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Background: Rehabilitation programs for patients with patellofemoral dysfunction aim to recruit the vastus medialis obliquus muscle (VMO) in an attempt to reduce pain and to improve patellar tracking. Objectives: The aim of the present study was to use surface EMG to assess the effectiveness of two isometric submaximal contractions (10% and 60% of maximal voluntary contraction, MVC) in promoting preferential activation of VMO over vastus medialis longus (VML) and vastus lateralis (VL) in open and closed kinetic chain isometric exercises with the knee joint fixed at 30, 60 and 90 degrees of flexion. Methods and Measures: Surface electromyography (EMG) signals were recorded with linear adhesive arrays of four electrodes from fourteen healthy young men (age 23.5±3.2, mean±SD) during isometric knee extension contractions at 10% and 60% of the maximum voluntary contraction (MVC) for 1 min and 20 s respectively at 30, 60 and 90 degrees of knee flexion. Initial values and rate of change (slope) of mean frequency (MNF), average rectified value (ARV) and conduction velocity (CV) of the EMG signal were calculated. Results: Comparisons between the force levels produced at 10% and 60% MVC revealed that the initial values of ARV and CV for the VL, VML and VMO muscle were greater at 60% MVC compared to 10% MVC (3-way ANOVA; F=536; p<0.001, F=49: p<0.01 for ARV and CV respectively). Comparisons between the different muscles demonstrated lower initial values of CV for VMO compared to VL and VLM at 10% and 60% of MVC (F=15; p<0.05). In addition, initial estimates of ARV were higher for VMO compared to VML at both force levels (F=66; p<0.05). Comparisons between open and closed kinetic chain exercises revealed higher initial estimates of ARV for open kinetic chain knee extension at both force levels (F=62; p<0.01). In addition, the absolute value of MNF slope appeared to increase at higher angles for closed kinetic chain at 60% MVC while it was minimum at 60° degrees for open kinetic chain. No significant differences were observed in the rate of change of CV and MNF among the three muscles. Conclusions: Based on the results of this study, both open and closed kinetic chain exercise similarly activate the three portions of the quadriceps muscle, suggesting that selective training of the vastii muscle is not achievable in these conditions. [ABSTRACT FROM AUTHOR]

Purpose: In this study, we investigated whether experimental knee pain alters lower limb kinematics and knee arthrokinematics during gait, and if this motor adaptation depends on the spatial characteristics of the painful stimulus., Methods: Twenty-one participants walked on a treadmill for 60-s trials, either without stimulation or while experiencing painful electrical stimulation in the medial, lateral or anterior region of the knee. Perceived pain location was analyzed using pain drawing. Gait spatiotemporal parameters, lower limb kinematics, and dispersion of the knee helical axes on the sagittal plane were quantified for each trial and compared between conditions using ANOVAs with repeated measures or Friedman tests., Results: Pain perception was localized in the area the stimulation was applied to. Compared to walking without pain, participants demonstrated reduced knee extension (1.5 ± 1.5 degrees, p = 0.002) and reduced hip extension (0.8 ± 1.1 degrees, p = 0.037) when pain was induced in the anterior region, but not medially or laterally. Anterior knee pain increased the mean distance of the helical axes during late stance (0.7 [0.3, 1.4], p = 0.010), while medial pain increased both mean distance (0.3 [0.1, 0.5], p = 0.037) and mean angle (1.2 ± 1.4, p = 0.010) during early swing., Conclusion: Acute, experimental knee pain alters gait kinematics and increases the dispersion of the helical axis. These adaptations depend on the spatial characteristics of the painful stimulus. These adaptations may reflect an attempt of the central nervous system to protect the painful tissue while searching for a less painful movement strategy., Competing Interests: Declarations Conflict of interest The authors declare no competing interests or conflicts of interest., (© 2024. The Author(s).)

