: While muscle inflexibility is associated with compromised blood flow in other body regions, findings of this study demonstrated no relationship between the variables within the lower legs of a sample of competitive runners. Sports medicine practitioners should consider these findings in their efforts to predict, prevent, and manage potential vascular and musculoskeletal adaptations among clients/patients who are competitive runners. [ABSTRACT FROM AUTHOR]

Frozen shoulder patients complains of pain, as well as a restriction or complete loss of mobility in all directions. The purpose of this pilot study is to find out the short term effects of virtual reality exergaming in frozen shoulder patients. 30 patients underwent virtual reality exergaming and conventional physiotherapy for 40 minutes. The total duration was 3 session in a week. Measurement were obtained at baseline and after one week of intervention. Pain and range of motion were measured using visual analogue scale and universal goniometer. Four goniometric measurements were taken encompassing shoulder flexion, abduction, internal rotation and external rotation. The subjects improved with pain and range of motion after 3 session using virtual reality exergaming and conventional Physiotherapy. In conclusion, the result suggest further investigation is needed using virtual reality exergaming for the longer period as an effective treatment for frozen shoulder. [ABSTRACT FROM AUTHOR]

Background: Although the effect of active warm-up (WU) on acute flexibility enhancement is well documented, the test-induced WU effect in muscle length test has not been widely studied. Objective: This study aimed to verify the test-induced WU effect on hamstring flexibility tests. Methods: The active knee extension (AKE) was performed using the right leg, whereas the straight leg raise (SLR) was performed using the left leg. Ten trials of AKE or SLR were performed: two as the pre-intervention trials (Pre); six as the WU intervention; and another two trials as the post-intervention (Post). During WU, subjects in the WO-Hold group performed six trials of the AKE or SLR without hold, and those in the W-Hold group performed six trials of the AKE or SLR with a 5[Formula: see text]s hold. Results: A significant difference was noted between Pre-AKE and Post-AKE, and between Pre-SLR and Post-SLR, respectively, in both the groups. The effect of WU is clear when performing consecutive AKE or SLR without any additional hold. Conclusion: Practitioners should be cautious in interpreting the testing result to avoid overestimation of the treatment effect since the test itself may induce substantial WU effect to the target tissues.

Abstract Background We currently lack clear definitions for structural and symptomatic spinal osteoarthritis (OA). To define spinal OA and create diagnostic criteria for this condition, it is necessary to determine the relationship between clinical signs and symptoms of back pain and radiographic features of OA. Notably, recent studies suggest a defining sign of spinal OA could be a limited or painful spinal range of motion (ROM). Therefore, our objective was to assess the association between restricted or painful active spinal ROM, and multilevel structural features of lumbar disc degeneration (LDD) (i.e., disc space narrowing, osteophytes) on radiographs. Methods We used the baseline data from the’Back Complaints in Older Adults’ (BACE) study. The association between a limited or painful active spinal ROM, and multilevel disc space narrowing or osteophytes was assessed using multivariable logistic regression adjusted for age, mean pain intensity in the previous week, sex, BMI, and the Fear Avoidance Belief Questionnaire score. Primary analyses were performed on imputed datasets. Results We included 675 patients with a mean age of 66.52 years (SD 7.69). Limited latero-flexion (fingertip that at best reached halfway up the upper leg) was associated with increased odds of having multilevel osteophytes (OR 1.85; 95% CI: 1.13 to 3.01). However, a limited or painful ROM in other directions (i.e., rotation, ante-flexion) was not associated with multilevel osteophytes, and a limited or painful active ROM in any direction was found to have no association with multilevel disc space narrowing. Conclusions Our study indicates that a restricted ROM in latero-flexion could potentially be a defining sign in future definitions of symptomatic spinal OA. However, since our results partially differ from previous studies, further research is needed to explore the association between active ROM and LDD.

Abstract Background Short term results of the change of center of rotation (COR) after Bryan cervical disc replacement (CDR) have been reported. However, there is a lack of long-term studies focusing on the COR and its influences on facet joint degeneration. Objective To evaluate the long-term clinical and radiographic results of Bryan CDR, and to explore the influence of deviated COR on facet joint degeneration at index level. Methods It is a retrospective follow up study conducted in China. Eighty-three consecutive patients who received single-level Bryan CDR were retrospectively reviewed. Clinical evaluation included Japanese Orthopaedic Association (JOA) score, Neck Disability Index (NDI), and Odom’s scale. Radiographic evaluation underwent before surgery, at early follow-up (3 months) and last follow-up (10 years). The radiographic parameters included range of motion (ROM), location of COR presented by the coordinates (COR-x, COR-y), and facet joint degeneration score. Correlation analysis was conducted between changes of COR and facet joint degeneration score. Results Fifty-nine patients were included, with an average age of 44.6 ± 7.4 years. The mean follow-up time was 135.7 ± 12.4 (120–155) months. JOA score, NDI and Odom’s scale showed significant improvements at last follow-up. The ROM was well preserved through follow-up. 33 patients (55.9%) showed deterioration of facet joint degeneration at index level. The increment of facet joint degeneration score at index level was strongly correlated with the change of COR-x (r = 0.758, P

