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Objective: We investigated whether adding lumbar motor control training with a pressure biofeedback unit improves outcomes of a conservative deep cervical flexor motor control program on neck pain, neck disability, deep cervical flexor endurance, and health status in middle-aged patients with chronic neck pain and forward head posture after eight weeks of interventions. Design: Randomized controlled trial. Setting: Outpatient setting. Subjects and interventions: A total of 113 males and females (mean age 39 ± 5 years) with chronic neck pain were randomized to three treatment groups, group 1 (n = 38) combined deep cervical flexor motor-control training and lumbar motor control exercise, group 2 (n = 37) deep cervical flexor motor control training alone, and group 3 (n = 38) passive treatment and education. Main outcome measures: Pain, neck disability, deep cervical flexor muscular endurance, and health status. Results: There were significant improvements in the combination group compared with the deep cervical flexor motor-control group alone (d = 2.03, 95% confidence interval (CI): −2.8 to −1.27, P = 0.021) for pain (d = −0.99, 95% CI = −1.75 to −0.23, P = 0.023), disability (d = 1.92, 95% CI = 0.86 to 2.98, P = 0.001), deep cervical flexor endurance, and (d = −2.75, 95% CI = −8.81 to −1.68, P = 0.037) for health status favoring the combination group. There were significant between-group differences favoring both active groups versus the passive control in all out comes. Conclusion: The addition of Lumbar motor control training as a complementary treatment may enhance effectiveness of deep cervical flexor motor control training on neck pain, neck disability, and deep cervical flexor endurance in patients with chronic moderate neck pain and forward head posture. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to evaluate the effect of conventional physiotherapy plus Dry Needling (DN) technique in patients with chronic nonspecific neck pain with Sternocleidomastoid (SCM) and Upper Trapezius (UT) muscles involvement. Methods: This study was designed as a single-blind randomized clinical trial. A total of 39 patients (19 men and 21 women) with chronic non-specific neck pain with a Mean±SD age of 38.13±5.68 years, a Mean±SD height of 168.28±8.34 cm, and a Mean±SD weight of 75.78±9.02 kg participated in this study. They were randomly divided into conventional physiotherapy (control group: n=19) and conventional physiotherapy plus DN (intervention group: n=20). SCM and UT muscle pain, neck disability, and thickness were assessed for all participants in the pretest, post-test, and follow-up periods. This study was reviewed and approved by the Faculty of Physical Education and Sport Science, University of Kharazmi, Tehran, Iran. Repeated measures analysis of variance and Bonferroni post hoc tests were used for data analysis using SPSS v. 22. Results: The results of 1-way analysis of variance showed that pain, neck disability, and SCM and UT muscle thickness in the intervention group had a significant decrease compared to the control group in the post-test and follow-up period (P<0.05). Also, according to the results of the corrected Bonferroni post hoc test, the intervention group showed a greater effect size than the control group in the post-test and the follow-up periods in the above variables. Conclusion: The present study results show that adding DN to conventional physiotherapy for neck pain can increase the effectiveness of intervention in relieving pain, disability, and SCM and UT muscle thickness in people with chronic neck pain. [ABSTRACT FROM AUTHOR]

Objective: To investigate if adding Kinesio tape to therapeutic exercise is an effective treatment to improve clinical outcomes compared to therapeutic exercise alone and no intervention, in patients with shoulder impingement syndrome. Design: Three-arm randomized controlled trial Setting: Outpatient setting Subjects: One hundred and twenty patients (mean (SD): age 37.8 (5.4)) with shoulder impingement syndrome. Intervention: Patients were randomly assigned to eight-weeks therapeutic exercise alone, therapeutic exercise with Kinesio tape, and control group. Main measures: Pain was measured with a numerical rating scale and disability and scapular kinematics were measured with a relative questionnaire and motion analysis software respectively, at baseline and after eight-weeks intervention. Results: There was significant differences in therapeutic exercise with Kinesio tape group vs. therapeutic exercise alone and control group respectively for pain (d = –0.34, P = 0.042; and d = –1.53, P = 0.001), disability (d = –0.46, P = 0.024; and d = –2.18, P = 0.001), scapular upward rotation at sagittal plane (d = 0.33, P = 0.033; and d = 0.68, P = 0.001), scapular plane (d = 0.18, P = 0.045; and d = 0.43, P = 0.001), scapular tilt at sagittal plane (d = 0.55, P = 0.043; and d = 1.39, P = 0.001), and scapular plane (d = 0.29, P = 0.034; and d = 0.58, P = 0.001). Therapeutic exercise alone was superior over control group in all significant outcomes (P < 0.05). Conclusion: Although therapeutic exercises alone showed positive effect on clinical outcomes, adding Kinesio tape to therapeutic exercises had more significant effects with larger effect sizes. Adding Kinesio tape to therapeutic exercise may be of some assistance to clinicians in improving clinical outcomes in patients with shoulder impingement syndrome. [ABSTRACT FROM AUTHOR]

