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Patricia Palomo-López,1 Ricardo Becerro-de-Bengoa-Vallejo,2 Marta Elena Losa-Iglesias,3 David Rodríguez-Sanz,4 César Calvo-Lobo,5 Daniel López-López6 1Department of Nursing, University Center of Plasencia, Universidad de Extremadura, Spain; 2School of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Spain; 3Faculty of Health Sciences, Universidad Rey Juan Carlos, Spain; 4Physiotherapy Department, Faculty of Health, Exercise and Sport, European University of Madrid, Villaviciosa de Odón, Madrid, Spain; 5Nursing and Physical Therapy Department, Faculty of Health Sciences, University of León, Ponferrada, León, Spain; 6Research, Health and Podiatry Unit, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, Spain Background and purpose: Plantar fasciitis (PF) is a foot disorder in adults secondary to an inflammatory response caused by repetitive micro-trauma. We evaluated and compared the impact on quality of life (QoL) related to foot health and general health between males and females with PF. Methods: In this cross-sectional descriptive study, patients with PF were recruited from a podiatry clinic. Physical examination, sociodemographic data, and the self-reported Foot Health Status Questionnaire (FHSQ) were recorded. The FHSQ has three sections and provides two composite scores from 0 to 100. Higher scores (close to 100) reflect better QoL related to foot health and health in general; lower scores (close to 0) denote a worse QoL related to these health items. Results: One hundred patients (49 males [42.38 ± 14.065 years old] and 51 females [43.90 ± 14.305 years old]) were recruited. Section one of the FHSQ evaluates four foot domains, and significant differences (P0.05). Section two assesses four domains of general wellbeing, and significant differences (P

Daniel López-López,1 María Martínez-Vázquez,1 Marta Elena Losa-Iglesias,2 César Calvo-Lobo,3 David Rodríguez-Sanz,4 Patricia Palomo-López,5 Ricardo Becerro-de-Bengoa-Vallejo6 1Research, Health and Podiatry Unit, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, Ferrol, Spain; 2Faculty of Health Sciences, Universidad Rey Juan Carlos, Madrid, Spain; 3Nursing and Physical Therapy Department, Institute of Biomedicine (IBIOMED), Universidad de León, Ponferrada, León, Spain; 4School of Sports Science, European University, Villaviciosa de Odón, Madrid, Spain; 5University Center of Plasencia, Universidad de Extremadura, Extremadura, Spain; 6School of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid, Spain Purpose: The aim of this study was to compare the health-related quality of life impact related to foot health and health in general in older adults with lesser toe deformities (LTD) and without any foot conditions. Methods: A case–control observational study was carried out following the Strengthening the Reporting of Observational Studies in Epidemiology criteria. A total of 100 older adults with a mean age of 74.39±6.02 years were recruited at an outpatient clinic; 50 of these subjects had LTD (case group) and 50 subjects were without any foot conditions (control group). Presence of LTD was determined in both feet using the Kelikian push-up test, and the Foot Health Status Questionnaire scores were self-reported.Results: The case group showed lower scores in quality of life in relation to health in general and to foot health specifically. Statistically significant differences (p

Patricia Palomo-López,1 David Rodríguez-Sanz,2 Ricardo Becerro-de-Bengoa-Vallejo,3 Marta Elena Losa-Iglesias,4 Jorge Guerrero-Martín,5 Cesar Calvo-Lobo,6 Daniel López-López7 1Department of Nursing, University Center of Plasencia, University of Extremadura, 2Department of Physical Therapy and Podiatry, Physical Therapy and Health Sciences, Research Group, Universidad Europea de Madrid, Madrid, 3School of Nursing, Physiotherapy and Podiatry, University Complutense of Madrid, 4Faculty of Health Sciences, University Rey Juan Carlos, 5Department of Nursing, Faculty of Medicine, Badajoz. University of Extremadura, 6Nursing and Physical Therapy Department, Institute of Biomedicine (IBIOMED), Universidad de León, Ponferrada, León, 7Research, Health and Podiatry Unit, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, Spain Purpose: The aim of this study was to analyze and compare foot health and general health in a sample of women divided into two groups: 1) those with breast cancer and undergoing chemotherapy treatment and 2) healthy women without breast cancer and with normalized reference values.Methods: A case–control observational study was performed. Two-hundred women with a mean age of 51.00±8.75 years were recruited from podiatric medicine and surgery clinics from the University of Extremadura (Plasencia, Spain) and the Hospital Infanta Cristina (Badajoz, Spain). The women were divided into case and control groups (undergoing chemotherapy treatment and healthy women, respectively). The Foot Health Status Questionnaire was used to assess foot health domain scores.Results: Significant differences between both groups were seen for foot pain (P=0.003), foot function (P