Abstract Background Restriction of movement at a joint due to disease or dysfunction can alter the range of motion (ROM) at other joints due to joint interactions. In this paper, we quantify the extent to which joint restrictions impact upper limb joint movements by conducting a disability simulation study that used wearable inertial sensors for three-dimensional (3D) motion capture. Methods We employed the Wearable Inertial Sensors for Exergames (WISE) system for assessing the ROM at the shoulder (flexion–extension, abduction–adduction, and internal–external rotation), elbow (flexion–extension), and forearm (pronation-supination). We recruited 20 healthy individuals to first perform instructed shoulder, elbow, and forearm movements without any external restrictions, and then perform the same movements with restriction braces placed to limit movement at the shoulder, elbow, and forearm, separately, to simulate disability. To quantify the extent to which a restriction at a non-instructed joint affected movement at an instructed joint, we computed average percentage reduction in ROM in the restricted versus unrestricted conditions. Moreover, we performed analysis of variance and post hoc Tukey tests (q statistic) to determine the statistical significance (p

Background: Frozen shoulder (FS) is a debilitating inflammatory condition affecting the shoulder capsule that causes significant pain and stiffness. Its etiology, pathophysiology, and treatment remain poorly understood. Although regarded as self-limiting, FS can have profound implications on the activities of daily living and usually takes 1-4 years to resolve on its own accord. In recalcitrant or severe cases where active range of motion (AROM) is extensively restricted, an arthroscopic 360° release may be performed. The aim of this study is to evaluate the clinical outcomes following the FS 360° arthroscopic release. Methods: An observational prospective cohort study was conducted assessing patient-reported outcome measures (PROMs) in patients who underwent the 360° arthroscopic release between July 2013 and January 2019. Various questionnaires were used to evaluate their shoulder preoperatively and at 2 weeks, 6 weeks, 3 months, 6 months, 12 months, and 24 months postoperatively. Relevant PROMs included the Oxford Shoulder Score; Western Ontario Shoulder Instability Index; Disabilities of the Arm, Shoulder, and Hand; Constant-Murley Score; American Shoulder and Elbow Surgeons score; and general measures of pain intensity (visual analog scale) and well-being (EQ-5D-3L). AROM movements included forward flexion, abduction, external rotation, internal rotation, as well as external and internal rotation at 90° of abduction. Results: Fifty consented patients underwent the arthroscopic FS 360° release. The mean age was 52.1 ± 7.7 years (range 35-72), and mean body mass index was 27.1 ± 4.7 kg/m2 (range 19.5-37.5). All PROMs, AROM movements, patient satisfaction, and EQ-5D-3L scores improved significantly between preoperative and 24-month time points (P .05). No complications or reoperations were reported. Conclusion: The arthroscopic 360° release is an effective and safe treatment modality for severe or recalcitrant FS. Statistically and clinically significant improvements in AROM and PROMs (Oxford Shoulder Score; Western Ontario Shoulder Instability Index; Disabilities of the Arm, Shoulder, and Hand; Constant-Murley Score; and American Shoulder and Elbow Surgeons score) occurred shortly after the surgery and progressively improved from 2 weeks to 24 months postoperatively, with the operative shoulder achieving similar range of motion as the nonpathological contralateral shoulder at 24 months.

Background: The purpose of this study was to assess impingement-free internal rotation (IR) in a virtual reverse shoulder arthroplasty simulation using a Statistical Shape Model based on scapula size. Methods: A database of over 10,000 scapulae utilized for preoperative planning for shoulder arthroplasty was analyzed with a Statistical Shape Model to obtain 5 scapula sizes including the mean and 2 standard deviations. For each scapula model, one glenosphere size (33-42 mm) was selected as the best fit based on consensus among 3 shoulder surgeons. Virtual implantation variables included 1) lateral offset (0-12 mm in 2-mm increments), 2) inferior eccentricity (0, 2.5, 5, and 7.5 mm), and 3) posterior eccentricity (0, 2.5, and 5 mm). The neck shaft angle was fixed at 135° with an inlay design humeral prosthesis. IR at the side (IR0) and in abduction (IRABD) were then simulated. Results: Maximum impingement-free IR0 was reached with increasing inferior offset in combination with increasing lateralization. Lateralization was the most important variable in increasing impingement-free IRABD. Maximum IRABD was reached at 4-6 mm of lateralization with smaller scapula (−2 to 0 standard deviation). Increasing lateralization up to 12 mm continues to increase IRABD for larger-sized scapula (+1 to +2 standard deviation). Optimal inferior offset and lateralization to maximize IR did have a small loss of external rotation in neutral abduction. There was no loss of external rotation in 60° of abduction. Conclusion: In a virtual model, the glenosphere position required to maximize IR varied by scapula size. For smaller scapulae, maximum IR0 was reached with a combination of 2.5-mm inferior offset and 0- 4 mm of lateralization. For larger scapulae, maximum IR0 was reached with a combination of 2.5 mm of inferior offset and 4 mm of lateralization. The amount of lateralization required to maximize IRABD also varies by scapula size. Maximum IRABD was reached in smaller scapula with 4-6 mm of lateralization and at least 12 mm of lateralization in larger scapula. These findings may be applied in the clinical decision-making process knowing that impingement-free IR and IRABD can be maximized with combinations of inferior offset and lateralization based on scapula size with minimal effect on external rotation and external rotation in 60° of abduction.