Background: Different individualized interventions have been used to improve chronic low back pain (CLBP). However, their superiority over group‐based interventions has yet to be elucidated. We compared an individualized treatment involving pain neuroscience education (PNE) plus motor control exercise (MCE) with group‐based exercise (GE) in patients with CLBP. Methods: Seventy‐three patients with CLBP were randomly assigned into the PNE plus MCE group (n = 37) and GE group (n = 36). Both PNE plus MCE and GE were administered twice weekly for 8 weeks. Pain intensity (as measured using the VAS), disability (as measured using the Roland‐Morris Disability Questionnaire), fear‐avoidance beliefs (as measured using the Fear‐Avoidance Beliefs Questionnaire), and self‐efficacy (as measured using the Pain Self‐Efficacy Questionnaire) were assessed at baseline and 8 weeks post‐intervention. A 2 × 2 variance analysis (treatment group × time) with a mixed‐model design was applied to statistically analyze the data. Results: Both groups showed significant improvements in all the outcome measures, with a large effect size (P < 0.001, partial eta squared [ηp2] = 0.66 to 0.81) after the intervention. The PNE plus MCE group showed greater improvements, with a moderate effect size in pain intensity (P = 0.041, ηp2 = 0.06) and disability (P = 0.021, ηp2 = 0.07) compared to the GE group. No significant difference was found in fear‐avoidance beliefs during physical activity and work, and self‐efficacy (P > 0.05) between the 2 groups. Conclusion: PNE and MCE seem to be better at reducing pain intensity and disability compared to GE, while no significant differences were observed for fear‐avoidance beliefs and self‐efficacy between the 2 groups in patients with CLBP. With regard to the superiority of individualized interventions over group‐based ones, more studies are warranted. [ABSTRACT FROM AUTHOR]

Background: The treatment of chronic low back pain (LBP) should target both behavioral variables and physical performance factors.Hypothesis: Cognitive functional treatment (CFT) and lumbar stabilization treatment (LST) will result in positive changes in pain and lumbar movement control (LMC) in patients with LBP.Study Design: Pretest-posttest intervention.Level Of Evidence: Level 3.Methods: After screening, 52 participants (mean age, 44.3 ± 2.46 years) with chronic LBP were allocated into CFT (n = 17), LST (n = 17), or control (n = 18) groups. Pain and LMC were evaluated before and after 8 weeks of intervention with visual analog scale (VAS) and Luomajoki LMC battery tests, respectively.Results: Compared with baseline, pain and LMC were reduced and improved significantly in both groups after 8 weeks. However, the changes in both variables were not significantly different between groups. Percent change for pain between pretest and posttest values in the LST group was a decrease of 45% (P = 0.003), compared with a decrease of 40% (P = 0.003) in the CFT group. Change in LMC in the LST group was a decrease of 100% (P = 0.026), compared with a decrease of 200% (P = 0.018) in the CFT group. There as no change for both variables in the control group.Conclusion: Both CFT and LST groups improved LMC scores and reduced pain intensity. However, there was no difference between the 2 experimental groups on pain and LMC test results.Clinical Relevance: In this study, intended to construct an intervention for people with chronic LBP, the primary aims were to help individuals "make sense of their pain," develop effective pain control strategies via body relaxation and extinction of safety behaviors, and adopt healthy lifestyle behaviors to affect cognitive factors known to affect pain sensitivity and disability. These primary aims were achieved through an emphasis on factors such as development of positive beliefs, reduced fear, increased awareness, enhanced understanding and control of pain, adaptive coping, enhanced self-efficacy, confidence, and improved mood through the class-based intervention. [ABSTRACT FROM AUTHOR]

