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Background: Stretching exercises and massage therapy are both suggested for pain relief in fibromyalgia syndrome. Previous studies have not proved their superiority over each other. This study compared the therapeutic effects of friction massage, stretching exercises, and analgesics on pain relief in patients with fibromyalgia syndrome.Methods: We evaluated 129 female patients with the diagnosis of primary fibromyalgia visited at the physical medicine clinics of Baqiyatallah Hospital in Tehran, Iran during 2010- 2011. Patients were randomly divided into three groups: the first group received 400 mg ibuprofen P.O. (3 times per day) and 25 mg nortriptyline (daily) P.O. as analgesic, the second group was treated by friction massage and the third group performed stretching exercises. Patients were assessed three times (initially, after one and four weeks) by visual analogue scale (VAS).Results: The mean age of participants was 60.46 years. The mean age in each treatment group was 46.66 years in medication group, 46.73 years in stretching group and 46.65 years in friction massage group. Changes in VAS score over 4 weeks were 2.4, 3.1 and 1.9, in the first, second, and third groups, respectively. The changes in VAS were significantly different in the first and second groups rather than the controls (P

In this retrospective study, records of Iranian Hajj pilgrims who were hospitalized in 2 Iranian hospitals in Mecca and Medina, Saudi Arabia, from 2005 to 2007, were reviewed. Of 600 patients who were hospitalized, 12 (2.0%) were admitted due to nephrological causes, which included kidney calculi (n = 7; 58.4%), acute kidney failure (n = 2; 16.7%), urinary tract infection (n = 1; 8.3%), urinary tract infection and urinary calculus (n = 1; 8.3%), and renal malignancy (n = 1; 8.3%). None of the patients needed referral to other healthcare centers, and all of them were discharged with good condition. Length of hospital stay was 1 to 4 days. There was no association between hospitalization due to nephrological causes and sociodemographic data, healthcare use, and outcome. This inpatient epidemiological study showed 2% of total admissions were related to nephrological conditions in Iranian Hajj pilgrims, most commonly due to easily treated conditions. [ABSTRACT FROM AUTHOR]

Objective: Biological effects of sulfur mustard (SM) on various systems have been investigated in both humans and animals. However, few studies are available on the effect of SM on the peripheral nervous system. In the present study, long-term effects of a single dose of SM on nerve conduction velocity and electromyography (EMG) pattern is evaluated in hindlimb of adult male rats.Methods: SM poisoning was induced by two means: subcutaneous injection of 1 and 3.5 mg/kg SM in two experimental groups (1 and 2) and cutaneous application of 8 and 13 mg/kg SM in groups 3 and 4. Sham and control groups received SM vehicle, isopropyl alcohol, and nothing, respectively. Electrophysiological assessments were performed after 26 weeks as follows: sciatic nerve conduction study that included measuring, amplitude, duration, and latency of M-wave, F-wave latency, and EMG study in resting and minimal contraction states.Results: Results indicate that sciatic nerve conduction velocity did not significantly change in any experimental groups. However, resting EMG records showed some abnormalities very similar to positive sharp waves and fasciculation reported in humans. These abnormalities were observed in 6 of 36 intoxicated rats.Conclusions: Although the present data are in favor of axonal degeneration, to rule out the possibility of other types of degeneration, additional thorough studies at ultrastructural level are suggested. [ABSTRACT FROM AUTHOR]

Background: Anxiety can exacerbate fear of falling and balance issues, potentially affecting intervention efficacy. This study examines exergaming's impact on fear of falling and balance in anxious and non-anxious older adults., Materials and Methods: Twenty older adults (10 anxious, 10 non-anxious) participated in six weeks of balance-oriented gaming. Fear of falling was assessed using the Falls Efficacy Scale and the Activities-specific Balance Confidence Scale. Balance was measured with the Berg Balance Scale and the Timed Up and Go Test before, after, and six weeks post-intervention., Results: Both groups showed significant improvements in balance and mobility, sustained during follow-up. However, only the non-anxious group exhibited significant reductions in fear of falling and increased balance confidence. Anxiety was linked to reduced enjoyment, lower efficacy perception, and heightened tension during the intervention., Conclusion: Exergaming improves balance and reduces fear of falling in non-anxious older adults. Anxiety may diminish these benefits., Clinical Implications: Assessing anxiety levels is crucial when prescribing exergaming interventions. Tailoring treatments to address anxiety could enhance outcomes.