Background and purpose: The human body functions as an integrated and coordinated unit, with each part capable of influencing the entire system. Modern science views the body holistically, addressing not only the treatment of symptoms but also the root cause of any disorder, often located far from the apparent site of the issue. This study aims to examine the effect of immediate release and static stretching of the gastrocnemius muscle and plantar fascia within the superficial back line on range of motion and chronic neck pain. Materials and methods: In this randomized clinical trial, 32 subjects with nonspecific chronic neck pain, aged 30-40 years, were recruited. Participants were randomly assigned into two equal groups: a control group (16 participants) and an intervention group (16 participants). The intervention group performed release and stretching exercises using a foam roller and band, respectively, while the control group did not receive any intervention. Neck range of motion in the sagittal plane was measured using a goniometer, and pain levels were assessed using a visual analog scale before and after the protocol. Data were analyzed using paired t-tests and ANCOVA at a significance level of 0.05 with SPSS software. Results: The ANCOVA test revealed a significant difference between the intervention and control groups in terms of neck pain (P=0.001) and neck range of motion in the sagittal plane, including neck flexion (P=0.001) and neck extension (P=0.001) among individuals with chronic neck pain. Paired t-test results showed that, in the intervention group, there were significant differences between pre-test and post-test scores for neck pain, neck flexion, and extension range of motion after participating in the stretching and myofascial release exercises on the gastrocnemius muscle and plantar fascia (P=0.001). However, no significant differences were found in the control group between the pre- and post-test stages (P>0.05). Conclusion: The use of self-release interventions and stretching exercises on the gastrocnemius muscle and plantar fascia appears to increase range of motion and reduce neck pain. These results suggest tension transmission along the superficial back line, which extends from the plantar fascia to the frontal muscles of the skull, meaning intervention at any point in this chain can affect the entire pathway. This method could be beneficial for individuals with acute neck pain or in cases where direct neck intervention is not possible. By targeting other areas along this muscle chain, improvements in neck symptoms may be achieved. Over recent years, this concept has garnered significant research interest, with a proliferation of studies affirming the existence of the posterior superficial back line through laboratory and cadaver research. Clinically, factors such as the tissue's viscoelastic properties, nerve receptors, and changes in the extracellular matrix are proposed to facilitate tension transmission along muscle chains, though the precise mechanism remains a “black box” in fascia tissue research. (Clinical Trials Registry Number: IRCT20200209046422N2)

Aims: Optimal glenoid positioning in reverse shoulder arthroplasty (RSA) is crucial to provide impingement-free range of motion (ROM). Lateralization and inclination correction are not yet systematically used. Using planning software, we simulated the most used glenoid implant positions. The primary goal was to determine the configuration that delivers the best theoretical impingement-free ROM. Methods: With the use of a 3D planning software (Blueprint) for RSA, 41 shoulders in 41 consecutive patients (17 males and 24 females; means age 73 years (SD 7)) undergoing RSA were planned. For the same anteroposterior positioning and retroversion of the glenoid implant, four different glenoid baseplate configurations were used on each shoulder to compare ROM: 1) no correction of the RSA angle and no lateralization (C-L-); 2) correction of the RSA angle with medialization by inferior reaming (C+M+); 3) correction of the RSA angle without lateralization by superior compensation (C+L-); and 4) correction of the RSA angle and additional lateralization (C+L+). The same humeral inlay implant and positioning were used on the humeral side for the four different glenoid configurations with a 3 mm symmetric 135° inclined polyethylene liner. Results: The configuration with lateralization and correction of the RSA angle (C+L+) led to better ROM in flexion, extension, adduction, and external rotation (p ≤ 0.001). Only internal rotation was not significantly different between groups (p = 0.388). The configuration where correction of the inclination was done by medialization (C+M+) led to the worst ROM in adduction, extension, abduction, flexion, and external rotation of the shoulder. Conclusion: Our software study shows that, when using a 135° inlay reversed humeral implant, correcting glenoid inclination (RSA angle 0°) and lateralizing the glenoid component by using an angled bony or metallic augment of 8 to 10 mm provides optimal impingement-free ROM. Cite this article: Bone Jt Open 2024;5(10):851–857.