This study was aimed to compare the effects of 8‐week conditioning training (CT) programs with and without feedback on lower limbs' biomechanics and injury incidence in free‐injury male runners and assess their effectiveness across a 1‐year observation. A total of 49 healthy male runners were randomly assigned to one of three groups of CT (n = 16), CT with feedback (n = 17), and placebo (n = 16) group. Kinematic and kinetic measurements were conducted at pre‐intervention, 8 weeks post‐intervention, and 1‐year follow‐up stage. Injury incidence was also measured at pre‐intervention and follow‐up stage. As a result, significant improvement was found in within‐group differences in CT and CT with feedback groups. Moreover, significant difference in CT with feedback group was observed in the kinetic outcome improvement after 8 weeks as compared to CT group. On the other side, there were no significant differences between the CT and CT with feedback groups in kinematic outcomes. However, the percentage of changes in kinematic outcomes were higher in CT with feedback group than those in the CT group. No significant change was observed in the placebo group in all the variables. There was comparative between‐group difference between CT with feedback group and the placebo one, favoring the former group. At 1‐year follow‐up, the injury incidence was reduced by 32% for CT group, 64.6% for CT with feedback group, and 15.5% for placebo. Thus, the CT with feedback was effective in improving biomechanics and reducing injury incidence. Improvements were generally maintained through 1 year, indicating potential for long‐term changes. This study demonstrates the applicability of using feedback with CT to enhance safer movement patterns in runners and may subsequently help prevent or reduce injury risks. [ABSTRACT FROM AUTHOR]

Background: Stiffness and restricted ROM affect muscle balance and alignment. The purpose of this research was to study the effect of iliopsoas tightness on hip ROM, muscle strength and alignment of lumbopelvic region in 11-14 years old adolescents. Methods: In this case-control study, 15 adolescents with iliopsoas tightness as experimental group, and 15 healthy adolescents which matched based on age, height, weight, BMI, dominant leg and sport experience participated voluntarily as control group. Universal goniometer (r=0.85-0.95) used for measuring ROM, flexible ruler (r=0.82) for kyphosis and lordosis degree, handheld dynamometer (r=0.98) for muscle strength and digital photos are used for pelvic tilt angle. Data analyzed using Independent t test, Pearson correlation coefficient and d Cohen's effect size. Results: There were significant differences between passive and active hip extension ROM, lumbar lordosis, pelvic tilt, iliopsoas strength, gluteus maximus/iliopsoas strength between groups. While, there were no significant differences in results of active and passive hip flexion ROM, kyphosis, and strength of gluteus maximus, rectus femoris and biceps femoris between groups. Also there were no significant correlations between lumbar lordosis and pelvic tilt with other variables in this study. Conclusion: Adolescents with iliopsoas tightness have limited hip extension ROM, greater pelvic tilt and lumbar lordosis and weaker iliopsoas strength in comparison to healthy counterparts. Iliopsoas stretching, corrective exercises for hyper lordosis and increased pelvic tilt and iliopsoas strengthening training should be included in football training programs. [ABSTRACT FROM AUTHOR]

Background: The gluteal-to- Tensor Fascia Latae muscle activation index is considered a valuable finding in the rehabilitation of disease such as low back pain. The aim of this study was to compare the effect of lumbo- pelvic general and selected exercises on pain, movement control and gluteal and TFL muscles activation in patients with lumbar movement control impairment. Methods: 39 subjects with nonspecific chronic low back pain and lumbar movement control impairment were recruited. Before and after the implementation of two different types of general and selected training protocols for lumbo- pelvic area, the pain, movement control and muscle activity measurement were done by using visual analogue scale, Lumajoki tests and surface electromyography respectively. Results: Mean Age of study was with mean age of 33.4±6.13 years old. The results showed that both groups of training increases the activity of the gluteal muscles but only the selected training led to pain decreases and movement control improvement. Selected training group consists of side step, clam with elastic resistance around thighs (CLAM), unilateral bridge (uni BRG), hip extension in quadruped on elbows with knee extending (QKE) and hip extension in quadruped on elbows with knee flexed (QKF) exercises increases more in the gluteal-to-Tensor index index that this is due to increased Gluteal muscles activity and decreased Tensor Fascia Latae activity after performing these exercises that this is a very important clinical finding. Conclusion: It is recommended that if the goal of rehabilitation is to preferentially activation and strengthening the gluteal muscles while minimizing Tensor Fascia Latae activation, then the CLAM, SIDE STEP, UniBRG, QKE, and QKF exercises appear to be most appropriate. [ABSTRACT FROM AUTHOR]

