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Background and Study Aim. The purpose of the study is a biomechanical examination of the inclusion of active flexibility in artistic gymnastic movements requiring mobility (muscles' ability to stretch), flexibility and other motor abilities such as force, power, etc. Material and Methods. The study included 17 girl gymnasts aged 7-9 years old, with a body height of 140.7±10.2, weight of 34.1±6.4, and a body mass index of 17.6±3.0. Data collection in the study was made by using performance tests developed by FIG such as a Forward-Backward Split, Side Spit, Arm-Trunk Angle Backward, Trunk Bent Forward, Leg Raise forward, Leg Raise Sideward, Bridge, Standing long Jump, Lift Trunk Forward-60secs, Angle Degree of the Leg Split Position in Cartwheel, and Arm-Upper Body Angle Backward in Bridge Technique. The Kinovea 0.8.15 program was used in the data analysis of the variables in the study. The SPSS 24 software program was used for the data analysis. Percentages of the angle degree calculated by the formula “%= (angle0 of the mobility in functional movement / angle0 of the active flexibility) *100” were found. Results. Results indicate that active flexibility was 90% functional in the leg raise sideward, 90% in the leg split during execution of the cartwheel, 17.5% in the bridge technique, and completely functional for the flexibility ratio expressed in the leg raise forward technique. In the analysis of the various elements of the similar biomechanics, the anatomic structure and similar body planes, it was concluded that active flexibility expressed in the movements required a mobility of around 65-75%. Conclusions.. it was determined that the functionality rate of the techniques requiring active flexibility and requiring mobility of the same biomechanical and anatomical structure was around 65-75%. Therefore, to execute 100% of the flexibility in action (during active elements) as it is in a passively or actively, it may significantly increase force, motor control, dynamic balance, coordination etc., in the large range of motion., Передумови та мета дослідження. Метою дослідження є біомеханічне дослідження включення активної гнучкості в художньо-гімнастичні рухи, що вимагають рухливості (здатність м’язів розтягуватися), гнучкості та інших рухових здібностей, таких як сила, сила тощо.Матеріал та методи. У дослідженні взяли участь 17 дівчат-гімнасток віком 7-9 років, із зростом тіла 140,7 ± 10,2, вагою 34,1 ± 6,4 та індексом маси тіла 17,6 ± 3,0. Збір даних у дослідженні проводився за допомогою тестів продуктивності, розроблених FIG , таких як Розбиття вперед-назад, бічна коса, кут нахилу рукоятки назад, нахил тулуба вперед, підняття ніг вперед, підняття ніг в сторону, міст, стрибок у довжину вперед, підйом стовбура вперед-60 секунд, кут нахилу положення розщеплення ніг у колесі та руці, верхній кут тіла назад у техніці мосту. Програма Kinovea 0.8.15 була використана для аналізу даних змінних у дослідженні. Для аналізу даних було використано програмне забезпечення SPSS 24. Визначено відсотки градусного кута, розрахованого за формулою "% = (кут0 рухливості у функціональному русі / кут0 активної гнучкості) * 100".Результати. Результати показують, що активна гнучкість була 90% функціональною при піднятті ноги вбік, 90% при розщепленні ноги під час виконання колеса, 17,5% у мостовій техніці та повністю функціональна для коефіцієнта гнучкості, вираженого в техніці підняття ноги вперед. В результаті аналізу різних елементів подібної біомеханіки, анатомічної будови та подібних площин тіла було зроблено висновок, що активна гнучкість, виражена в рухах, вимагає рухливості близько 65-75%.Висновки. Було встановлено, що рівень функціональності методів, що вимагають активної гнучкості та вимагають рухливості тієї самої біомеханічної та анатомічної структури, становив близько 65-75%. Отже, щоб виконати 100% гнучкості в дії (під час активних елементів), як це відбувається пасивно чи активно, це може значно збільшити силу, моторний контроль, динамічний баланс, координацію тощо у великому діапазоні рухів.

Background: Globally, burns are a serious public health problem and Knee post burn scar flexion contractures, makes up 22% of large joint contractures. Stretching is effective method to improve muscle length and mulligan bent leg raise is a modification of straight leg raise which increase hamstring flexibility and length. Aim of Study: This study has been conducted to evaluate the effect of the mulligan bent leg raise technique on elongation of hamstring muscle and the reflection of that on some quan-titative gait parameters and the range of motion (ROM) of knee extension. Patients and Methods: Thirty male patients between 30- 50 years were participated in this study, with a second-degree posterior leg burn and a total body surface area of 15-20%. They were divided randomly into two equal groups, study group (A), 15 patients received mulligan bent leg raise technique plus the traditional physical therapy program and control group (B), 15 patients received only the same traditional physical therapy program. Measurements were recorded before treatment and after third, sixth and eighth week of treatment (session for 30 minutes, 5 days/week for a total period of 2 months). A 16-meter walkway and tape measure were used to measure the quantitative gait parameters, while manual goniometer was used for measuring ROM of knee flexion. patients were exam-ined at the outpatient clinic of Cairo University during the period from December 2020 to February 2021. Results: There was a significant decrease in knee flexion ROM and step width and a significant increase in step length and stride length of the study group (group A) at post I, post II and post III compared with that of the control group (group B) (p < 0.001). Conclusion: It is concluded that the mulligan bent leg raise technique is effective in elongating the hamstring muscle as reflected by the improved gait parameters as well as the ROM of knee extension.

Background Lower exercise capacity, as measured by 6-minute walk distance (6MWD), is associated with incident heart failure (HF). Among those without HF, the associations of measures of cardiac function with 6MWD are unclear, and may provide insight regarding the risk of incident HF. Objectives The purpose of this study was to understand the relationships between cardiac function and exercise capacity. Methods This study evaluated the associations of cardiac mechanics with 6MWD in the sixth examination of the Multi-Ethnic Study of Atherosclerosis. Echocardiography (2-dimensional, Doppler, and speckle-tracking) was performed at rest and after passive leg raise to evaluate functional reserve after intravascular volume challenge. Results Of 2,096 participants without HF (mean age 73 years, 48% men, 58% non-White), individuals with lower (worse) left atrial (LA) reservoir strain were older and had higher blood pressure. Lower resting LA reservoir strain (β coefficient per SD decrease: −5.0; 95% confidence interval [CI]: −8.8 to −1.3 m; p = 0.009), inability to augment LA reservoir strain after passive leg raise (β coefficient per SD decrease: −5.8; 95% CI: −9.1 to −2.5 m; p Conclusions Among individuals without HF, worse biatrial function, lack of LA functional reserve, and worse LV diastolic function were associated with reduced submaximal exercise capacity. Therapies aimed to improve these functional domains may increase exercise capacity and prevent HF.