Introduction: Mechanical Low Back Pain (MLBP) is a prevalent condition that significantly impacts individuals’ quality of life and healthcare systems worldwide. The management of MLBP has explored various manual therapy techniques, including Maitland mobilisation; however, the immediate effects and comparative efficacy of these techniques remain subjects of ongoing investigation. Aim: To evaluate the immediate effects of Maitland mobilisation compared to other manual therapy techniques on flexion and extension Range of Motion (ROM) in patients with MLBP. Materials and Methods: The present systematic review involved a comprehensive search of electronic databases, including PubMed, Cochrane Library, and Google Scholar, from January 2017 to March 2024. The search utilised the keywords “Randomised Controlled Trials (RCTs)”, “Maitland mobilisation”, and “mechanical low back pain”. Studies comparing the immediate effects of Maitland mobilisation with other manual therapy techniques on flexion and extension ROM in patients with MLBP were included. Data extraction and quality assessment were performed using established protocols. Results: Nine studies met the inclusion criteria and were included in the review. The findings revealed that Maitland mobilisation demonstrated significant immediate effects on both flexion and extension ROM in patients with MLBP. Improvements were particularly noted in lumbar flexion following Maitland mobilisation, while lumbar extension showed greater enhancement after specific techniques such as Posteroanterior (PA) mobilisation. Additionally, combination therapies, such as core stability exercises coupled with Maitland manual therapy, showed promising results in reducing disability associated with MLBP. Conclusion: This review investigated the immediate effects of Maitland mobilisation on ROM in MLBP. While some studies indicated improvements in ROM, the evidence for its effectiveness compared to other interventions and its long-term impact on pain and function remains unclear. Future well-designed studies are needed to definitively assess the role of Maitland mobilisation in the management of MLBP.

Objective Lower limb deformity in children with cerebral palsy (CP) is a common musculoskeletal problem and planovalgus is the most prevalent, characterized by talus median subluxation, calcaneal valgus, and supinated forefoot. According to studies, one issue in orthopedics and pathology is the accurate diagnosis and proper treatment of planovalgus deformity in children with bilateral spastic cerebral palsy, which has attracted researchers’ attention. Accordingly, the present study investigates the effect of planovalgus deformity on the motor performance and balance of these children. Materials & Methods This cross-sectional study employed a descriptive-analytical design. The convenient sampling method was used among children with bilateral spastic cerebral palsy, diagnosed with unilateral planovalgus, who were referred to the clinics of the University of Social Welfare and Rehabilitation Sciences (Nezam Mafi) and occupational therapy clinics from September 2022 to February 2023 in Tehran City, Iran. Meanwhile, all participants were willing to cooperate in this research. A total of 27 participants were evaluated by an occupational therapist based on the specified criteria and gross motor function classification system (GMFCS), which included the assessments of balance, muscle strength, range of motion, and pain. Data analysis was done using the SPSS software, version 16. Results The results revealed a statistically significant difference between the mean range of motion of ankle dorsiflexion and knee extension between the two limbs (P

Context: Hip muscle imbalance, especially between gluteal muscles and tensor fasciae latae (TFL), is one of the risk factors for developing low back pain which should be considered in rehabilitation programs. This study compared the effect of exercises with gluteal-to-TFL muscle activation index above and below 50 on pain intensity, disability, and lower limbs' range of motion (ROM) in patients with nonspecific chronic low back pain. Design: A semiexperimental intervention study with a pretest and posttest. Methods: A total of 45 patients with nonspecific chronic low back pain were randomly divided into 2 experimental groups of gluteal-to-TFL muscle activation index above 50 (n = 15), below 50 (n = 15), and a control group (n = 15). Pain intensity (visual analog scale), disability (Roland–Morris Disability Questionnaire), and lower limbs' ROM including hip extension, hip abduction, hip external rotation, and knee extension (goniometer) were assessed at pretest and after 8 weeks of intervention. Results: Within-group comparison showed significant improvement of pain, disability, and ROMs in both experimental groups. No significant changes were observed in the control group. In between-group analysis, significant differences were observed in group of gluteal-to-TFL muscle activation index above 50 for only pain (P =.03) and disability (P =.01). For ROMs, although clinical improvement of lower limbs' ROMs was higher in group of gluteal-to-TFL muscle activation index above 50, no statistically significant differences were found between 2 experimental groups. Both experimental groups were superior to the control group for all outcomes. Conclusions: Findings indicate the statistically and clinically superior effectiveness of exercises with a gluteal-to-TFL muscle activation index above 50 in the reduction of pain and disability. Based on the clinical significance of exercises with a gluteal-to-TFL muscle activation index above 50 for improving ROMs, utilizing specific exercises that more activated gluteal muscle compared to TFL is recommended for patient with restricted lower limbs' ROMs. [ABSTRACT FROM AUTHOR]