The purpose of the present study was to investigate correlative and predictive relationship of lower extremity anatomical alignment, isometric hip abduction and external rotation strength with jump-landing biomechanics using Landing Error Scoring System (LESS). Anatomical alignment and isometric lower extremity muscle strength of 30 active men (mean age of 21.27±2.12 years) have been assessed through goniometry and dynamometry tests, respectively. Then, subjects have performed LESS test for the analysis of their jump-landing biomechanics. There was no significant correlative or predictive relationship between overall LESS score and femoral anteversion angle, tibiofemoral angle, Q angle, navicular drop, tibial torsion, abduction and external rotation isometric strength (P>.05). However, statistically significant negative correlation has been found between knee hyperextension angle and LESS score (P= .01, r= -.4). The findings of the present study showed that lower extremity anatomical alignment and isometric strength measurements has no significant relationship with dynamic biomechanics of jump-landing. This is probably due to the difference in nature of static and isometric measurements and dynamic functional movements. [ABSTRACT FROM AUTHOR]

This study aimed to reveal the functional ability of functional movement screening (FMS) scores in determining an athlete's predisposition to injury. One hundred (50 females and 50 males) university level athletes, weight of 69.44 ± 5.84 kg, height of 172.69 ± 7.26 cm, age of 22.56 ± 2.99 years and Baecke score 21.66 ± 1.73, practised in football, handball and basketball sports (at least for 5 years), with no recent (<6 weeks) history of musculoskeletal injury were recruited. Of the 100 subjects, 35 of them suffered an acute, lower extremity (ankle = 20 and knee = 15 subjects) injury. An odds ratio was calculated at 4.70, meaning that an athlete has an approximately 4.7 times greater chance of suffering a lower extremity injury during a regular competitive season if they score less than 17 on the FMS. This study provides FMS reference values for university level athletes that will assist in the interpretation of individual scores when screening athletes for musculoskeletal injury and performance factors. More research is still necessary before implementing the FMS into a pre-participation physical examination for athletics, but due to the low cost and its simplicity to implement, it should be considered by clinicians and researchers in the future. [ABSTRACT FROM PUBLISHER]

Background and Aim: The Functional Movement Screen (FMSTM) is a screening instrument that evaluates selective fundamental movement patterns. The main aim of this study was to investigate the relationship between the FMSTM score and history of injury, and attempt to determine which active students are prone to injury. Methods: One hundred physically active (50 females and 50 males) students, between 18 and 25 years of age, with no recent (<6 weeks) history of musculoskeletal injury were recruited. All participants performed the FMSTM and were scored using the previously established standardized FMSTM criteria. The chi square, independent t-test, one-way analysis of variance, and POSTHOC Bonferroni tests were used for data analysis with a preset alpha value of p<0.05. Results: Of the 100 subjects, 35 suffered an acute lower extremity (ankle=20, knee=15) injury in practice or competition. An odds ratio was calculated at 4.70, meaning that an athlete had an approximately 4.7 times greater chance of suffering a lower extremity injury during a regular competitive season if they scored less than 17 on the FMSTM. There were statistical differences between the pre-season FMSTM scores of the injured and non-injured groups, the ankle injury, knee injury, and non-injured groups, and also between contact injury, non-contact injury, and non-injured groups. Discussion and Conclusion: This cross-sectional study provides FMSTM reference values for physically active students, which will assist in the interpretation of individual scores when screening athletes for musculoskeletal injury and performance factors. More research is still necessary before implementing the FMSTM into a pre-participation physical examination (PPE) for athletics, but due to the low cost and its simplicity to implement, it should be considered by clinicians and researchers in the future. Level of Evidence: 2B [ABSTRACT FROM AUTHOR]

The purpose of this study was to show that: being "in context" and "similarity" in fatiguing protocols to the main aspects of sport doesn't alter wrestlers balance. Twenty professional male wrestling athletes (age 26.2±1 yr, VO2max 62.3±3.1 ml kg min) participated in this study (10 in experimental and 10 subjects in control group) and completed a fatigue protocol. In this study, regular wrestling match used for metabolic fatigue protocol. Biodex balance system and lactometer used for evaluation of balance and blood lactate level (respectively). For statistical analysis, Pearson correlation coefficient, paired t-test, sample t and ANOVA tests were used. Based on these study results, the static balance alterations in experimental group (eye opened and eye closed positions) were respectively 0.16% and 3.17% that this wasn't statistically meaningful. Also, Dynamic balance alterations in experimental group (eye opened and eye closed positions) were 0.12% and 0.41% (respectively) that this weren't statistically meaningful. There wasn't significant relationship between lactate acid accumulation and variations of stability indices (r=-0/570, p<0.05). One of the best Justifications for no alteration in wrestlers balance is that: fatiguing protocol exerted in this study is "in context" and "similar" to wrestling main training and this can apply Anticipatory postural adjustment system for further maintaining postural stability. The probable mechanisms that through them neck fatigue did affect static and dynamic stability could be include of alteration in afferent sensory inputs, decreasing in postural adjustment, increase in COP displacement, increase in delay time and decease in muscular activity, alteration in proprioception and dysfunction of contractile units in anti gravity muscle following. [ABSTRACT FROM AUTHOR]