Background: Fluid therapy plays a major role in the management of critically ill patients. Yet assessment of intravascular volume in these patients is challenging. Different invasive and non-invasive methods have been used with variable results. The passive leg raise (PLR) maneuver has been recommended by international guidelines as a means to determine appropriate fluid resuscitation. We performed this systematic review and meta-analysis to determine if using this method of volume assessment has an impact on mortality outcome in patients with septic shock. Methods: This study is a systematic review and meta-analysis. We searched available data in the MEDLINE, CINAHL, EMBASE, and CENTRAL databases from inception until October 2020 for prospective, randomized, controlled trials that compared PLR-guided fluid resuscitation to standard care in adult patients with septic shock. Our primary outcome was mortality at the longest duration of follow-up. Results: We screened 1,425 article titles and abstracts. Of the 23 full-text articles reviewed, 5 studies with 462 patients met our eligibility criteria. Odds ratios (ORs) and associated 95% confidence intervals (CIs) for mortality at the longest reported time interval were calculated for each study. Using random effects modeling, the pooled OR (95% CI) for mortality with a PLR-guided resuscitation strategy was 0.82 (0.52 -1.30). The included studies were not blinded and they ranged from having low to high risk of bias using the Cochrane Risk of Bias Tool. Conclusion: Our analysis showed there was no statistically significant difference in mortality among septic shock patients treated with PLR-guided resuscitation vs. those with standard care.

Intra-operative hypotension is a known predictor of adverse events and poor outcomes following major surgery. Hypotension often occurs on induction of anaesthesia, typically attributed to hypovolaemia and the haemodynamic effects of anaesthetic agents. We assessed the efficacy of fluid optimisation for reducing the incidence of hypotension on induction of anaesthesia. This prospective trial enrolled 283 patients undergoing radical cystectomy and randomly allocated them to goal-directed fluid therapy (n = 142) or standard fluid therapy (n = 141). Goal-directed fluid therapy patients received fluid optimisation based on stroke volume response to passive leg raise before induction; those with positive passive leg raise received intravenous crystalloid fluid boluses until stroke volume was optimised. Baseline mean arterial pressure was measured on the morning of surgery and on arriving in the operating theatre. This post-hoc analysis defined haemodynamic instability as either a > 30% relative drop in mean arterial pressure compared with baseline or absolute mean arterial pressure < 55 mmHg, within 15 min of induction. Forty-two (30%) goal-directed fluid therapy patients underwent fluid optimisation after finding an intravascular fluid deficit via passive leg raise testing; 106 (75%) goal-directed fluid therapy and 112 (79%) standard fluid therapy patients met criteria for haemodynamic instability. There was no significant difference in the incidence of haemodynamic instability between the goal-directed fluid therapy and standard fluid therapy groups using absolute mean arterial pressure drop below 55 mmHg (p = 0.58) or using pre-surgical testing or pre-surgical mean arterial pressure values as baseline (p = 0.21, p = 0.89, respectively); however, the difference in the incidence of haemodynamic instability was significant using the operating theatre baseline mean arterial pressure (p = 0.004). We conclude that fluid optimisation before induction of general anaesthesia did not significantly impact haemodynamic instability.

Background: Total knee arthroplasty (TKA) is associated with moderate-to-severe postoperative pain despite multimodal opioid-sparing analgesia. Pain catastrophising or preoperative opioid therapy is associated with increased postoperative pain. Preoperative glucocorticoid improves pain after TKA, but dose-finding studies and benefit in high pain responders are lacking. Methods: A randomised double-blind controlled trial with preoperative high-dose intravenous dexamethasone 1 mg kg−1 or intermediate-dose dexamethasone 0.3 mg kg−1 in 88 patients undergoing TKA with preoperative pain catastrophising score >20 or regular opioid use was designed. The primary outcome was the proportion of patients experiencing moderate-to-severe pain (VAS >30) during a 5 m walk 24 h postoperatively. Secondary outcomes included pain at rest during nights and at passive leg raise, C-reactive protein, opioid use, quality of sleep, Quality of Recovery-15 and Opioid-Related Symptom Distress Scale, readmission, and complications. Results: Moderate-to-severe pain when walking 24 h postoperatively was reduced (high dose vs intermediate dose, 49% vs 79%; P−1 i.v., dexamethasone 1 mg kg−1 reduced moderate-to-severe pain 24 h after TKA and improved recovery in high pain responders without apparent side-effects. Clinical trial registration: NCT03763734.

Introduction: Blind fascia iliaca compartment block (FICB) and ultrasound guided femoral nerve block (FNB) are two types of peripheral nerve blocks, commonly used in preoperative pain management in patients with hip fractures in Danish emergency departments. The aim of this study was to compare the efficacy in pain management of these two types of peripheral nerve blocks in the preoperative period in patients with hip fractures. Method: We performed a randomized controlled study. The primary outcome was the proportion of patients with a numeric rating scale (NRS) pain score equal to three or less at rest and after passive leg raise test three hours after block administration. Results: A total of 88 patients were included in the study and 67 patients in the statistical analysis with 33 in the FICB group and 34 in the FNB group. The results showed a significant reduction in the proportion of patients with an NRS score higher than three, three hours after administration of either FICB or FNB compared to at inclusion. There was no significant difference in pain scores between patients receiving FICB versus patients receiving FNB at rest or after passive leg raise (p = 0.25 and p = 0.86, respectively). Conclusion: Blind FICB and ultrasound guided FNB were effective in preoperative pain management in patients with hip fractures. The results showed that the two types of peripheral nerve blocks were equally efficient in providing pain management in the preoperative period.

Background. Exhaled carbon dioxide (CO2) reflects cardiac output (CO) provided stable ventilation and metabolism. Detecting CO changes may help distinguish hypovolemia or cardiac dysfunction from other causes of haemodynamic instability. We investigated whether CO2 measured as end-tidal concentration (EtCO2) and eliminated volume per breath (VtCO2) reflect sudden changes in cardiac output (CO). Methods. We measured changes in CO, VtCO2, and EtCO2 during right ventricular pacing and passive leg raise in 33 ventilated patients after open heart surgery. CO was measured with oesophageal Doppler. Results. During right ventricular pacing, CO was reduced by 21% (CI 18–24; p<0.001), VtCO2 by 11% (CI 7.9–13; p<0.001), and EtCO2 by 4.9% (CI 3.6–6.1; p<0.001). During passive leg raise, CO increased by 21% (CI 17–24; p<0.001), VtCO2 by 10% (CI 7.8–12; p<0.001), and EtCO2 by 4.2% (CI 3.2–5.1; p<0.001). Changes in VtCO2 were significantly larger than changes in EtCO2 (ventricular pacing: 11% vs. 4.9% (p<0.001); passive leg raise: 10% vs. 4.2% (p<0.001)). Relative changes in CO correlated with changes in VtCO2 (ρ=0.53; p=0.002) and EtCO2 (ρ=0.47; p=0.006) only during reductions in CO. When dichotomising CO changes at 15%, only EtCO2 detected a CO change as judged by area under the receiver operating characteristic curve. Conclusion. VtCO2 and EtCO2 reflected reductions in cardiac output, although correlations were modest. The changes in VtCO2 were larger than the changes in EtCO2, but only EtCO2 detected CO reduction as judged by receiver operating characteristic curves. The predictive ability of EtCO2 in this setting was fair. This trial is registered with NCT02070861.