Inertial sensors may help clinicians to assess patients' movement and potentially support clinical decision making. Our aim was to determine whether shoulder range of motion during movement tasks measured using inertial sensors is capable of accurately discriminating between patients with different shoulder problems. Inertial sensors were used to measure 3-dimensional shoulder motion during 6 tasks of 37 patients on the waiting list for shoulder surgery. Discriminant function analysis was used to identify whether the range of motion of different tasks could classify patients with different shoulder problems. The discriminant function analysis could correctly classify 91.9% of patients into one of the 3 diagnostic groups based. The tasks that associated a patient with a particular diagnostic group were the following: subacromial decompression: abduction, rotator cuff repair of tears ≤5 cm: flexion and rotator cuff repair of tears >5 cm: combing hair, abduction, and horizontal abduction–adduction. The discriminant function analysis showed that range of motion measured by inertial sensors can correctly classify patients and could be used as a screening tool to support surgery planning. [ABSTRACT FROM AUTHOR]

Context: Physical performance tests (PPTs) and mobility tests have been widely used in sports rehabilitation. However, the feasibility of PPTs and mobility tests via telehealth is unknown. Objectives: To verify the feasibility of PPTs and mobility tests to assess athletes via telehealth. Design: This is a feasibility study. Participants: Athletes enrolled in a sports team or club for at least 2 years and with previous enrollment in a competitive league were recruited through advertisements on social media. The athletes included in this study (mean age = 25.9 y, from different sports) performed a battery of PPTs and mobility tests for the lower-extremity or upper-extremity and trunk, according to their sport modality. Main Outcome Measure: The feasibility was assessed with recruitment, success, and dropout rates. In addition, athletes' perceptions of easiness, satisfaction, and safety during the lower-extremity or upper-extremity and trunk PPTs and mobility tests were assessed. Results: Seventy-three athletes were included, between January and April 2021: 41 were allocated to the lower-extremity and 32 to the upper-extremity and trunk PPTs and mobility test, according to their sports modality. The overall dropout rate was 20.55%; >89% of the athletes agreed that the PPTs and mobility tests via telehealth were easy to perform, >78% were satisfied, and >75% felt safe during the assessments. Conclusion: This study indicated that these 2 batteries of performance and mobility tests via telehealth are feasible to assess the lower and upper-extremities, and the trunk of athletes, considering the adherence, athletes' perception of easiness, satisfaction, and safety. [ABSTRACT FROM AUTHOR]

Tears within the stabilizing muscles of the shoulder, known as the rotator cuff (RC), are the most common cause of shoulder pain-often presenting in older patients and requiring expensive advanced imaging for diagnosis. Despite the high prevalence of RC tears within the elderly population, there is no previously published work examining shoulder kinematics using markerless motion capture in the context of shoulder injury. Here we show that a simple string pulling behavior task, where subjects pull a string using hand-over-hand motions, provides a reliable readout of shoulder mobility across animals and humans. We find that both mice and humans with RC tears exhibit decreased movement amplitude, prolonged movement time, and quantitative changes in waveform shape during string pulling task performance. In rodents, we further note the degradation of low dimensional, temporally coordinated movements after injury. Furthermore, a logistic regression model built on our biomarker ensemble succeeds in classifying human patients as having a RC tear with > 90% accuracy. Our results demonstrate how a combined framework bridging animal models, motion capture, convolutional neural networks, and algorithmic assessment of movement quality enables future research into the development of smartphone-based, at-home diagnostic tests for shoulder injury.

Shoulder shape directly impacts forelimb function by contributing to glenohumeral (GH) range-of-motion (ROM). However, identifying traits that contribute most to ROM and visualizing how they do so remains challenging, ultimately limiting our ability to reconstruct function and behaviour in fossil species. To address these limitations, we developed an in silico proximity-driven model to simulate and visualize three-dimensional (3D) GH rotations in living primate species with diverse locomotor profiles, identify those shapes that are most predictive of ROM using geometric morphometrics, and apply subsequent insights to interpret function and behaviour in the fossil hominin Australopithecus sediba. We found that ROM metrics that incorporated 3D rotations best discriminated locomotor groups, and the magnitude of ROM (mobility) was decoupled from the anatomical location of ROM (e.g. high abduction versus low abduction). Morphological traits that enhanced mobility were decoupled from those that enabled overhead positions, and all non-human apes possessed the latter but not necessarily the former. Model simulation in A. sediba predicted high mobility and a ROM centred at lower abduction levels than in living apes but higher than in modern humans. Together these results identify novel form-to-function relationships in the shoulder and enhance visualization tools to reconstruct past function and behaviour.