Boots are often used in sports, occupations, and rehabilitation. However, there are few studies on the biomechanical alterations after wearing boots. The current study aimed to compare the effects of running shoes and boots on running biomechanics. Kinematics and ground reaction forces were recorded from 17 healthy males during running at 3.3 m/s with shoe and boot conditions. Temporal distance gait variables, ground reaction force components as well as lower limb joints angle, moment, and power were compared using Paired t-test and Statistical Parametric Mapping package for time-series analysis. Running with boots was associated with greater stride, step, flight, and swing times, greater flight length, and smaller cadence (p<0.05). The only effect of boots on lower limb joints kinematics during running was a reduction in ankle range of motion (p<0.05). Significantly greater hip flexor, abductor, and internal rotator moments, greater knee extensor and abductor moments, and ankle plantar flexor moments were observed at push-off phase of running as well as greater ankle dorsiflexor moment at early-stance in boot condition (p<0.05). Also, knee joint positive power was greater with a significant temporal shift in boot condition, suggesting a compensatory mechanism in response to limited ankle range of motion and the inability of the ankle joint to generate the required power. Our findings showed that running with boots is physically more demanding and is associated with a greater net contribution of muscles spanning hip and knee joints in order to generate more power and compensate for the ankle joint limitations, consequently, may increase the risk of both musculoskeletal injuries and degenerative joint diseases., Competing Interests: The authors have declared that no competing interests exist.

In the recent years, prolotherapy is increasingly being used in the field of musculoskeletal medicine. However, few studies have investigated its effectiveness in plantar fasciitis (PF). The purpose of this study was to compare the effectiveness of ultrasound-guided dextrose prolotherapy with radial extracorporeal shock wave therapy (ESWT) in the treatment of chronic PF. This randomized controlled trial was conducted on 59 patients with chronic PF. Patients were randomly assigned into two groups receiving three sessions of radial ESWT (29 patients) vs. two sessions of ultrasound-guided intrafascial 2 cc dextrose 20% injection (30 patients). The following outcome measures were assessed before and then six weeks and 12 weeks after the treatments: pain intensity by visual analog scale (VAS), daily life and exercise activities by Foot and Ankle Ability Measure (FAAM), and the plantar fascia thickness by ultrasonographic imaging. The VAS and FAAM scales showed significant improvements of pain and function in both study groups 6 weeks and 12 weeks after the treatments. A significant reduction was noted for plantar fascia thickness at these intervals (all p < .05). The inter-group comparison revealed that except for the FAAM-sport subscale which favored ESWT, the interaction effects of group and time were not significant for other outcome measures. Dextrose prolotherapy has comparable efficacy to radial ESWT in reducing pain, daily-life functional limitation, and plantar fascia thickness in patients with PF. No serious adverse effects were observed in either group. LEVEL OF EVIDENCE: Level I, randomized controlled trial., (Copyright © 2020 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.)

Background and Aims: Carpal tunnel syndrome is the most prevalent peripheral neuropathy and has a considerable burden on health services. We tried to compare the therapeutic effects of local corticosteroid injection, low-level laser, and corticosteroid phonophoresis in the treatment of carpal tunnel syndrome., Subjects and Methods: We performed a randomized clinical trial with three parallel groups. The study was carried out at a University Hospital. In total, 42 participants including 31(73.8%) women were randomly allocated to the treatment groups with equal sizes. We assessed pain, symptom severity and functional status with Boston Carpal Tunnel Questionnaire, and performed median nerve conduction velocity studies. Evaluations were done before the interventions and in the fourth week of study. For the group corticosteroid, under the guidance of sonography, methylprednisolone with lidocaine was injected into the carpal tunnel. For laser therapy, we administered 10 sessions, each lasting 10 seconds. We used topical hydrocortisone acetate gel 10% as the anti-inflammatory agent with phonophoresis, 3 times per week for 10 sessions., Results: Within-group analyses with paired t-test showed that local corticosteroid, laser, and phonophoresis are all effective treatments. Between-group analyses with ANOVA indicated that there were significant differences among the groups after four weeks in terms of pain (p = 0.004), in favor of corticosteroid; and in sensory delay (p = 0.001), in favor of laser. For the Boston Carpal Tunnel Questionnaire and median nerve motor latency, the results were not significant. There was no important side-effect after four weeks of follow-up., Conclusion: The three treatments are comparable and beneficial for carpal tunnel syndrome., (2020, Japan Medical Laser Laboratory.)