Mechanical Low Back Pain (LBP) is the result of poor posture which causes mechanical stress on the lower back. Data from Sanglah General Hospital in 2010 stated that of the 249 outpatient LBP patients, 26% -37% had a tendency to relapse, and 11% -12% had disabilities. LBP does not only have an impact on health, especially on musculoskeletal injuries, but it can give an impact on work and work productivity which it can have an impact on patient finances. Effective treatment for LBP can be a solution to patient complaints. Physiotherapists can provide treatments such as Ultrasound, Mulligan Bent Leg and Back Massage. This study was purpose to compare the effectiveness of the combination of Back Massage and Ultrasound with Mulligan Bent Leg Raise and Ultrasound in reducing pain and disability due to Mechanical LBP. The research method used was experimental randomized pre-test and post-test control group design. The results of this study were back massage intervention with ultrasound (p

Background. Regular physical activity plays an important role in the treatment of patients with cystic fibrosis (CF). This study is aimed at investigating the effects of a 12-month partially supervised exercise program on attributes of health-related and motor performance fitness, lung function (ppFEV1), BMI, and habitual physical activity (HPA, steps/day) in adults with CF. Methods. Attributes of health-related and motor performance fitness were examined at the beginning (T0), after 6 (T1), and 12 months (T2) on the basis of five test items: forward bend (FB), bent knee hip extension (HE), plank leg raise (PLR), standing long jump (SLJ), and standing on one leg (OLS). Additionally, we recorded HPA by accelerometry, peak exercise performance ( W peak ) by an incremental cycle test, ppFEV1, and BMI. During the first six months, there was close supervision by an experienced sport therapist. Results. 26 CF patients (8 female, mean age 26.5 ± 7.9 years; ppFEV1 53.7 ± 21.0 ) completed the exercise program. Significant improvements were recorded from T0 to T1 (FB: p ≤ 0.05 ; PLR, OLS: p ≤ 0.01 ) and from T0 to T2 (FB, PLR: p ≤ 0.01 and HE, OLS: p ≤ 0.05 ). W peak , ppFEV1, BMI, and HPA showed no significant improvement between the single test points and over the entire study period (all p > 0.05 ). Conclusion. Our results show trainability of adults with CF in aspects of health-related and motor performance fitness during a partially supervised exercise program. Close supervision positively influences the results. Using a simple test setup seems to be a promising tool for evaluating the effects of exercise programs in CF and could serve as an additional outcome parameter in future clinical trials. Trial registration: ClinicalTrials.gov (retrospectively registered May 8, 2018).

Objective: To compare the effectiveness of bent leg raise technique and neurodynamics in patients with low back pain that radiates up to the knee. Methods: The pre-test post-test control group study was conducted at Department of Physical therapy, Maqsood Medical Complex and General Hospital Peshawar from February to July 2019. Patients with radiating low back pain of both genders aged 18-60 years were included in the study. Patients were divided into Group-A and Group-B. Group-A patients received Mulligan bent leg raise technique while Group-B patients received neurodynamics. Both groups received five sessions per week, for four weeks. Numeric pain rating scale, Oswestry disability index and goniometer was used to assess pain, functional disability and straight leg raise range before and after the interventions. Data was analyzed using SPSS version 20. Results: Thirty-two participants with mean age of 38.81±9.94 years, participated in the study. There were no significant differences (P-value >0.05) between the two groups at baseline. Post-treatment, within Group-Analysis showed that all three variables (pain, functional disability and straight leg raise range) significantly (P0.05) between the two groups. Conclusion: Both neurodynamics and bent leg raise technique significantly improved pain, functional disability and straight leg raise range in patients with low back pain that radiates up to the knee. However, there were no significant differences between the groups who received either neurodynamics or bent leg raise technique. doi: https://doi.org/10.12669/pjms.38.1.4010 How to cite this:Adnan M, Arsh A, Ali B, Ahmad S. Effectiveness of bent leg raise technique and neurodynamics in patients with radiating low back pain. Pak J Med Sci. 2022;38(1):47-51. doi: https://doi.org/10.12669/pjms.38.1.4010 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Background Heart failure with preserved ejection fraction (HFpEF) is a frequent and disabling disease, but can be difficult to diagnose. Due to limited sensitivity of non-invasive evaluation of left ventricular (LV) diastolic dysfunction, invasive measurement may be warranted. The gold standard for diagnosing HFpEF is invasive measurement of LV end-diastolic pressure or its surrogate pulmonary capillary wedge pressure (PCWP). In case of normal LV filling pressures at rest (PCWP@rest Purpose To assess the diagnostic value of PCWP@legraise during right heart catheterization for HFpEF. Methods We reviewed all consecutive patients who received a diagnostic right heart catheterization with PCWP-measurements at rest, passive leg raise and during exercise (minimally >40% peak VO2) between 2017 and 2020 in a tertiary medical center (n=124). Zero reference point was defined mid-thorax. PCWP was measured end-expiratory mid A-wave. Patients with insufficient data (n=17), uninterpretable tracings (n=13) or PCWP@rest >16 mmHg were excluded (n=19). The diagnostic value of PCWP@legraise was compared to the gold standard for HFpEF (PCWP@exercise). Results We analyzed 75 patients, with a mean age of 58 (±16) years, female (60%), mean BMI 27.8 (±5.5). HFpEF was diagnosed in 47% of the cases, non-HFpEF existed of pulmonary arterial hypertension (23%), chronic thrombo-embolic disease (15%) or other (15%). Figure 1A shows PCWP@rest, PCWP@legraise, PCWP@exercise for HFpEF and non-HFpEF. The diagnostic performance of PCWP@legraise was higher than PCWP@rest (Figure 1B; AUC 0.83 vs 0.75). PCWP@legraise ≥22 mmHg had a specificity of 100% and a positive predictive value of 100% for diagnosing HFpEF and could be used as a cut-off for diagnosing HFpEF. PCWP@legraise of ≥13 mmHg had a sensitivity of 98% and a negative predictive value of 93%, and could be used as a cut-off for excluding HFpEF. If these cut-offs were used to refute or diagnose HFpEF, 17 patients (23%) could have been differed from exercise during right heart catheterization. The change in PCWP due to passive leg raise was of lower diagnostic value than the absolute value of PCWP@legraise. Conclusion In our cohort, the leg raise maneuver is of diagnostic value. With the proposed PCWP@legraise criteria for HFpEF - validated against the gold standard (PCWP@exercise) - the exercise could have been omitted in almost a quarter of the cases. More (external) validation is warranted. Figure 1 Funding Acknowledgement Type of funding source: None