Background: Understanding the causes and mechanisms underlying musculoskeletal pain is crucial for developing effective treatments and improving patient outcomes. Self-report measures, such as the Pain Drawing Scale, involve individuals rating their level of pain on a scale. In this technique, individuals color the area where they experience pain, and the resulting picture is rated based on the depicted pain intensity. Analyzing pain drawings (PDs) typically involves measuring the size of the pain region. There are several studies focusing on assessing the clinical use of PDs, and now, with the introduction of digital PDs, the usability and reliability of these platforms need validation. Comparative studies between traditional and digital PDs have shown good agreement and reliability. The evolution of PD acquisition over the last 2 decades mirrors the commercialization of digital technologies. However, the pen-on-paper approach seems to be more accepted by patients, but there is currently no standardized method for scanning PDs., Objective: The objective of this study was to evaluate the accuracy of PD analysis performed by a web platform using various digital scanners. The primary goal was to demonstrate that simple and affordable mobile devices can be used to acquire PDs without losing important information., Methods: Two sets of PDs were generated: one with the addition of 216 colored circles and another composed of various red shapes distributed randomly on a frontal view body chart of an adult male. These drawings were then printed in color on A4 sheets, including QR codes at the corners in order to allow automatic alignment, and subsequently scanned using different devices and apps. The scanners used were flatbed scanners of different sizes and prices (professional, portable flatbed, and home printer or scanner), smartphones with varying price ranges, and 6 virtual scanner apps. The acquisitions were made under normal light conditions by the same operator., Results: High-saturation colors, such as red, cyan, magenta, and yellow, were accurately identified by all devices. The percentage error for small, medium, and large pain spots was consistently below 20% for all devices, with smaller values associated with larger areas. In addition, a significant negative correlation was observed between the percentage of error and spot size (R=-0.237; P=.04). The proposed platform proved to be robust and reliable for acquiring paper PDs via a wide range of scanning devices., Conclusions: This study demonstrates that a web platform can accurately analyze PDs acquired through various digital scanners. The findings support the use of simple and cost-effective mobile devices for PD acquisition without compromising the quality of data. Standardizing the scanning process using the proposed platform can contribute to more efficient and consistent PD analysis in clinical and research settings., (© Corrado Cescon, Giuseppe Landolfi, Niko Bonomi, Marco Derboni, Vincenzo Giuffrida, Andrea Emilio Rizzoli, Paolo Maino, Eva Koetsier, Marco Barbero. Originally published in JMIR mHealth and uHealth (https://mhealth.jmir.org).)

Background: A pain drawing is a self-administered assessment that requires the patient to shade in on a body chart the areas in which he or she experiences pain, regardless of the intensity. Pain drawings have already been validated in several adult populations., Objectives: The aim of this study is to establish adolescents' test-retest reliability in reporting the extent and location of their pain using a paper-based pain drawing., Study Design: A one-day test-retest reliability study was set up., Setting: The study took place in 2 separate locations-a pediatric hospital and a private physiotherapy practice in Ticino, in the southern part of Switzerland. This reliability study was approved by the local ethics committee of Ticino (2021-00492 CE 3832)., Methods: Adolescents with musculoskeletal pain (aged 11-16 years) were included. All participants were asked to shade the areas in which they experienced pain over the previous week. After the administration of a questionnaire and the acquisition of further personal data, the pain drawing was administered again. The pain drawings were then scanned and analyzed using a digital platform, which allowed the extraction of pain extent and location values. The test-retest reliability was evaluated on these data. The intraclass correlation coefficient and Bland-Altman analysis were used to assess the reliability of the reporting of the pain extent, whereas the Jaccard similarity coefficient was used to calculate the reliability of the reporting of the pain location., Results: The reporting of the pain extent was observed to have excellent test-retest reliability: ICC2,1: 0.959 (95% CI: 0.925-0.978). The Bland-Altman analysis showed a mean difference close to 0: -0.010% (limits of agreements -0.962 to 0.942). The reliability of the reporting of pain location was also supported by the Jaccard index mean score of 0.82 (± 0.19)., Limitations: Reliability of reporting may vary depending on the nature of the pain, its duration, or the type of disorder and body areas involved., Conclusions: Adolescents complaining musculoskeletal pain showed reliability in reporting pain extent and location using pain drawings.