Cesar Calvo-Lobo,1 Juan Manuel Vilar Fernández,2 Ricardo Becerro-de-Bengoa-Vallejo,3 Marta Elena Losa-Iglesias,4 David Rodríguez-Sanz,5 Patricia Palomo López,6 Daniel López López7 1Physical Therapy Department, Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimiento, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid; 2Modeling, Optimization and Statistical Inference Research Group, Universidade da Coruña, A Coruña; 3School of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid; 4Faculty of Health Sciences, Universidad Rey Juan Carlos, Madrid; 5Physical Therapy & Health Sciences Research Group, Facultad de Ciencias de la Salud, el Ejercicio y el Deporte, Universidad Europea de Madrid, Madrid; 6University Center of Plasencia, Universidad de Extremadura, Badajoz; 7Research, Health and Podiatry Unit, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, A Coruña, Spain Background and purpose: Nonspecific low back pain (LBP) is the most prevalent musculoskeletal condition in various age ranges and is associated with depression. The aim of this study was to determine the Beck Depression Inventory (BDI) scores in participants with nonspecific LBP and no-pain by age distribution.Methods: A case–control study was carried out following the Strengthening the Reporting of Observational Studies in Epidemiology criteria. A sample of 332 participants, divided into the following age categories: 19–24 (n=11), 25–39 (n=66), 40–64 (n=90), 65–79 (n=124), and ≥80 (n=41) years was recruited from domiciliary visits and an outpatient clinic. The BDI scores were self-reported in participants with nonspecific acute or subacute (≤3 months) LBP (n=166) and no-pain (n=166).Results: The BDI scores, mean ± standard deviation, showed statistically significant differences (p

Background: there is a high risk of falls in older adults. One of the factors contributing to fall episodes is advancing age due to deterioration of the proprioceptive system. Certain clinical procedures improve balance and posture, such as the use of insoles., Objective: the objective of this study was to evaluate the impact of hard and soft insoles on static foot balance in healthy older adults compared to barefoot people., Methods: a clinical trial was conducted with a sample size of 150 healthy adults (69 male and 81 women) with a mean age of 69.03 ± 3.82 years. Postural control was evaluated in different conditions of barefoot balance with hard and soft insoles., Results: All tests were statistically significant ( p < 0.001). The test with soft insoles presented higher stabilometric values and presented worse postural control compared to the barefoot and hard insoles in all eyes-open and eyes-closed conditions., Conclusions: Hard and soft insoles show no improvement in postural control compared to barefoot standing. The findings suggest that soft insoles may result in impaired balance during standing. The density of the materials in the insoles emerges as a significant factor influencing postural control.

Benefits of neural mobilization (NM) have been described in musculoskeletal patients. The effects of NM on balance appear to be unclear in research, and no studies have tested the possible effects of NM on plantar pressures. Eighteen subjects were evaluated pre and post bilateral gliding of the sciatic nerve and its branches posterior tibial nerve, lateral dorsocutaneous, medial and intermediate dorsocutaneous nerves. Static variables of the plantar footprint and stabilometric variables were measured in a pre-post study. We found no differences in plantar pressure variables, Rearfoot maximum pressure (p = 0.376), Rearfoot medium pressure (p = 0.106), Rearfoot surface (p = 0.896), Midfoot maximum pressure (p = 0.975), Midfoot medium pressure (p = 0.950), Midfoot surface (p = 0.470) Forefoot maximum pressure (p = 0.559), Forefoot medium pressure(p = 0.481), Forefoot surface (p = 0.234), and stabilometric variables either, X-Displacement eyes-open (p = 0.086), Y-Displacement eyes-open (p = 0.544), Surface eyes-open (p = 0.411), Medium speed latero-lateral displacement eyes-open (p = 0.613), Medium speed anteroposterior displacement eyes-open (p = 0.442), X Displacement eyes-closed (p = 0.126), Y-Displacement eyes-closed (p = 0.077), Surface eyes-closed (p = 0.502), Medium speed latero-lateral displacement eyes-closed (p = 0.956), Medium speed anteroposterior displacement eyes-closed (p = 0.349). All variables don´t have significant differences however the measurements had a high reliability with at least an ICC of 0.769. NM doesn´t change plantar pressures or improve balance in healthy non-athletes subjects. NCT05190900., (© 2024. The Author(s).)