Background Exercise-induced elevation of pulmonary arterial wedge pressure (PAWP) may show preclinical or exercise-induced left ventricular diastolic dysfunction. Invasive hemodynamic assessment during provocative maneuvers, like exercise and volume challenge, in these patients allows greater sensitivity to diagnose or exclude HFpEF. The aim of this study was to examine how the leg raise, which is a simple way to increase preload, can detect exercise-induced PAWP elevation. Methods Four hundred seventy-nine patients (60±14y.o, mean pulmonary arterial pressure (PAP) 19mmHg, PAWP 8mmHg, CTEPH /IPAH/CTD-PH/SOB unknown reason: 357/56/38/28pts) with near-normal PAP and normal PAWP at rest underwent symptom-limited exercise test using supine cycle ergometer with right heart catheter. Exercise-induced elevation in PAWP of over 20mmHg was defined as exercise-induced elevation group. Results ΔPAWP (after leg raise - rest) in the exercise-induced elevation group was significantly higher (6.0±4.1 vs. 2.7±3.9mmHg, p Conclusion Leg raise can easily detect occult left ventricular diastolic dysfunction. Funding Acknowledgement Type of funding source: None

Rectus abdominis diastasis is regarded as a risk factor for abdominal muscle dysfunction and reduced quality of life postpartum. It is thought that specific exercises and additional physical support might reduce the diastasis, with a need to establish efficacy in doing so.Determine the effect of four abdominal exercises as well as Tubigrip or taping in reducing rectus abdominis diastases three weeks postpartum.Cross-sectional repeated measures comparison.32 women undertook a single session of ultrasound imaging. Ultrasound measurements of inter-rectus distance were taken at rest and during: 1) crook lying abdominal "drawing in" exercise; 2) crook lying trunk curl-up; 3) early Sahrmann level leg raise; 4) McGill side lying plank. The curl-up and abdominal "drawing in" exercises were assessed under two further conditions: a) wearing Tubigrip, b) taping across the diastasis. Data analyses involved repeated measures ANOVA.At rest the mean inter-rectus distance above and below the umbilicus was 3.5 cm (SD:1.1) and 2.6 cm (SD:1.2) respectively. A significant decrease (19%, p 0.05) was observed at both measurement points during the curl-up exercise. No other exercises elicited a significant difference compared to resting. At rest, wearing Tubigrip reduced the inter-rectus distance (7%, p 0.05). During exercise, there was no additional change in the inter-rectus distance (p 0.05) with supports.The curl-up exercise was most effective in reducing inter-rectus distance. As no exercises invoked an increase in the rectus diastasis, they could not be regarded as potentially detrimental. Tubigrip and taping did not add to the effects of these exercises.

Background: Study is to compare the effectiveness of Jack knife stretching and Proprioceptive Neuromuscular Facilitation (PNF) stretching Technique in asymptomatic individuals with hamstring tightness. Aims and Objectives : 1. To study the effect of jack-knife stretching on the individuals with asymptomatic hamstring tightness in terms of Active knee extension test, finger to floor, passive SLR and LEFS Questionnaire.2.To Study the effect of PNF stretching on individuals with asymptomatic hamstring tightness. 3.To compare the effect of Jack knife and PNF stretching in individuals with hamstring tightness. Material and Method: Ethical approval was obtained. 56 healthy subjects were assigned into two groups. PNF (hold relax) stretching technique was given to the Group A and Group B received Jack Knife stretching. Active knee extension test, Finger to floor test, Passive single leg raise test and Lower extremity functional scale these parameters were measured . Results: Intra-group comparison for all the outcome measures in both the groups showed statistical significance. Inter-group comparison for all the outcome measures for both the groups had differences but showed statistical significance. Group B Jack knife stretching was more effective than group A PNF (hold relax) stretching. Conclusion: The present study results indicate that to increase hamstring flexibility both the treatment techniques i.e PNF stretching and jack knife stretching are effective in asymptomatic individuals with hamstring tightness. Thus, our study shows jack knife stretching gives immediate effect due to closed pack position of stretching compared to open pack position of PNF group

BACKGROUND: Determination of fluid responsiveness (FR) associated with intravascular fluid resuscitation in hypotensive patients poses a challenge, with current best evidence methods fraught with poor retest reliability and difficulty in image acquisition (Osman, Crit Care Med 2007; 35: 64; Marik, Crit Care Med 2009; 37: 2642). Doppler carotid blood flow with passive leg raise (PLR) is a recent modality for determining FR (Marik, Chest 2013; 143: 364). PURPOSE: This study aimed to determine whether emergency physicians with limited ultrasound experience can reliably acquire this skill. METHOD: This prospective study recruited 60 emergency physicians with varying experience, who underwent a 3‐step learning programme. Participants performed carotid velocity time integral (VTi) Doppler on healthy subjects, followed by repeat measurements in the PLR position. A 16‐point checklist and time recorded were assessed for each sonographer, with each participant completing a post‐study questionnaire to evaluate perceived competence and ease of skill acquisition. RESULTS: Of the 60 emergency physicians recruited, 37 (61.6%) were inexperienced and 23 (38.4%) were experienced. Against the 16‐point assessment, 61% completed assessment without any errors. Fifty‐six out of 60 (94.3%) completed the assessment to acceptable standard with errors recognised and corrected, and four participants (6.7%) made critical errors without correction (Figure 1). Average (±SEM) total scan time was 4:52 ± 0:19, with no significant difference found between inexperienced and experienced groups. CONCLUSIONS: This study demonstrated feasibility to train emergency physicians, demonstrating that average FR assessment was obtained within 5 min, with no difference between prior experience in scan quality/time taken. 94% completed the scan to acceptable standards, demonstrating ease of carotid Doppler flow with PLR to provide critical information in management of the hypotensive patient.