This case report presents the treatment of a patient with shoulder calcification and reduced Range of Motion (ROM) using a combination of Extracorporeal Shockwave Therapy (ESWT) and telerehabilitation. The patient received three sessions of ESWT, once per week, followed by daily guided shoulder exercises delivered via telerehabilitation for three weeks. Pre- and post-treatment assessments included goniometry for ROM, the Shoulder Pain and Disability Index (SPADI) score for shoulder function and X-ray imaging. The results demonstrated significant improvements in pain, function and ROM suggesting the potential benefits of this combined approach in reducing patient burden and promoting sustainability in physiotherapy.

Objective: Using a rat model, we investigated the effect of multidisciplinary rehabilitation, including aerobic training and ointment, on the ROM, vWF, VEGF content, and femoral artery hemodynamics in rats with joint contracture. Methods: A total of 44 Wistar rats were divided into the normal control group (NC, eight rats) and the experimental group (EG). A joint contracture model was established for the rats in the EG group by an external fixator. After fixator removal, 32 rats are further divided into the MC, SC, RE, and SR groups (n = 8). Before and after the 42 day intervention, the ROM, vWF, VEGF, PS, ED, and RI were measured using X-ray imaging, ELISA, and color Doppler ultrasound, respectively. Results: After fixator removal, ROM for EG group was lower than that of the NC group (p <.01). After the intervention, ROM for the SR, RE, and SC groups was improved. The ROM for the SR group reached a similar value for NC group. vWF and VEGF levels in SR group were lower than in the MC, SC, and RE groups (p <.05), and had a similar value to the NC groups. PS value for SR and RE groups was higher than the MC and SC groups. The RI value for SR group was higher than that of NC and MC groups. Conclusion: Multidisciplinary rehabilitation used in this study can treat joint contracture synergistically. It improves the ROM of the joint, reduces the content of vWF and VEGF, and improves the femoral artery hemodynamics. [ABSTRACT FROM AUTHOR]

To identify the potential role of humeral retrotorsion (HRT) and range of motion (ROM) as a risk factor for shoulder overuse injury in elite youth handball players. The hypothesis was that increased HRT is associated with an increased risk of shoulder overuse injury. Over 2 seasons, 258 elite youth handball players (52% boys; age:14 ± 0.8 years) were included. Preseason assessment included HRT and glenohumeral internal and external (ER) rotational ROM using ultrasound and a manual goniometer. Sports-specific adaptations between male and female athletes and the dominant and nondominant shoulder were calculated. In addition, players completed standardized questionnaires over the 2018-2019 or 2019-20 season and reported any shoulder overuse symptoms using the Western Ontario Shoulder Index questionnaire. Comparing male and female players showed significantly decreased HRT and decreased internal ROM in the dominant side of male athletes (P ≤.027). No other difference was found. Significant side-to-side differences between the dominant and nondominant shoulder were found for HRT, internal rotation, and ER, regardless of sex (P <.001). For total range of motion, only female athletes showed a significant increase in the dominant arm (P =.032). The dominant side showed a significantly higher glenohumeral internal rotation deficit in male athletes than in female athletes (10° ± 17° vs 5° ± 10°, P =.011). Adaptations in HRT, ER gain, and total range of motion gain were not significant. Over the course of the 2 seasons, 20 athletes reported shoulder overuse injuries. Although glenohumeral internal rotation deficit was borderline nonsignificant (P =.056), none of the parameters tested were significantly associated with shoulder overuse injuries. Despite significant side-to-side differences and sport-specific adaptations, individual preseason screening of humeral retrotorsion and soft tissue adaptations does not identify elite youth handball athletes at increased risk of shoulder overuse injury. [ABSTRACT FROM AUTHOR]

Soldiers and firefighters have a hazardous job profile. They have worn heavy clothing that reduces body's natural movability. In these circumstances, our objectives are to explore the effect of three layers light-weight clothing system: on kinetic/kinematic changes during different maneuverability, six gait phases, and on different body joints. We assessed four different exerted forces, six gait phases, and joint angles of five body movements amongst 63 trials of Indian soldiers by standardized protocol of Ergomaster 4.6 software. No significant changes were observed except in sitting position and shearing force of gait pattern. Hence, it allows for natural biomechanics and gait pattern. [ABSTRACT FROM AUTHOR]

Développé à la seconde is a classic ballet movement that requires the maintenance of a high hip joint range of motion (ROM) and muscle strength. However, the contribution of these hip joint biomechanical parameters to this movement's esthetic performance is unclear. Therefore, this study evaluated hip joint biomechanical characteristics of 21 experienced ballet dancers (15–29 y old) and verified the relationship between these variables with the développé à la seconde static and dynamic performance. Correlations between age, ballet practice time, gluteus maximus and gluteus medius thicknesses, ROM, and muscle strength with absolute and relative static and dynamic performances were verified. Flexors, extensors, and internal rotators peak strength and external rotation ROM were highly correlated with absolute and relative static performances (0.5–0.7). Flexors and extensors strength and external and internal rotation ROM showed the highest correlations with the développé dynamic performance (0.49–0.67). Flexor strength and flexor and internal rotation ROM predicted 26% to 41% of this movement's static and dynamic performances. Thus, from a biomechanical perspective, clinical assessment of hip strength and ROM may be used to predict the quality of the ballet dancers' performance of the développé à la seconde and guide classical ballet training. [ABSTRACT FROM AUTHOR]