Cerebral palsy (CP) is the most common movement disorder in children that is associated with life-long disability and multiple impairments. The clinical manifestations of CP vary among children. CP is accompanied by a wide range of problems and has a broad spectrum. Children with CP demonstrate poor fine and dross motor function due to psychomotor disturbances. Early rehabilitation programs are essential for children with CP and should be appropriate for the age and functional condition of the patients. Kinesio taping (KT) technique is a relatively new technique applied in rehabilitation programs of CP. This article reviews the effects of KT techniques on improving motor skills in children with CP. In this study, we used keywords "cerebral palsy, Kinesio Tape, KT and Taping" in the national and international electronic databases between 1999 and 2016. Out of the 43 articles obtained, 21 studies met the inclusion criteria. There are several different applications about KT technique in children with CP. Review of the literature demonstrated that the impact of this technique on gross and fine motor function and dynamic activities is more effective than postural and static activities. Also this technique has more effectiveness in the child at higher developmental and motor stages. The majority of consistent findings showed that KT technique as part of a multimodal therapy program can be effective in the rehabilitation of children with CP to improve motor function and dynamic activities especially in higher developmental and motor stages.

The aim of conducting this study was to determine the prevalence of PTS among patients with carpal tunnel syndrome. The study was conducted from March 2014 to April 2015 in the EDX ward and clinic of physical medicine and rehabilitation at the university hospital; Baqiytallah, a large referral practice and research center in Tehran. We included patients with clinical symptoms and signs of CTS. Clinical assessments were aimed to the diagnosis of CTS and PTS. At the next stage, ultrasound study was performed for the participants with suspected CTS. Sample size calculations were based on the formula: [Formula: see text]. Results showed that 13 (8.8%) patients presented electrodiagnostic, and 27 (18.2%) had clinical manifestations of pronator teres syndrome of which, 17 showed ultrasonic signs of the syndrome. In addition, 2, 7, and 8 out of the 17 patients had mild, moderate, and sever carpal tunnel syndrome, respectively. Age was not significantly different between the patients with, and without pronator teres syndrome ( p -value=0.179). Nine participants with pronator teres syndrome were male and there was a significant difference concerning sex ( p -value=0.013). There was a good agreement between electrodiagnostic and ultrasound findings (Cohen's kappa coefficient=0.71, p -value<0.0001). Taken together, pronator teres syndrome should be considered as a possibility among patients with carpal tunnel syndrome especially in sever forms. Both electrodiagnostic and sonographic studies are efficient for diagnosing pronator teres syndrome. Men are more prone to develop pronator teres syndrome.

Context: Use of a handrim wheelchair could force the wrist into extreme excursions and encroachment of the median nerve., Objective: We performed a study of the prevalence of carpal tunnel syndrome in prolonged wheelchair users., Design and Setting: A cross-sectional study was conducted for one year in an outpatient clinic of spinal cord injury., Participants: Patients had traumatic injury at the first thoracic level and below, with time since injury of at least 5 years., Outcome Measure: The prevalence of carpal tunnel syndrome by history taking, clinical examinations and motor and sensory nerve conduction studies of median nerve performed for both hands., Results: Participants (N = 297) were all male. Mean (SD) age and duration since injury were 48 (8.5) and 23 (6.6) years, respectively. A significant difference in median duration of injury based on the severity of the syndrome (P < 0.001), and a significant trend in time since injury for the severity (P (one tailed) < 0.001) were seen. There was a significant difference in the median age among the groups (P = 0.009), and the median increased with the severity (P (one tailed) = 0.001)., Conclusions: Carpal tunnel syndrome is a common side effect of the long time use of wheelchair, and its severity is associated with duration of wheelchair use and age. Alternative methods for wheelchair propulsion should be developed to diminish the likelihood of the syndrome.

Objective: Neurodevelopmental treatments are an advanced therapeutic approach practiced by experienced occupational therapists for the rehabilitation of children with cerebral palsy. The primary challenge in children with cerebral palsy is gross motor dysfunction. We studied the effects of neurodevelopmental therapy on gross motor function in children with cerebral palsy., Materials & Methods: In a quasi-experimental design, 28 children with cerebral palsy were randomly divided into two groups. Neurodevelopmental therapy was given to a first group (n=15) with a mean age of 4.9 years; and a second group with a mean age 4.4 years (n=13) who were the control group. All children were evaluated with the Gross Motor Function Measure. Treatments were scheduled for three - one-hour sessions per week for 3 months., Results: We obtained statistically significant differences in the values between the baseline and post treatment in two groups. The groups were significantly different in laying and rolling (P=0.000), sitting (0.002), crawling and kneeling (0.004), and standing abilities (P=0.005). However, there were no significant differences in walking, running, and jumping abilities between the two groups (0.090)., Conclusion: We concluded that the neurodevelopmental treatment improved gross motor function in children with cerebral palsy in four dimensions (laying and rolling, sitting, crawling and kneeling, and standing). However, walking, running, and jumping did not improve significantly.