Introduction: This study aims to investigate whether a pain neuroscience education (PNE) combined with a blended exercises programme including aerobic, resistance, neuromuscular, breathing, stretching and balance exercises and diet education provides greater pain relief and improvement in functional and psychological factors than PNE and blended exercises alone and whether 'exercise booster sessions (EBS)' approach may improve outcomes and increase adherence in patients with knee osteoarthritis (KOA) (by telerehabilitation (TR))., Methods and Analysis: In this single-blind randomised controlled trial, 129 patients (both genders; age >40) diagnosed with KOA will be randomly assigned to one of the 2 2 treatment combinations as: (1) blended exercises alone (36 sessions over 12 weeks), (2) PNE alone (three sessions over 2 weeks), (3) combination of PNE with blended exercises (exercise three times a week for 12 weeks combined with three sessions of PNE) and (4) a control group. Outcome assessors will be blinded towards group allocation. The primary outcome variables are the visual analogue scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis index in knee osteoarthritis (WOMAC) score. Secondary outcomes include Pain Self-Efficacy Questionnaire (PSEQ), Depression, Anxiety and Stress Scale (DASS), Tampa Scale for Kinesiophobia (TSK), Short Falls Efficacy Scale International (FES-I), Pain Catastrophising Scale (PCS), Short Form Health Survey (SF-12) and Exercise Adherence Rating Scale (EARS), 30 s sit-to-stand test (30CST), Timed Up and Go (TUG), lower limbs' muscle strength and lower limb joints' active range of motion (AROM) will be performed at baseline, 3 and 6 months' postinterventions. The primary and secondary outcomes will assess at baseline, 3 months and 6 months postinterventions.The findings will be useful in establishing an effective treatment strategy covering multiple aspects behind KOA. The study protocol is conducted in clinical settings, thereby enhancing the possibility of future implementation of the treatments in the healthcare systems and self-care management. Results in comparison between groups will help to clarify the most effective of mixed-method TR (blended exercise, PNE, EBS with diet education) on more improvement in pain, functional and psychological factors in patients with KOA. This study will combine some of the most critical interventions, to be able to introduce a 'gold standard therapy' in the treatment of KOA., Ethics and Dissemination: The trial has been approved by the ethics committee for research involving human subjects of the Sport Sciences Research Institute of Iran (IR.SSRC.REC.1401.021). The study findings will be published in international peer-reviewed journals., Trial Registration Number: IRCTID: IRCT20220510054814N1., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Muscles work synergistically to support the body during landing. Myofascial meridians have been described to classify muscles into functional synergies. The role that these functional lines plays in positioning the trunk and lower extremity of patients with anterior cruciate ligament reconstruction (ACLR) and healthy athletes during drop landing tasks remains unclear., Research Question: The purpose of this study was to compare the front and back functional lines (FFL and BFL) muscle activation in patients with ACLR and healthy participants during single leg vertical drop jump (SLVDJ)., Methods: Thirty-two male athletes (post-ACLR = 16, healthy = 16) participated (age = 23.3 ± 2.3 years). Superficial electromyography of FFL (adductor longus [AL], rectus abdominis [RA], pectoralis major) and BFL (vastus lateralis [VL], gluteus maximus [GMax], latissimus dorsi [LD]) was collected during the SLVDJ and compared at initial contact and maximum knee flexion between groups using t-tests and limbs using paired-samples t-tests., Results: In the FFL, the AL (p < 0.05) and RA (p < 0.05) muscles were more active in the healthy group compared to the ACLR group at initial contact and maximum knee flexion. PM demonstrated greater activation in the healthy group only at maximum knee flexion (p < 0.05). In the BFL, the VL (p < 0.05) and GMax (p < 0.05) muscles were more active in the ACLR group, whereas the LD (p < 0.05) muscles demonstrated greater activation in the healthy group at initial contact and maximum knee flexion. There were no healthy group inter-limb differences in FFL and BFL activation. ACLR participants demonstrated greater non-injured limb VL, AL, GMax and LD activation (p < 0.05) and greater injured limb PM and RA activation (p < 0.05)., Significance: Based on the present data, patients after ACLR may present with an alteration in BFL and FFL muscles activation during a drop jump task. Functional line muscles during dynamic activities may change lower extremity positioning and lead to increase ACL injury risk., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Purpose: This study aimed to evaluate the effects of scapular-focused treatment with (SFTF) and without (SFT) feedback on pain, function, and scapular kinematics in patients with Shoulder Impingement Syndrome (SIS)., Methods: Seventy-five males and females with SIS were randomly assigned into SFTF (n = 25), SFT (n = 25) and control (n = 25) groups. The primary outcome was pain, assessed by Visual Analog Scale (VAS). The secondary outcomes were function and scapular kinematics, assessed by DASH Questionnaire and a 3-D motion capture, respectively. All outcomes were measured at the baseline and after the 8-week interventions., Results: A post hoc analysis performed to show significant differences between groups after the 8-week interventions. For pain, there were significant differences between SFTF vs. SFT (ES (95% CI) = - 0.3(- 0.4 to - 0.1); P = 0.04), SFTF vs. control (ES (95% CI) = 1.3(0.7-1.9); P = 0.01). For DASH, also, there were significant differences between SFTF vs. SFT (ES (95% CI) = 1.8(1.1-2.4); P = 0.03), SFTF vs. control (ES (95% CI) = 4.4(3.3-5.4); P = 0.01), and SFT vs. control (ES (95% CI) = 2.6(1.8-3.4); P = 0.01). For scapular internal rotation (the sagittal or scapular planes), scapular upward rotation, and the scapular tilt, however, there were no differences between SFTF vs. SFT., Conclusion: Based on the study results, a rehabilitation program integrated with verbal feedbacks is effective to relieve pain, and improve function and scapular kinematics in patients with SIS. Adding feedback to an exercise therapy could clinically enhance outcomes in patients with SIS., Level of Evidence: Level II., Trial Registration: This study was prospectively registered at UMIN-CTR website, and the unique trail number is UMIN000036399.