OBJECTIVES:Adequate assessment of fluid responsiveness in shock necessitates correct interpretation of hemodynamic changes induced by preload challenge. This study evaluates the accuracy of point-of-care Doppler ultrasound assessment of the change in carotid corrected flow time induced by a passive leg raise maneuver as a predictor of fluid responsiveness. Noninvasive cardiac output monitoring (NICOM, Cheetah Medical, Newton Center, MA) system based on a bioreactance method was used. DESIGN:Prospective, noninterventional study. SETTING:ICU at a large academic center. PATIENTS:Patients with new, undifferentiated shock, and vasopressor requirements despite fluid resuscitation were included. Patients with significant cardiac disease and conditions that precluded adequate passive leg raising were excluded. INTERVENTIONS:Carotid corrected flow time was measured via ultrasound before and after a passive leg raise maneuver. Predicted fluid responsiveness was defined as greater than 10% increase in stroke volume on noninvasive cardiac output monitoring following passive leg raise. Images and measurements were reanalyzed by a second, blinded physician. The accuracy of change in carotid corrected flow time to predict fluid responsiveness was evaluated using receiver operating characteristic analysis. MEASUREMENTS AND MAIN RESULTS:Seventy-seven subjects were enrolled with 54 (70.1%) classified as fluid responders by noninvasive cardiac output monitoring. The average change in carotid corrected flow time after passive leg raise for fluid responders was 14.1 ± 18.7 ms versus -4.0 ± 8 ms for nonresponders (p < 0.001). Receiver operating characteristic analysis demonstrated that change in carotid corrected flow time is an accurate predictor of fluid responsiveness status (area under the curve, 0.88; 95% CI, 0.80-0.96) and a 7 ms increase in carotid corrected flow time post passive leg raise was shown to have a 97% positive predictive value and 82% accuracy in detecting fluid responsiveness using noninvasive cardiac output monitoring as a reference standard. Mechanical ventilation, respiratory rate, and high positive end-expiratory pressure had no significant impact on test performance. Post hoc blinded evaluation of bedside acquired measurements demonstrated agreement between evaluators. CONCLUSIONS:Change in carotid corrected flow time can predict fluid responsiveness status after a passive leg raise maneuver. Using point-of-care ultrasound to assess change in carotid corrected flow time is an acceptable and reproducible method for noninvasive identification of fluid responsiveness in critically ill patients with undifferentiated shock.

Objectives The aim of this study was to investigate the value of bedside echocardiography with a passive leg raise as a noninvasive marker of volume responsiveness. Methods This work was a prospective observational study of patients with end-stage renal disease presenting to the emergency department. The left ventricular outflow tract (LVOT) velocity time integral (VTI) was obtained. Measurements before and after dialysis as well as before and after the passive leg raise were recorded. Results Fifty-four patients were enrolled, in whom the mean volume of fluid removed ± SD was 3.89 ± 0.91 L. In the predialysis cohort, the mean LVOT VTI was 28.05 cm (95% confidence interval [CI], 26.55-29.55 cm). After the passive leg raise, the mean VTI was 28.52 cm (95% CI, 26.98-30.07 cm). In the postdialysis cohort, the mean VTI was 30.31 cm (95% CI, 28.92-31.69 cm), and it increased to 34.91 cm (95% CI, 33.11-36.72 cm) after the passive leg raise. The Δ VTI values were 1.83% (95% CI, 0.12%-3.55%) in the predialysis group and 15.05% (95% CI, 12.76%-17.34%) in the postdialysis cohort. When stratified by fluid removal, the mean Δ VTI values after hemodialysis were 12.64% (95% CI, 9.79%-15.49%) and 16.84% (95% CI, 13.47%-20.22%) for patients who had less than 4 L and 4 L or greater removed, respectively. In patients without congestive heart failure, the Δ VTI was 15.28% (95% CI, 12.25%-18.32%), whereas for those with congestive heart failure, the mean change was 14.63% (95% CI, 10.91%-18.35%). Conclusions The LVOT VTI in conjunction with a passive leg raise seems to correlate with the volume status and volume responsiveness.

Çalışmamızın amacı hamstring kası kısalığına mulligan bent leg raise (BLR) tekniği ve kinezyoteyp (KT) uygulamasının anlık ve 24 saatlik etkisini ve belirlemektir. Çalışmaya hamstring kısalığı olan 54 kişi katılmış ve randomize olarak iki gruba ayrılmıştır. (grup 1= BLR grubu, grup 2= KT grubu). Hamstring kısalığını değerlendirmek amacıyla otur-uzan testi yapılmış ve aktif diz ekstensiyon derecesi halo gonyometre ile ölçülmüştür. Değerlendirmeler uygulamadan önce, 30 dakika sonra ve 24 saat sonra yapılmıştır. Değerlendirmelerin analizi sonucunda her iki grupta da otur- uzan testi ve aktif diz ekstensiyon derecesinde anlamlı artış gözlenmiştir (p=0,000). Gruplar kendi aralarında karşılaştırıldığında, otur- uzan testinde 30 dakika sonra yapılan ölçümlerde BLR tekniğinin (p=0,010); 24 saat sonra yapılan ölçümlerde ise KT uygulamasının (0.032) etkinliğinin istatistiksel olarak daha anlamlı olduğu bulunmuştur. Aktif diz ekstensiyon derecesinde ise 30 dakika sonra yapılan ölçümlerde BLR tekniğinin (0,00) etkinliği istatistiksel olarak daha anlamlı bulunmuştur. Diğer test parametrelerinde istatistiksel olarak anlamlı bir farklılık bulunmamıştır. Hem KT uygulaması hem de BLR tekniği hamstring kası esnekliğinin artırılmasında etkilidir. Hamstring kısalığına yönelik anlık etki istendiğinde BLR tekniğinin, daha uzun süreli etki istendiğinde ise KT uygulamasının daha etkili olduğu belirlenmiştir.

Normalizing to a reference signal is essential when analysing and comparing electromyography signals across or within individuals. However, studies have shown that MVC testing may not be as reliable in persons with acute and chronic pain.The purpose of this study was to compare the test-retest reliability of the muscle activity in the biceps femoris and gluteus maximus between a novel sub-MVC and standard MVC protocols.This study utilized a single individual repeated measures design with 12 participants performing multiple trials of both the sub-MVC and MVC tasks on two separate days. The participant position in the prone leg raise task was standardised with an ultrasonic sensor to improve task precession between trials/days. Day-to-day and trial-to-trial reliability of the maximal muscle activity was examined using ICC and SEM.Day-to-day and trial-to-trial reliability of the EMG activity in the BF and GM were high (0.70-0.89) to very high (≥0.90) for both test procedures. %SEM was5-10% for both tests on a given day but higher in the day-to-day comparisons. The lower amplitude of the sub-MVC is a likely contributor to increased %SEM (8-13%) in the day-to-day comparison.The findings show that the sub-MVC modified prone double leg raise results in GM and BF EMG measures similar in reliability and precision to the standard MVC tasks. Therefore, the modified prone double leg raise may be a useful substitute for traditional MVC testing for normalizing EMG signals of the BF and GM.

[Purpose] Most of rehabilitation programmes for Anterior Cruciate Ligament (ACL) injury focus on quadriceps-hamstrings activation imbalances and less is known about kinetically linked muscles. This study investigated electromyographic activity of selected trunk, core, and thigh muscles during common rehabilitation exercises for ACL injury. [Subjects and Methods] Twelve active female volunteers participated in this cross-sectional laboratory study. Surface EMG was used to compare activation of eight trunk, hip/core, and lower limb muscles: Erector Spinae (ES), Rectus Abdominis (RA), Gluteus Maximus (GM), Vastus Lateralis (VL), Rectus Femoris (RF), Vastus Medialis (VM), Biceps Femoris (BF), and Semitendinosus (ST) during Forward Lunge, Double Leg Raise, Glute Bridge, Sit-Up, and Squat. [Results] Forward lunge produced significantly higher activation in the VM (61.1 ± 19.4), VL (59.2 ± 12.9), and RF (32.0 ± 2.6). Double leg raise generated highest activity in the RF (26.6 ± 2.8) and RA (43.3 ± 4.4); and Glute Bridge in the GM (44.5 ± 19.0) and BF (22.4 ± 4.3). Sit-up produced the highest activation in the RF (36.6 ± 4.7) followed by RA (18.9 ± 3.8). Squat produced a higher activation in VL (55.0 ± 12.9), VM (51.5 ± 18.2), and ES (40.4 ± 18.3). [Conclusion] This study provide further evidence for developing training programmes for ACL injury prevention and rehabilitation. A combination of exercises to reinstate quadriceps-hamstrings activation balance and enhance core stability is recommended.