Cerebral palsy is the most common cause of spasticity and physical disability in children and spasticity is one of the commonest problems in those with neurological disease. The management of spasticity in children with cerebral palsy requires a multidisciplinary effort and should be started as early as possible. There are a number of treatments available for the management of spasticity. This article reviews the variety of options available for the clinical management of spasticity.

Background: Tennis elbow (TE) is a common musculotendinous degenerative disorder of the extensor origin at the lateral humeral epicondyle. Different modes of treatment are used for management of tennis elbow., Objectives: This study investigated the effect of the taping technique (TT) on pain, grip strength and wrist extension force in treatment of tennis elbow., Patients and Methods: Thirty patients (16 men /14 women with a mean age of 32.2 years) with tennis elbow of their dominant arm participated in this study. Outcome measures were assessment of pain at the lateral aspect of the elbow, grip strength and wrist extension force before and five to ten minutes after application of elbow tape on the affected and unaffected arms. A Visual Analog Scale was used to assess pain. A dynamometer and a hand-held dynamometer were used for evaluation of grip strength and wrist extension force, respectively., Results: Among the variables, significant differences were found in wrist extension forces between effected and unaffected arms (P = 0.02). Changes in grip strength showed statically significant improvements in the affected arm compared to the unaffected arm (P = 0.03). Also, in assessment of pain at the lateral epicondyle, the mean change between affected and unaffected arms was significant, with P = 0.001., Conclusions: The taping technique, as applied in this study demonstrates an impressive effect on wrist extension force and grip strength of patients with TE. Elbow taping also reduces pain at the lateral aspect of the elbow in these patients.

Background: Annually millions of Muslims depart to Saudi Arabia for performing a religious pilgrimage called "Hajj". In this ceremony, pilgrims face numerous health hazards and injuries such as pressing in overcrowding, sliding, burning, falling down, traffic accidents etc. The main purpose of this study was to determine the prevalence of injuries in Hajj period across 2004 to 2008., Methods: This study was conducted on 253808 Iranian pilgrims on five consecutive years of Hajj ceremonies, from 2004 to 2008. We used a report sheet with 13 types of injuries and 13 mechanisms of these injuries. SPSS V13.5 soft ware was used for analyzing the data. ANOVA and independent sample t - test was conducted, and relationships were considered significant at P< 0.05., Results: The most common injuries was "tissue contusions and ruptures "(about 76/10000), and "tendon lesions" (about 62/10000). In addition, the most common mechanism of injuries was "ankle sprain" (69/10000) during the five consecutive years. The prevalence of all fractures was about 49/10000 and the proportion of burning with hot water or fire was about 40/10000. Changes of all causes of the injuries were significant in this study (P< 0.05)., Conclusions: We have suggested some directions for preventing of injuries and related Injuries in Hajj, in this study.

Background: Increased complaints by school students about back and shoulder pain and discomfort have raised concerns among parents, education professionals, and orthopedists and these discomforts may be because of schoolbag carriage. The aim of this study was to investigate of relationship of musculoskeletal symptoms with weight of backpack in Tehran secondary school students., Methods: This cross-sectional study was performed in the city of Tehran in 2009. Two hundred thirteen students participated in study. Nordic Musculoskeletal Questionnaire was used, asking about complaints of back, neck, and/or shoulders. Length and weight of the children were determined. Schoolbags were weighed, and the relative weight of the schoolbag was calculated., Results: Most prevalent musculoskeletal discomfort was in shoulders as 38.1%, neck 27.6% and back 16.7%. Average difference of weight of backpack in sample that had musculoskeletal with other samples was significant (P< 0.05)., Conclusion: Weight of the backpack appears to be strongly related to the occurrence of shoulder, neck, back, and extremities complaints in students. Although musculoskeletal discomforts are believed to be multifactorial in origin, the carriage and manipulating of heavy backpack is signally a suspected factor and may represent an overlooked daily physical stress for secondary students.