Objectives: To examine changes in pain outcomes to fully evaluate the effect of adding sensorimotor training to manual therapy and exercise in patients with chronic neck pain and sensorimotor deficits. Concordance was examined between pain distribution and pain intensity and patient-reported outcomes., Methods: Participants (n=152) were randomly allocated into 4 intervention groups: One group received local neck treatment (NT) comprising manual therapy and exercise and the other 3 groups received additional sensorimotor training (either joint position sense/oculomotor exercises, balance exercises or both). Treatment was delivered twice a week for 6 weeks. Pain and patient-reported outcomes were measured at baseline, posttreatment, and 3-, 6- and 12-month follow-ups., Results: There were greater changes in pain location, extent, and intensity at 6- and 12-month follow-ups in the sensorimotor training groups compared with the NT group ( P <0.05). A greater number of patients in the sensorimotor training groups gained ≥50% reduction in pain extent and intensity relative to the NT group at 6 and 12 months ( P <0.05). Clinical improvement in pain extent was concordant with pain intensity (adjusted kappa=056 to 0.66, %agreement=78.3 to 82.9, P <0.001) and disability (adjusted kappa=0.47 to 0.58, % agreement=73.7 to 79.0, P <0.01) at 3-, 6- and 12-month follow-ups, but not with function and well-being. The concordance tended to decline with time., Discussion: Multiple aspects of the pain experience improved in the longer term by adding sensorimotor training to NT for patients with neck pain and sensorimotor deficits. The concordance between pain and patient-reported outcomes was not always evident and varied over time, suggesting the need for multidimensional assessments of pain., Competing Interests: This work was supported by the Thailand Science Research and Innovation (TSRI): Research Career Development Grant (RSA) [grant number 6180020]. The funder played no role in the design, conduct, or reporting of this study. The authors declare no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: Pen-on-paper pain drawing are an easily administered self-reported measure that enables patients to report the spatial distribution of their pain. The digitalization of pain drawings has facilitated the extraction of quantitative metrics, such as pain extent and location. This study aimed to assess the reliability of pen-on-paper pain drawing analysis conducted by an automated pain-spot recognition algorithm using various scanning procedures., Methods: One hundred pain drawings, completed by patients experiencing somatic pain, were repeatedly scanned using diverse technologies and devices. Seven datasets were created, enabling reliability assessments including inter-device, inter-scanner, inter-mobile, inter-software, intra- and inter-operator. Subsequently, the automated pain-spot recognition algorithm estimated pain extent and location values for each digitized pain drawing. The relative reliability of pain extent analysis was determined using the intraclass correlation coefficient, while absolute reliability was evaluated through the standard error of measurement and minimum detectable change. The reliability of pain location analysis was computed using the Jaccard similarity index., Results: The reliability analysis of pain extent consistently yielded intraclass correlation coefficient values above 0.90 for all scanning procedures, with standard error of measurement ranging from 0.03% to 0.13% and minimum detectable change from 0.08% to 0.38%. The mean Jaccard index scores across all dataset comparisons exceeded 0.90., Conclusions: The analysis of pen-on-paper pain drawings demonstrated excellent reliability, suggesting that the automated pain-spot recognition algorithm is unaffected by scanning procedures. These findings support the algorithm's applicability in both research and clinical practice., Competing Interests: Disclosures and Acknowledgments No conflict of interest exists in the submission of this manuscript, and the manuscript is approved by all authors for publication., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: The clinically relevant healing process of a ruptured and repaired Achilles tendon (AT) can last more than a year. The purpose of this cross-sectional study was to test if shear wave tensiometry is able to detect AT loading changes between a surgically managed AT rupture versus the unaffected contralateral tendon. Our secondary aims were to evaluate differences in mechanical properties when measured with myotonometry and morphological properties of the tendons measured with ultrasonographic imaging., Methods: Twenty-one patients with surgically treated AT ruptures were investigated 12-37 months after surgery. Tendon load was measured using a shear wave tensiometer composed of an array of 4 accelerometers fixed on the tendon. Shear wave speed along the Achilles tendon was evaluated at different levels of ankle torque for both the operated and the unaffected side. Mechanical properties of the tendons were evaluated using MyotonPRO and morphological properties using ultrasonographic imaging. Friedman test was used to assess differences in AT wave speed, stiffness, thickness, and cross-sectional area between the operated and the unaffected tendon., Results: We found a significant shear wave speed difference between sides at every ankle joint torque ( P  < .05) with a large effect size for the lowest ankle torque and small to medium effect sizes for higher ankle torque. Stiffness, thickness, and cross-sectional area of the operated tendon remained significantly higher compared to the unaffected side., Conclusion: In this cohort, we found that shear wave tensiometry can detect differences between operated and unaffected AT during a standardized loading procedure. The shear wave speed along the operated tendon, as well as the mechanical and morphologic properties, remains higher for 1-3 years after a rupture., Level of Evidence: Level III, case-control study., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. ICMJE forms for all authors are available online.