The pulse amplitude ratio, the ratio of pulse pressure at the end of a Valsalva maneuver to before the onset of Valsalva, correlates with filling pressure. This study aimed to noninvasively estimate cardiac filling pressure in patients with heart failure. We developed a noninvasive handheld device to measure pulse amplitude ratio using finger photoplethysmography. In 69 patients who underwent right heart catheterization, photoplethysmography waveforms were recorded during a standardized Valsalva maneuver, and in 60 of these patients, pulse amplitude ratio was able to be calculated. Pulse amplitude ratio correlated with pulmonary capillary wedge pressure (PCWP) (r = 0.58, p 15 mm Hg was statistically significant (p 15 mm Hg with 73% sensitivity and 77% specificity. Pulse amplitude ratio also increased by an average of 0.03 with a leg raise maneuver (p = 0.05, n = 36). In conclusion, we demonstrate that noninvasively measured response to the Valsalva maneuver in patients with HF can estimate PCWP and also detect changes within a single patient.

Objective Assessment of Corrected Flow Time (FTc) in carotid artery has been suggested recently as a measure of intravascular volume status. This study aimed to determine the reference values of FTc in carotid artery in a normal population. Methods A total number of 142 healthy volunteers (73 females and 69 males) with a mean age of 36.65 ± 10.52 years were included. Results The mean FTc in carotid artery was 325.18 ± 22.15 ms0.5. The mean value of FTc differed significantly between females and males both before and after passive leg raise (PLR) (330.18 ± 21.61 ms0.5 vs. 319.88 ± 21.62, P = 0.005 before PLR, and 336.89 ± 22.95 ms0.5 vs. 326.51 ± 21.21, P = 0.006 after PLR). Conclusion This study would potentially pave the way to determine clinically significant cutoff points in order to assess the diagnostic accuracy of FTc in predicting intravascular volume status and fluid therapy responsiveness.

Rationale: Assessment of fluid responsiveness relies on dynamic echocardiographic parameters that have not yet been compared in large cohorts.Objectives: To determine the diagnostic accuracy of dynamic parameters used to predict fluid responsiveness in ventilated patients with a circulatory failure of any cause.Methods: In this multicenter prospective study, respiratory variations of superior vena cava diameter (∆SVC) measured using transesophageal echocardiography, of inferior vena cava diameter (∆IVC) measured using transthoracic echocardiography, of the maximal Doppler velocity in left ventricular outflow tract (∆VmaxAo) measured using either approach, and pulse pressure variations (∆PP) were recorded with the patient in the semirecumbent position. In each patient, a passive leg raise was performed and an increase of aortic velocity time integral greater than or equal to 10% defined fluid responsiveness.Measurements and Main Results: Among 540 patients (379 men; age, 65 ± 13 yr; Simplified Acute Physio...

Various stretching technique have been used to improve muscle flexibility in rehabilitation and sports .Mechanisms involving the efficacy of a stretching technique were studied and certain conclusions indicate one technique better than the other. The aim of the present study was to measure hamstring flexibility after giving Myofacial Release Technique (MFR) and Mulligan Bent Leg Raise (BLR) and comparing the effects between the two techniques. A study was conducted among 30 asymptomatic physiotherapy students ranging from 18 – 25year of age with bilateral hamstring tightness and were randomized to one of the two groups- Myofacial Release Technique (n=15) and Bent Leg Raise Technique (n=15).Hamstring Flexibility was measured using Sit And Reach Test before the treatment after a week of treatment and follow up at the end of 2nd week. Analysis revealed that both Myofacial Release Technique and Mulligan Bent Leg Raise Technique has improved hamstring flexibility bilaterally, but Mulligan Bent Leg Raise Technique was more effective than Myofacial Release Technique as there was significant increase in flexibility after giving Mulligan Bent Leg Raise Technique.

Introduction: Preoperative fasting was long regarded as an important cause of fluid depletion, leading to hemodynamic instability during surgery should replenishment is not promptly instituted. Lately, this traditional point of view has been progressively challenged, and a growing number of authors now propose a more restrictive approach to fluid management, although doubt remains as to the true hemodynamic influence of preoperative fasting. Methods: We designed an observational, analytic, prospective, longitudinal study in which 31 ASA 1 and ASA 2 volunteers underwent an echocardiographic examination both before and after a fasting period of at least 6 hours (h). Data from both static and dynamic preload indices were obtained on both periods, and subsequently compared. Results: Static preload indices exhibited a markedly variable behaviour with fasting. Dynamic indices, however, were far more consistent with one another, all pointing in the same direction, i.e., evidencing no statistically significant change with the fasting period. We also analysed the reliability of dynamic indices to respond to known, intentional preload changes. Aortic velocity time integral (VTI) variation with the passive leg raise manoeuvre was the only variable that proved to be sensitive enough to consistently signal the presence of preload variation. Conclusion: Fasting does not appear to cause a change in preload of conscious volunteers nor does it significantly alter their position in the Frank–Starling curve, even with longer fasting times than usually recommended. Transaortic VTI variation with the passive leg raise manoeuvre is the most robust dynamic index (of those studied) to evaluate preload responsiveness in spontaneously breathing patients. Resumo: Introdução: O jejum no pré-operatório é há muito tempo considerado como uma importante causa de depleção de líquidos, levando à instabilidade hemodinâmica durante a cirurgia, caso a reposição não seja prontamente instituída. Recentemente, esse ponto de vista tradicional vem sendo progressivamente desafiado, e um número crescente de autores agora propõe uma abordagem mais restritiva para o controle de líquidos, embora permaneçam dúvidas quanto à verdadeira influência hemodinâmica do jejum no pré-operatório. Métodos: Estudo observacional, analítico, prospectivo e longitudinal, no qual 31 voluntários ASA I e II foram submetidos a exame ecocardiográfico antes e após um período de jejum de no mínimo 6 horas. Os dados dos índices de pré-carga tanto estáticos quanto dinâmicos foram obtidos em ambos os períodos e, subsequentemente, comparados. Resultados: Os índices estáticos de pré-carga mostraram um comportamento acentuadamente variável com o jejum. Os índices dinâmicos, entretanto, foram bem mais consistentes entre si, todos apontando na mesma direção; isto é, não evidenciando nenhuma alteração estatisticamente significativa com o período de jejum. Analisamos também a confiabilidade dos índices dinâmicos para responder a alterações pré-carga intencionais conhecidas. A variação da integral de velocidade-tempo (VTI) aórtica com a manobra de elevação passiva dos membros inferiores foi a única variável que mostrou sensibilidade suficiente para sinalizar de forma consistente a presença de variação na pré-carga. Conclusão: O jejum não pareceu causar uma alteração na pré-carga de voluntários conscientes nem alterou substancialmente a sua posição na curva de Frank-Starling, mesmo com tempos de jejum mais prolongados que o normalmente recomendado. A variação do VTI transaórtico com a manobra de elevação passiva dos membros inferiores foi o índice dinâmico mais robusto (dos estudados) para avaliar a capacidade de resposta a variações da pré-carga em pacientes respirando espontaneamente. Keywords: Fasting, Echocardiography, Fluid therapy, Hemodynamics, Palavras-chave: Jejum, Ecocardiografia, Fluidoterapia, Hemodinâmica