Objective: The objective of this study was to calculate central motor conduction time (CMCT) of median and ulnar nerves in normal volunteers. Conduction time across the lower part of the brachial plexus was measured by using magnetic stimulation over the motor cortex and brachial plexus and recording the evoked response in hand muscles., Design: This descriptive study was done on 112 upper limbs of healthy volunteers. Forty-six limbs belonging to men and sixty-six belonging to women were studied by magnetic stimulation of both motor cortex and brachial plexus and recording the evoked response in thenar and hypothenar muscles. Stimulation of the motor cortex gives rise to absolute latency of each nerve whereas stimulation of the brachial plexus results in peripheral conduction time. The difference between these two values was considered the central motor conduction time (CMCT)., Results: In summary the result are as follows; Cortex-thenar latency = 21.4 ms (SD = 1.7), CMCT-thenar = 9.6 ms (SD = 1.9), Cortex-hypothenar latency = 21.3 ms (SD = 1.8), CMCT-hypothenar = 9.4 ms (SD = 1.8)., Conclusion: These findings showed that there is no meaningful difference between two genders. CMCT calculated by this method is a little longer than that obtained by electrical stimulation that is due to the more distally placed second stimulation. We recommend magnetic stimulation as the method of choice to calculate CMCT and its use for lower brachial plexus conduction time. This method could serve as a diagnostic tool for diagnosis of lower plexus entrapment and injuries especially in early stages.

Introduction: That the ulnar nerve compromise occurs concomitant with the carpal tunnel syndrome (CTS) has been cited by previous studies. It seems that the previously mentioned incidence is much higher than what we observe in our electrodiagnosis studies., Material and Method: A prospective study was designed to evaluate the incidence of ulnar nerve compromise in patients with electrodiagnostic evidence of CTS according to age and sex, and also to determine the site of ulnar nerve involvement., Results: One hundred and sixty five limbs with standard elestrodiagnostic criteria of CTS were evaluated In 9.7% of the tested limbs, the ulnar nerve was involved. The site of the involvement was the wrist area in 43.75%. The elbow region was involved in 43.75%, and in 12.5%, the forearm region was involved. The most prevalent age range of concomitant involvement was 45-54 years old. In patents who had sensory symptoms in the 4th and 5th fingers, the incidence of concomitant ulnar nerve compromise was significantly higher (p < 0.001) than the patients without these symptoms., Discussion: In patients with CTS, concomitant ulnar nerve compromise is much lower than the incidence mentioned in previous researches. Apparently the rate of involvement in wrist and elbow are equal. It is recommended that in evaluation of patients for CTS especially when the patient has sensory symptoms in the hand, special attention is paid to ulnar nerve involvement and two nerve comparison tests are interpreted with caution.

Background: Pressure sores are important and common complications of spinal cord injury. Many preventive and therapeutic approaches have been tried and new trials are evolving. One relatively recent method is application of a hydrocolloid dressing (HD). In this study we compared the therapeutic effects of HD on pressure ulcer healing with two other topical applications, phenytoin cream (PC) and simple dressing (SD)., Methods: Ninety-one stage I and stage II pressure ulcers of 83 paraplegic male victims of the Iran-Iraq war were randomly allocated to three treatment groups. Mean age and weight of the participants were 36.64 +/- 6.04 years and 61.12 +/- 5.08 kg, respectively. All the patients were managed in long term care units or in their homes for 8 weeks by a team of general practitioners and nurses, and the ulcer status was recorded as "Complete healing", "Partial healing", "Without improvement" and "Worsening"., Results: Complete healing of ulcers, regardless of location and stage, was better in the HD group than the PC [23/31(74.19%) vs 12/30(40%); difference: 34.19%, 95% CI = 10.85-57.52, (P < 0.01)] or the SD [23/31(74.19%) vs 8/30(26.66%); difference: 47.53%, 95% CI = 25.45-69.61, (P < 0.005)] groups. Complete healing of stage I ulcers in the HD group [11/13(85%)] was better than in the SD [5/11(45%); difference: 40%, 95% CI = 4.7-75.22, (P < 0.05)] or PC [2/9 (22%); difference: 63%, 95% CI = 29.69-96.3, (P < 0.005)] groups. Complete healing of stage II ulcer in the HD group [12/18 (67%)] was better than in the SD group [3/19(16%); difference: 51%, 95% CI = 23.73-78.26, (P < 0.005)], but not significantly different from the PC group [10/21 (48%); difference: 19%, 95% CI = -11.47-49.47, (P > 0.05)]. We performed a second analysis considering only one ulcer per patient (i.e. 83 ulcers in 83 patients). This "per patient" analysis showed that complete ulcer healing in the HD group was better than in the PC [20/28(71.4%) vs 11/28 (39.3%); difference: 32.1%, 95% CI = 7.4-56.7, (P < 0.01)] or SD [20/28(71.4%) vs 8/27 (29.6%); difference: 41.8%, 95% CI = 17.7-65.8, (P < 0.005)] groups., Conclusion: We deduced that HD is the most effective method investigated for treating stage I and II pressure ulcers in young paraplegic men.