Background: Shear wave tensiometry is a recent promising technology which can be used to evaluate tendon loading. Knowing the clinimetric features (e.g., reliability) of this technology is important for use in clinical and research settings., Objectives: To evaluate the inter-session reliability of a novel shear wave tensiometer for the assessment of Achilles tendon loading. A further aim was to test the construct validity of this device by evaluating its precision in detecting Achilles tendon loading changes induced by a plantar flexor isometric contraction of increasing intensity., Method: Ten healthy participants were recruited. Five measurements were performed at different time points to evaluate inter-session reliability. Shear wave speed along the Achilles tendon was evaluated during different isometric contractions using a shear wave tensiometer composed of an array of four accelerometers fixed on the tendon, ranging from 4 to 8.5 cm from the calcaneal insertion of the tendon. Test-retest, intra- and inter-session reliability were determined using intraclass correlation coefficient (ICC 3.1 ). Absolute reliability was calculated using the standard error of measurement and minimal detectable change., Results: Test-retest reliability was good to excellent (ICC 3.1 0.87-0.99) for each of the contraction levels examined. Intra-session reliability was good to excellent (ICC 3.1 0.85-0.96) and inter-session reliability was also good to excellent (ICC 3.1 0.75-0.93) for each of the contraction levels., Conclusions: This study confirms the reliability of this novel device. Future studies analyzing participants with Achilles tendinopathy are needed to evaluate the capability of shear wave tensiometry to detect transient changes in loading due to pathology., Competing Interests: Declaration of competing interest None., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Sensitization mechanisms are thought to play a role in the perception of pain in people with cluster headache. No study has investigated the relation between the spatial extent of pain in cluster headache and measures of sensitization or other clinical features., Objective: Our aim was to investigate if the size of the painful area in people with cluster headache relates to widespread pressure sensitivity, headache features, and psychological outcomes., Methods: Forty men with episodic cluster headache reported their symptoms on a digital body chart and pain extent was calculated. Pressure pain thresholds were assessed locally over the temporalis muscle and the C5-C6 joint and at a remote site over the tibialis anterior to assess widespread pressure sensitivity. Clinical features of headache attacks, and anxiety/depressive levels were also assessed. Patients were assessed during a period of remission 6 months after their last pain attack and after treatment discontinuation., Results: Thirty-two (80%) and thirty (75%) patients reported their headaches in the orbital and the frontal areas, respectively. No significant associations (rho values ranging from -0.228 to 0.187, P values ranging from 0.157 to 0.861) were found between pain extent and pressure pain thresholds in trigeminal, extra-trigeminal, and distant pain-free areas, headache clinical features, and anxiety and depressive levels., Conclusion: Pain extent in the trigemino-cervical area was not related to the degree of pressure pain sensitivity or headache features in men with episodic cluster headache during a period of remission.