This paper proposes a method of developing a mobile application for an abdominal exercise machine. Currently, inexpensive exercise machines, which are sold internationally, do not give feedback to users about the workout they engage in. Therefore, it would be useful to develop an app that could monitor physical activity on low-cost exercise machines. An additional benefit of using smartphones is that the exercise data can be cast to larger TV screens and monitors. Leg raise and lower cycles, as well as the number of back raise and lower cycles, were determined from angles measured by smartphones equipped with accelerometers connected to the bars of an abdominal exercise machine. In addition, an Android application for abdominal exercise machines was created based on the method. The app allows users to monitor their abdominal exercises by setting parameters related to raising and lowering their legs and the backs of their bodies. The results of physical activity were displayed on a smartphone screen and spoken using Text to Speech technology.

Background: Nonspecific low backache is a pain, muscle tension, or stiffness localized between the costal margin and inferior gluteal folds, without sciatica. Only 10% of the cases have a specific cause. One of the risk factors is poor hamstring flexibility. Mulligan’s BLR and IASTM have shown to improve hamstring flexibility. No studies have compared both. Therefore the study was undertaken. Methods: 48 subjects, mean age 34.27 ± 5.30 were recruited. Group A (24 - 15 male and 9 female) received TENS, Mulligan’s BLR and conventional exercises. Group B (24 - 12 male and 12 female) received TENS, M2T for Hamstrings and conventional exercises. Outcome measures were taken pre-treatment session 1 and post-treatment session 6. Results: Pre and post mean the difference in group A [BLR] was 5.96 ± 0.95 for NPRS, 19.38 ±7.28 for Right AKET, 20.54 ± 6.78 for Left AKET, 2.07 ± 6.49 for Lumbar lordosis and 28.38 ± 9.73 for QBPDS. Pre and post mean the difference in group B [M2T] was 5.71 ± 1.20 for NPRS, 17.00 ± 6.94 for Right AKET, 15.75 ± 6.50 for Left AKET, 1.20 ± 4.76 for Lumbar lordosis and 26.42 ± 11.38 for QBPDS. The intragroup comparison was statistically significant, p = 0.0001 for all outcome measures. Intergroup comparison was statistically significant, p < 0.05 for Left AKET (p=0.0161). Conclusion: Interventions given were equally effective in reducing pain, improving hamstring flexibility, and reducing disability within the group but not between the groups except left AKET.

Background Anticipatory postural adjustments (APAs) occur in the trunk during tasks such as rapid limb movement and are impaired in individuals with musculoskeletal and neurological dysfunction. To understand APA impairment, it is important to first determine if APAs can be measured reliably and which characteristics of APAs are task-invariant. Research question What is the test-retest reliability of latency, amplitude and muscle activation patterns (synergies) of trunk APAs during arm-raise and leg-raise tasks, and to what extent are these APA characteristics invariant across tasks at the individual and group levels? Methods 15 young adults (mean age: 23.7 (±3.2) years) performed six trials of a rapid arm raise task in standing and a leg raise task in supine on two occasions. Latency, amplitude and coactivation of APAs in the erector spinae and external/internal oblique musculature were measured, and APA synergies were identified with principle components analysis. Test-retest reliability across the two sessions was calculated with intraclass correlation coefficients. Task-invariance was assessed at the individual level with correlation and at the group level with tests of equivalence. Results Most variables demonstrated acceptable test-retest reliability. Synergies and many features of APA activation varied across tasks, although at the individual level, motor performance time and amplitude of lumbar erector spinae activation were significantly correlated across tasks. Average pre-motor reaction time, external oblique latency, contralateral oblique amplitude and internal oblique coactivation were equivalent across tasks. Significance Characteristics of trunk muscle APAs quantified during a single task may not be representative of an anticipatory postural control strategy that generalizes across tasks. Therefore, APAs must be assessed during multiple tasks with varying biomechanical demands to adequately investigate mechanisms contributing to movement dysfunction. The reliability analysis in this study facilitates interpretation of group differences or changes in APA behavior in response to intervention for the selected tasks.

BACKGROUND Various forms of trunk exercise have been used for increasing abdominal strength. The plank exercise and bilateral leg raise exercise are one of these trunk exercises. However, there are few studies that compared the effects of these exercise variations. OBJECTIVE The present study aimed to investigate how effectively the trunk muscles during plank and bilateral leg raise exercises are activated. METHOD Surface electromyography responses of the rectus abdominis, internal oblique, and erector spinae muscles were investigated during the plank and bilateral leg raise exercise with different hip position. A total of 18 healthy, physically active female volunteers completed the normal plank exercise, plank exercise with placing the lower leg in a horizontal condition, bilateral leg raise exercise, and bilateral leg raise with lower leg as horizontal condition. RESULTS The horizontal condition caused significant increases in activity of the internal oblique muscles compared with the general condition (p< 0.05). The bilateral leg raise exercise showed significantly greater activation in the rectus abdominis compared to the plank exercise (p< 0.05). CONCLUSION The present study showed that the horizontal condition had the advantage of activating the internal oblique muscles, and the leg raise exercise is effective in strengthening global muscle such as the rectus abdominis.