Background: In this study, the effect of adding a smartphone app to an 8-week global postural reeducation (GPR) on neck pain, endurance, quality of life, and forward head posture (FHP) in patients with chronic neck pain and FHP was evaluated., Methods: Sixty male and female office workers (38.5 ± 9.1 years) with chronic neck pain were randomly assigned into three groups: group 1 (GPR+ a smartphone app, n = 20), group 2 (GPR alone, n = 20), and group 3 (the control group, n = 20). The primary outcome was pain and the secondary outcomes were disability, quality of life, endurance, and posture. Pain, disability, endurance, quality of life, and posture were evaluated using the visual analog scale (VAS), neck disability index (NDI), progressive iso-inertial lifting evaluation (PILE) test, quality of life questionnaire (SF-36), and photogrammetry, respectively, at pre-and post-8-week interventions. A one-way analysis of covariance (ANCOVA) has been conducted to statistically analyze the data., Results: The GPR+ a smartphone app had statistically significant improvements versus GPR alone in pain (mean difference, - 2.05 ± 0.65, ES (95% CI) - 0.50 (- 1.04 to - 0.01), P = 0.04), disability (difference = 11.5 ± 1.2, ES (95% CI) = 0.31 (0.22 to 0.97), p = 0.033), FHP (difference = 1.6 ± 0.2, ES (95% CI) = 0.31 (0.09 to 0.92), p = 0.047), and endurance (difference = 2 ± 3.3, ES (95% CI) = 0.51 (0.02 to 1.03), p = 0.039). Both of the GPR+ a smartphone app and GPR alone groups had statistically significant differences versus the control group in all outcomes., Conclusion: When a workplace assessment and management could not be as part of any intervention, adding a smartphone app to GPR for NP may be an appropriate tool to administer a home and work exercise program resulting in elevating pain and disability, as well as improving FHP and endurance., Trial Registration: Current Controlled Trials using the UMIN-RCT website UMIN000039720 . Retrospectively registered on January 9, 2020.