We aimed to investigate the relationship between pain extent, as a sign of sensitization, and sensory-related, cognitive and psychological variables in hospitalized COVID-19 survivors with post-COVID pain. One hundred and forty-six (67 males, 79 females) previously hospitalized COVID-19 survivors with post-COVID pain completed demographic (age, sex, height, weight), sensory-related (Central Sensitization Inventory, Self-Report Leeds Assessment of Neuropathic Symptoms), cognitive (Pain Catastrophizing Scale, Tampa Scale for Kinesiophobia) and psychological (Hospital Anxiety and Depression Scale, Pittsburgh Sleep Quality Index) variables. Pain extent and frequency maps were calculated from pain drawings using customized software. After conducting a correlation analysis to determine the relationships between variables, a stepwise linear regression model was performed to identify pain extent predictors, if available. Pain extent was significantly and weakly associated with pain intensity (r = -0.201, p = 0.014): the larger the pain extent, the lower the pain intensity. No other significant association was observed between pain extent and sensory-related, cognitive, or psychological variables in individuals with post-COVID pain. Females had higher pain intensity, more sensitization-associated symptoms, higher anxiety, lower sleep quality, and higher kinesiophobia levels than males. Sex differences correlation analyses revealed that pain extent was associated with pain intensity in males, but not in females. Pain extent was not associated with any of the measured variables and was also not related to the presence of sensitization-associated symptoms in our sample of COVID-19 survivors with long-term post-COVID pain.

Background: This study aims to investigate the acute effects of a single oral administration of a creatine-based multi-ingredient pre-workout supplement (MIPS) on performance fatigability and maximal force production after a resistance exercise protocol (REP)., Methods: Eighteen adult males (age: 23 ± 1 years; body mass: 76.4 ± 1.5 kg; height: 1.77 ± 0.01 m) were enrolled in a randomized, double-blind, crossover design study. Subjects received a single dose of a MIPS (3 g of creatine, 2 g of arginine, 1 g of glutamine, 1 g of taurine, and 800 mg of β-alanine) or creatine citrate (CC) (3 g of creatine) or a placebo (PLA) in three successive trials 1 week apart. In a randomized order, participants consumed either MIPS, CC, or PLA and performed a REP 2 h later. Before ingestion and immediately after REP, subjects performed isometric contractions of the dominant biceps brachii: two maximal voluntary contractions (MVCs), followed by a 20% MVC for 90 s and a 60% MVC until exhaustion. Surface electromyographic indices of performance fatigability, conduction velocity (CV), and fractal dimension (FD) were obtained from the surface electromyographic signal (sEMG). Time to perform the task (TtT), basal blood lactate (BL), and BL after REP were also measured., Results: Following REP, statistically significant ( P < 0.05) pre-post mean for ΔTtT between MIPS (-7.06 s) and PLA (+0.222 s), ΔCV slopes (20% MVC) between MIPS (0.0082%) and PLA (-0.0519%) and for ΔCV slopes (60% MVC) between MIPS (0.199%) and PLA (-0.154%) were found. A pairwise comparison analysis showed no statistically significant differences in other variables between groups and condition vs. condition., Conclusion: After REP, a creatine-enriched MIPS resulted in greater improvement of sEMG descriptors of performance fatigability and TtT compared with PLA. Conversely, no statistically significant differences in outcomes measured were observed between CC and PLA or MIPS and CC., Competing Interests: SMP reports grants or contracts from the U.S. National Dairy Council, Dairy Farmers of Canada, Roquette Freres, Nestle Health Sciences, National Science and Engineering Research Council, and Canadian Institutes for Health Research during the conduct of the study; personal fees from U.S. National Dairy Council, non-financial support from Enhanced Recovery, outside the submitted work. In addition, SMP has a patent Canadian 3052324 issued to Exerkine, and a patent US 20200230197 pending to Exerkine but reports no financial gains from any patent or related work. None of the organizations or companies mentioned by SMP has commercial or financial relationships with Syform S.r.l. that could be construed as a potential conflict of interest in this study. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Negro, Cerullo, Perna, Beretta-Piccoli, Rondanelli, Liguori, Cena, Phillips, Cescon and D’Antona.)