The purpose of this study was to determine the relation between posturally increased intra-abdominal pressure and lower/upper esophageal sphincter pressure changes in patients with gastroesophageal reflux disease. We used high resolution manometry to measure pressure changes in lower and upper esophageal sphincter during bilateral leg rise. We also examined whether the rate of lower and upper esophageal sphincter pressure would increase during leg raise differentially in individuals with versus without normal resting pressure. Fifty eight patients with gastroesophageal reflux disease participated in the study. High resolution manometry was performed in relaxed supine position, then lower and upper esophageal sphincter pressure was measured. Finally, the subjects were instructed to keep their legs lifted while performing 90-degree flexion at the hips and knees and the pressure was measured again. Paired t-test and independent samples t-test were used. There was a significant increase in both lower (P 0.001) and upper esophageal sphincter pressure (P = 0.034) during leg raise compared to the initial resting position. Individuals with initially higher pressure in lower esophageal sphincter (10 mmHg) exhibited a greater pressure increase during leg raise than those with initially lower pressure (pressure ≤10 mmHg; P = 0.002). Similarly individuals with higher resting upper esophageal sphincter pressure (44 mmHg) showed a greater pressure increase during leg raise than those with lower resting pressure (≤44 mmHg; P 0.001). The results illustrate the influence of postural leg activities on intraesophageal pressure in patients with gastroesophageal reflux disease, indicating by means of high resolution manometry that diaphragmatic postural and sphincter function are likely interrelated in this population.

Low back ache (LBA) is a common musculoskeletal disorder sometimes associated with a positive limited Straight leg raise (SLR) test. Mulligan's bent leg raise (BLR) and Butler's neural tissue mobilization (NTM) are commonly used techniques for the treatment of low back ache where SLR is limited. The aim of this study was to evaluate the effect of both the techniques on pain and limited SLR in patients with LBA. Thirty one patients with LBA with radiculopathy were randomly allocated into 2 groups; BLR [n = 16] NTM [n = 15]. The outcome measures i.e. visual analogue scale (VAS) for pain and universal goniometer for measuring SLR range of motion (SROM) were assessed at the baseline, post intervention and after 24 h (follow up). Within group analysis using paired t-test revealed a significant difference between pre-treatment and post-treatment VAS and SROM score(p 0.05). However no difference was seen between pre-treatment and follow up (p 0.05). The study showed that both techniques produce immediate improvement in pain and SLR range but this effect was not maintained during the follow up period.

[Purpose] This study aimed to determine the effect of abdominal muscle activities and the activation ratio related to trunk stabilization to compare the effects between the abdominal drawing-in maneuver and lumbar stabilization exercises on an unstable base of support. [Subjects and Methods] Study subjects were 20 male and 10 female adults in their 20s without lumbar pain, who were equally and randomly assigned to either the abdominal drawing-in maneuver group and the lumbar stabilization exercise group. Abdominal muscle activation and ratio was measured using a wireless TeleMyo DTS during right leg raise exercises while sitting on a Swiss ball. [Results] Differences in rectus abdominis, external oblique abdominis, and internal oblique abdominis muscle activation were observed before and after treatment. Significant differences were observed between the groups in the muscle activation of the external oblique abdominis and internal oblique abdominis, and the muscle activation ratio of external oblique abdominis/rectus abdominis and internal oblique abdominis/rectus abdominis. [Conclusion] Consequently trunk stability exercise enhances internal oblique abdominis activity and increases trunk stabilization. In addition, the abdominal drawing-in maneuver facilitates the deep muscle more than LSE in abdominal muscle. Therefore, abdominal drawing-in maneuver is more effective than lumbar stabilization exercises in facilitating trunk stabilization.

The purpose of this study was to investigate the effect of Abdominal Enhancement (AE) on the muscle activation of vastus medialis obliquus (VMO), vastus lateralis (VL) and rectus femoris (RF) muscle activation levels during eccentric, isometric and concentric phases of single leg raise (SLR), single leg wall squat (SLWS) and forward lunge (FL) exercises. Sixteen healthy individuals (Age: 24.6 ± 1.7 years) were included in the study. Internal Obliques/Transversus Abdominis (IO/TA), VMO, RF and VL muscle activation levels were measured by surface EMG during the exercises in two conditions: with and without AE. The abdominal drawing-in technique was used for AE. Repeated-measures analysis of variance was performed for statistical analysis. With AE, the average of IO/TA muscle activation level was 28.9%. VMO and VL muscle activation levels were significantly greater with AE during SLR (p = .02), SLWS (p .001) and FL (VMO, p = .008, VL, p = .04) exercises. The effect of AE on VMO muscle activation level ranged from 2.5% to 5% (Effect size range: 0.54 to 0.91) and VL muscle activation level ranged from 2.1% to 5.5% (Effect size range: 0.35-1.24). RF muscle activation level did not change with AE (p .05). The results of this study showed that AE increased VMO and VL muscle activities during SLR, SLWS and FL exercises but the corresponding changes were small. Even if this is not enough for muscle strengthening, exercises with AE may be used to enhance knee joint stability while controlling lumbopelvic stability.

Purpose: Passive leg raise (PLR), in combination with technologies capable of capturing stroke volume changes, has been widely adopted in the management of shock. However, dedicated evaluation of safety, feasibility, and receptiveness of patients and nursing staff to PLR maneuver is missing. Methods: A noninterventional, prospective trial recruited adult patients with onset of undifferentiated shock within 24 hours with persistent vasopressor requirements despite fluid resuscitation. A standardized PLR maneuver was used to compare two noninvasive hemodynamic monitoring systems, each without significant impact on the performance of the maneuver. Safety and efficacy of the PLR were evaluated via subjective and objective measures. Objective measures of patient comfort and tolerance were evaluated through changes in vital signs, sedation, and analgesia requirements. Nurses and awake patients completed surveys on their experience. Results: Seventy-nine patients were enrolled. Testing was aborted in 2 cases for medical reasons (one patient developed rapid atrial fibrillation, second had profound desaturation). Of all, 5.4% of patients required additional vasopressor support after completion of the PLR maneuver due to persistent hypotension and 4.1% of patients required additional sedation. Among awake patients (N = 35), 6% reported pain and 29% reported discomfort. A total of 11% of nurses reported minor technical difficulties with the maneuver. Conclusion: Passive leg raise maneuver leads to a few serious but reversible complications in a selected population of hemodynamically unstable patients. Although it provides relevant diagnostic information, it may impact patient care. Treating physician should be aware of infrequent but possible complications and appreciate the impact of the maneuver on patients’ comfort and nursing workload.

Purpose of the current study was to compare early effectiveness of pain relieve of 3 in 1 regional pain catheter to local infiltration anesthesia (LIA) in primary total knee arthroplasty (TKA). Secondary endpoint was quadriceps muscle strength after both procedures. A single-center, prospective, randomized controlled trial was performed. Patients eligible to TKA were either randomized into group 3 in 1 regional pain catheter (C), or group local infiltration anesthesia (L). Pain relieve was assessed by visual analogue scale (VAS) at rest and under physical activity (PA) prior to surgery (t0) and at days one through six. In addition, quadriceps muscle strength ( = straight leg raise) was tested according to the Manual Muscle Testing Scale. Functional outcome was measured using the Oxford Knee Score (OKS) preoperatively and 6 months postoperatively. 121 patients were included in the study. 59 (48.8%) patients were allocated to group C, 62 (51.2%) patients to Group L. No differences concerning pain level evaluated by VAS could be detected between the groups at any time. Comparing straight leg raise test group L was significantly superior over the complete postoperative period (p