Purpose: The purpose of the study was to investigate the influence of a 72-h KT application on trunk and lower extremity kinematics during different landing tasks., Methods: Twenty-nine competitive male athletes participated in this study. The sum of knee valgus and lateral trunk lean, symmetry index (SI), and peak angles of lateral trunk lean, hip flexion, knee abduction and flexion were assessed for all participants during single-leg drop landing (SLDL), single-leg vertical drop jump (SLVDJ), vertical drop jump (DLVDJ), and double leg forward jump (DLFJ), at baseline and seventy-two hours following KT application., Results: The KT application resulted in more knee flexion and abduction, sum of knee valgus and lateral trunk lean as compared with the non-KT condition during SLDL (P < 0.05). Nonetheless, there were no differences in SI, maximum angle of the lateral trunk lean during SLDL, SLVDJ, nor hip flexion, knee abduction, and flexion during DLVDJ, and DLFJ tasks (P > 0.05)., Conclusions: The research findings suggest that KT after 72-h application may improve knee abduction and sum of knee valgus and lateral trunk lean during SLDL, knee flexion during SLDL and SLVDJ in individuals displaying risky single-leg kinematics. Therefore, KT application may marginally improve high-risk landing kinematics in competitive male athletes., Level of Evidence: Level III.

Purpose: The purpose of this study was to examine how attentional focus during training influences the effects of a 6-week hip-knee strength training program on pain, function, strength, and kinematics in males and females with Patellofemoral pain (PFP)., Methods: Seventy-five males and females with PFP were randomly allocated to a group that trained with an internal focus (n = 25), a group that trained with an external focus (n = 25), or a control group (n = 25). All patients completed testing before (baseline) and after (posttest) the 6-week period. The primary outcome was pain, assessed by Visual Analog Scale (VAS). The secondary outcomes were function, hip muscles strength and lower extremity kinematics, assessed by Kujala Questionnaire, handheld dynamometer and a 2-D motion capture, respectively. All outcomes were measured at the baseline and after the 6-week intervention. Analysis of covariance was used to compare posttest outcomes among the groups while accounting for group differences in baseline performance., Results: The hip-knee strengthening exercises resulted in improved knee valgus (ES(95 % CI) = 0.43(0.26 to 0.75), p = 0.03), and external rotator strength (ES(95 % CI) = 0.51(0.12 to 0.78), p = 0.03) for males and females who trained with an external compared to internal focus., Conclusions: Our findings indicate that males and females with PFP may benefit from completing a hip-knee strengthening training program with an external focus vs. an internal focus. Physical therapists and clinicians should consider using instructions that promote an external focus when implementing hip-knee strengthening training programs with PFP patients. This result could be strengthened or re-enforced by larger studies with longer follow up., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Purpose: Gait analysis is an important index in the clinical treatment of people with anterior cruciate ligament (ACL) injury. Following unilateral ACL reconstruction (ACLR), the knee kinetic asymmetries are likely to affect the gait cycle. Therefore, the aim of this study was to examine the symmetries of vertical ground reaction force (vGRF) and select the knee muscle activity in gait cycles in participants with and without unilateral ACLR., Methods: In this cross-sectional study, vGRF and muscle activity data in difference gait cycles were collected from 56 male subjects (28 with unilateral ACLR and 28 healthy subjects) using force plate and electromyography (EMG), respectively. MATLAB software was used for data analysis and independent t test was employed to compare the two groups., Results: No significant difference was seen between the two groups in the variable of first peak force symmetry (n.s). However, there was a significant difference in the second-peak force symmetry index between the two groups (p ≤ 0.001). Regarding muscle activity symmetry in the braking phase of gait, a significant difference was observed in rectus femoris between the two groups (p ≤ 0.001), while no difference was seen in medial gastrocnemius and biceps femoris activity (n.s). In the propulsive phase of gait, there was a significant difference in medial gastrocnemius and biceps femoris muscles activity between the two groups (p ≤ 0.001), while no difference was found in rectus femoris muscle activity (n.s)., Conclusions: The results revealed that unilateral ACLR creates asymmetry in vGRF and muscle activities in different phases of the gait cycle. So, more attention should be paid to this problem in clinical settings, and also to the use of therapeutic interventions to reduce the amount of kinetic asymmetries., Level of Evidence: III.