Introduction Post-mastectomy physiotherapy typically includes massage, exercise, and stretching, but often fails to treat post-surgical scar tissue, a significant contributor to long-term disability. This study aimed to compare conventional therapy with myofascial manual therapy for treating post-surgical scar tissue in post-mastectomy patients and to determine the effectiveness of these treatments. Methods The study was an experimental controlled study with pre- and post-testing of two parallel groups. Forty-eight women experiencing shoulder and/or upper torso impairment following mastectomy were randomly allocated to either a control group ( n = 21) or a myofascial therapy group ( n = 27). Conventional physiotherapy involving exercise and massage or myofascial therapy was used. Pre- and post-therapy measurements included muscle length, pain intensity, range of motion (ROM), and scar mobility. Results Myofascial therapy was superior to conventional physiotherapy in reducing the percentage of patients with below-normal muscle lengths at several sites. Significant decreases from baseline were observed in the treatment group for the pars clavicularis, descending trapezius, pars sternocostalis, latissimus dorsi, and levator scapulae muscles. Myofascial therapy also improved mobility in the scar area, with increases of 3 mm relative to the xiphoid process and 4 mm relative to the coracoid. Conclusions Our study indicates that myofascial interventions improve upper limb ROM and muscle elasticity in the upper limb girdle of post-mastectomy patients. These findings provide empirical evidence supporting the benefits of myofascial intervention over conventional physiotherapy in the treatment of post-surgical scar tissue in this patient group.

Abstract Silent manipulation is a procedure for frozen shoulders that involves manipulating the shoulder while the patient is awake by performing C5, C6, and C7 cervical nerve root block under ultrasound guidance. This retrospective study, conducted at Yokohama City University Hospital, aimed to evaluate the clinical outcomes of silent manipulation and assess whether the experience level of the practitioner influenced treatment efficacy. Between October 2020 and January 2022, 53 patients who met the inclusion criteria underwent silent manipulation for frozen shoulder. The procedure was performed by either an experienced or a less experienced practitioner, and the patients were followed-up for up to 1 year post-treatment. Silent manipulation resulted in significant improvements in shoulder range of motion, as measured by forward flexion, abduction, external rotation, and hand-behind-back, as well as in patient-reported outcomes, including disabilities of the arm, shoulder, and hand and Shoulder 36 scores. These improvements were observed 1 week, 3 months, and 1 year after silent manipulation, indicating the short-term efficacy of the procedure. Furthermore, this study revealed that the practitioners’ level of experience played a significant role in the outcomes. The experienced doctor achieved better 1st external rotation and belt tying outcomes, as well as Shoulder 36 pain, muscle strength, and activities of daily living domain scores. This suggests that technical expertise in silent manipulation is crucial to achieve optimal outcomes. Silent manipulation offers an effective therapeutic approach for frozen shoulder, leading to significant improvements in range of motion and patient satisfaction. Practitioner expertise is a vital factor in treatment success, emphasizing the importance of skilled professionals in the performance of this procedure.

Abstract Background The purpose of this study was to investigate the clinical and radiographic outcomes and to determine the survivorship of a high-flexion design total knee arthroplasty (TKA) prosthesis, the LOSPA knee system, over a follow-up period of 10–12 years. Methods The study included 386 patients (503 TKAs) who were treated with TKA from 2011 to 2013 (follow-up period 10–12 years).The patients were assessed clinically using range of motion (ROM) of the knee, the Knee Society scoring system (KSS), and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). For radiographic analysis, the positions of femoral and tibial implants as α, β, γ, and δ angles, hip knee ankle (HKA) angle, and radiolucent lines were used. Kaplan–Meier survival analysis was performed. Results Mean ROM improved significantly from the preoperative baseline of 117.3° to 126.5° at the final follow-up (p