Objectives: This study aimed to evaluate the effects of corrective exercises on posture, pain, and muscle activation of patients with chronic neck pain exposed to anterior-posterior perturbation., Methods: A total of 32 women (37.76 ± 3.83 years) with chronic, nonspecific neck pain were randomized into corrective exercise and control groups. The experimental group underwent a corrective exercise program for 8 weeks, 30 min/d, 3 days per week. The control group received active self-exercise instructions. Neck pain, forward head and protracted shoulder posture, and timing of superficial neck muscle activation were evaluated using the visual analog scale, photogrammetry, and electromyogram, respectively, before and then 48 hours after the 8-week program for both the experimental and control groups. All measurements at pretest and posttest were taken by a blinded assessor., Results: Significant alterations were observed in cervical angle (P = .003, effect size = 0.329), shoulder angle (P = .008, effect size = 0.457), neck pain and disability (P = .009, effect size = 0.645), movement control (P = .038, effect size = 0.353), activation onset of the upper trapezius (P = .015, effect size = 0.746), the sternocleidomastoid (P = .018, effect size = 0.879) and cervical erector spinae (P = .031, effect size = 0.765), and the root mean square of the upper trapezius (P = .033, effect size = 0.742), the sternocleidomastoid (P = .041, effect size = 0.587), and the cervical erector spinae (P = .024, effect size = 0.832) in the intervention group from pre- to posttest (P < .05)., Conclusion: Positive and significant alterations have been observed in the forward head and protracted shoulder posture, the timing of superficial neck muscle activation, neck pain, and disability in female patients with chronic neck pain exposed to anterior-posterior perturbation after performing an 8-week corrective exercise program., (Copyright © 2020. Published by Elsevier Inc.)

Purpose: To investigate the effect of therapeutic exercise (TE) on pain, disability, posture, and health status in female dentists suffering from chronic neck pain (NP)., Methods: 48 female dentists (40-45 years) suffering from NP were randomly divided into two experimental (n = 24) and control (n = 24) groups. Experimental group received 8 weeks of TE aimed to improve (1) muscle coordination and proprioception, (2) muscular endurance, and (3) muscle strength. Control group received no specific exercises. The pain, disability, posture (forward head and protracted shoulder angles), and health status were assessed at baseline and after an 8-week TE by visual analogue scale (VAS), neck disability index (NDI), photogrammetry, and self-rated general health questionnaire, respectively. Wilcoxon and Mann-Whitney non-parametric tests were used for statistical analysis., Results: There were significant between-group differences in neck pain [p = 0.003, 0.86 (0.09-1.65)], disability [p = 0.009, ES (95% CI) = 0.78 (0.020-1.37)], forward head angle [p = 0.039, ES (95% CI) = 0.61 (0.034-1.19)], protracted shoulder angle [p = 0.031, ES (95% CI) = 0.64 (0.062-1.22)], and health status [p = 0.022, ES (95% CI) = 0.68 (0.102-1.26)] favoring the corrective exercise group. There were significant within-group changes in pain, disability, posture, and health status in the experimental group. However, there were no within group changes in the control group., Conclusions: TEs successfully alleviated pain, disability, posture, and health status in female dentists suffering from chronic NP. Considering the extremely large effect size of TEs, this intervention was recommended to neck pain treatment in patients suffering from chronic NP, poor posture, and health problem.

Background: Long-standing groin pain (LSGP) is a chronic painful condition resulting in both impaired performance and time loss from participation in multidirectional field sport., Research Question: What are the differences in intersegmental coordination strategy and variability of trunk-pelvic and thigh coupling during change of direction in subjects with athletic LSGP and asymptomatic control subjects?, Methods: A motion analysis system was used to collect 3-D kinematic data of the continuous relative phase and the variability of the right and left leg hip. Thoracic-thigh segment data were also collected during multiple ipsilateral turns at a self-selected pace from 16 males with LSGP and 16 asymptomatic controls. It is worth mentioning that, for a more detailed analysis, we divided each cycle diagram into four phases. Independent T-tests were used to compare the two groups., Results: Subjects with LSGP demonstrate except in phase 2 of the left foot, more out-of-phase movement with both increased variabilities in right/ left thigh - pelvic coupling, right/ left thigh-thoracic, and pelvic- thoracic in every 4 phases and in the decoupling of segmental coordination., Significance: Decrease in coordination with higher variability is apparent in subjects with LSGP and this aberrant coordination may lead to unexpected compensatory strategies and control impairments., Competing Interests: Declaration of Competing Interest We confirm that there are no known conflicts of interest associated with this publication and there has been no financial support for this work that could have influenced its outcome. The researchers independently collected, analyzed, and interpreted the results and have no financial interests in the results of this study. Furthermore, dissemination of the results of this study does not constitute endorsement by the researchers or their institutional affiliations., (Copyright © 2020 Elsevier B.V. All rights reserved.)