Abstract Background Stretching exercises are widely used for pain relief and show positive effects on musculoskeletal, nociplastic and neuropathic pain; the magnitude of altered pain sensitivity responses following regular stretching is currently unknown. This study aimed to investigate the effect of six weeks of regular stretching exercise on regional and widespread pain sensitivity and range of motion and the effect of stretching cessation on regional and widespread pain sensitivity and range of motion. Methods An experimental single-blind longitudinal repeated measures study. Twenty-six healthy adults were recruited. Regional and distant pressure pain thresholds and passive knee extension range of motion were measured at three points: before (baseline) and after six weeks (post-stretch) of daily bilateral hamstring stretching exercises and following four weeks of cessation (post-cessation) from stretching exercises. Results Participants had a mean ± standard deviation (range) age of 23.8 ± 2.1 (21–30) years. There was a 36.7% increase in regional (p = 0.003), an 18.7% increase in distant pressure pain thresholds (p = 0.042) and a 3.6% increase in range of motion (p = 0.002) between baseline and post-stretch measures. No statistically significant differences were found for regional (p = 1.000) or distant pressure pain thresholds (p = 1.000), or range of motion (p = 1.000) between post-stretch and post-cessation. A 41.2% increase in distant pressure pain thresholds (p = 0.001), a 15.4% increase in regional pressure pain thresholds from baseline to post-cessation (p = 0.127) and a 3.6% increase in passive knee extension range of motion (p = 0.005) were found from baseline to post-cessation. Conclusions Six weeks of regular stretching exercises significantly decreased regional and widespread pain sensitivity. Moreover, the results showed that the hypoalgesic effect of stretching on regional and widespread pain sensitivity persisted following four weeks of cessation. The results further support the rationale of adding stretching exercises to rehabilitation efforts for patients experiencing nociceptive, nociplastic, and neuropathic pain. However, further research is needed to investigate how the long-term effects of stretching exercises compare with no treatment in clinical populations. Trial registration The trial was registered June 1st, 2021 at ClinicalTrials.gov (Trial registration number NCT04919681).

Purpose: Conflicting evidence exists about the appropriate intra-operative soft tissue balance in posterior-stabilized (PS) total knee arthroplasty (TKA). The purpose of this prospective observational study was to investigate the impact of intra-operative soft tissue balance on post-operative knee flexion angle. Methods: A single surgeon performed 164 TKAs using a single brand of PS prosthesis via the subvastus approach without using a pneumatic tourniquet. Intra-operative soft tissue balance was quantified as the gaps between the femoral component and tibial osteotomy surface with the knee flexed at 0°, 30°, 90°, and 120° with the patellofemoral joint reduced. Multiple regression analyses were employed to identify independent predictors of knee flexion angle 1 year after TKA. Result: The pre-operative knee flexion angle and the gap difference between 120° and 0° flexion were positively correlated with knee flexion angle 1 year after TKA [β ​= ​0.37, 95% confidence interval (CI) 0.26–0.48, P ​

Abstract This pilot study aims to evaluate concurrent validity using the goniometer as a reference tool and test–retest reliability of flexion of metacarpal phalangeal joint (MCP) measurements taken from a finger training device (air-guitar system) in healthy participants. There were ten self -reported asymptomatic participants recruited to test the devices. The measurements of all metacarpophangeal joints of the dominant hands were conducted using a finger goniometer and the air-guitar system. Two measuring sessions were conducted on the same day. The concurrent validity of the air-guitar indicated by strong concordance correlation coefficient (0.62–0.90) with the goniometer and mean difference (approximately 1°) between the two instruments are well below the limit of 5°. The test–retest reliability of MCP measurements from the air-guitar glove (0.82–0.99) was acceptable as a clinically meaningful measurement tool as the intraclass correlation coefficients were higher than 0.7. The standard error of measurement and minimal detectable change of the air-guitar are similar to those of the goniometer. The air-guitar tracking features, when used as a home-based therapy tool, may assist in monitoring change of MCP flexion over a time course with good reliability and strongly associated with the measurements from the goniometer.

Background and Study Aim. Effective warm-up routines are critical for enhancing athletic performance and reducing injury risk. Joint distraction exercises are hypothesized to improve range of motion (ROM), flexibility, and jump performance, yet their effects are not well-documented in volleyball. This study aims to investigate the impact of joint distraction exercises applied to the lower extremities during warm-ups on ROM, flexibility, and jump performance in female volleyball players. Material and Methods. Twenty-four female volleyball players voluntarily participated in this study. The standard protocol included routine warm-ups followed by pre-tests measuring flexibility, range of motion (ROM), vertical jump (VJ), and horizontal jump (HJ). After a 48-hour rest period to minimize fatigue effects, the athletes underwent joint distraction exercises using elastic bands targeted at the lower extremities. Post-tests were conducted after these specific warm-up exercises to assess any changes. Data analysis was performed using SPSS software Results. The study found no significant difference in hip flexion range of motion (ROM) scores following joint distraction exercises (p > 0.05). However, statistically significant improvements were observed in overall flexibility, ankle dorsiflexion ROM, and both vertical and horizontal jump performances (p < 0.05). Conclusions. The study demonstrates that joint distraction exercises during warm-ups significantly enhance flexibility, range of motion (ROM), and jump performance in female volleyball players. Incorporating these exercises into routine warm-ups could be crucial for optimizing athletic performance and potentially reducing injury risks.

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