Introduction: The aim of the present study was to determine the effectiveness of simultaneous bilateral visual diaphragm biofeedback (BFB) from ultrasonography in conjunction with inspiratory muscle training (IMT) on diaphragmatic thickness during normal breathing and respiratory and clinical outcomes in patients with non-specific low back pain (NSLBP) and determine the influence of age and sex. Methods: A single-blind randomized clinical trial was carried out (NCT04582812). A total sample of 96 patients with NSLBP was recruited and randomized by sex-based stratification into IMT ( n = 48) and BFB + IMT ( n = 48) interventions over 8 weeks. Bilateral diaphragmatic thickness at maximum inspiration (T ins ) and expiration (T exp ), respiratory pressures, lung function, pain intensity, bilateral pressure pain threshold (PPT), disability, and quality of life were measured at baseline and after 8 weeks. Results: The BFB + IMT group showed significant differences ( p < 0.05) with increased left hemidiaphragm thickness at T ins and T ins-exp ( d = 0.38-053), and right and left PPT ( d = 0.71-0.74) versus the IMT group. The interaction with sex was statistically significant ( p = 0.007; F (1,81) = 7.756; η p 2 = 0.087) and higher left hemidiaphragm thickness at T ins was predicted by the BFB + IMT group ( R 2 = 0.099; β = 0.050; F (1,82) = 8.997; p = 0.004) and male sex ( R 2 = 0.079; β = 0.045; F (1,81) = 7.756; p = 0.007). Furthermore, greater left hemidiaphragm thickness at T ins-exp was predicted by younger age ( R 2 = 0.052; β = -0.001; F (1,82) = 4.540; p = 0.036). Discussion: The simultaneous bilateral visual diaphragm biofeedback by ultrasonography in conjunction with IMT was effective in both increasing the left diaphragmatic thickness during inspiration, which was positively influenced and predicted by male sex and younger age, and increasing the bilateral PPT of the paraspinal muscles in patients with NSLBP., Competing Interests: The authors declare competing financial interests due to a patent registration carried out as a utility model for the bilateral thoracic orthosis, including both the right and left holding devices for two ultrasound probes, in the Spanish Patent and Trademark Office (Number of application: U202200045; Publication number: ES1288519; Issue Date: 30 March 2022)., (Copyright © 2024 Molina-Hernández, Rodríguez-Sanz, Chicharro, Becerro-de-Bengoa-Vallejo, Losa-Iglesias, Vicente-Campos, Marugán-Rubio, Gutiérrez-Torre and Calvo-Lobo.)

The aim of the present study was to determine the gender respiratory differences of bilateral diaphragm thickness, respiratory pressures, and pulmonary function in patients with low back pain (LBP). A sample of 90 participants with nonspecific LBP was recruited and matched paired by sex (45 women and 45 men). Respiratory outcomes included bilateral diaphragm thickness by ultrasonography, respiratory muscle strength by maximum inspiratory (MIP) and expiratory (MEP) pressures, and pulmonary function by forced expiratory volume during 1 s (FEV 1 ), forced vital capacity (FVC) and FEV 1 /FVC spirometry parameters. The comparison of respiratory outcomes presented significant differences ( p < 0.001), with a large effect size ( d = 1.26-1.58) showing means differences (95% CI) for MIP of -32.26 (-42.99, -21.53) cm H 2 O, MEP of -50.66 (-64.08, -37.25) cm H 2 O, FEV 1 of -0.92 (-1.18, -0.65) L, and FVC of -1.00 (-1.32, -0.69) L, with lower values for females versus males. Gender-based respiratory differences were presented for maximum respiratory pressures and pulmonary function in patients with nonspecific LBP. Women presented greater inspiratory and expiratory muscle weakness as well as worse lung function, although these differences were not linked to diaphragm thickness during normal breathing.

Background: COVID-19 demonstrated the possibility of neurological complications such as loss of sense of smell and taste, together with respiratory problems. Respiratory training and rehabilitation of neurological sequelae are essential to improve respiratory function and thus quality of life, and the aim of this study is to evaluate the efficacy of a pulmonary and neurological rehabilitation program., Objectives: To apply a treatment to reduce dyspnea, increase exertional capacity, increase vital capacity and respiratory muscle strength, together with an increase in olfactory and gustatory sensitivity in post-SARS-CoV-2 patients., Methods: A randomised controlled experimental study was conducted in 220 patients with a medical diagnosis of COVID-19 and more than 5 months of evolution, dyspnoea or perceived fatigue, including olfactory and gustatory perception problems, of whom 200 patients completed the study. 100 patients were randomly assigned to the intervention group, consisting of an inspiratory training treatment plan (Powerbreathe Plus®) combined with aerobic exercise and olfactory gustatory treatment for 31 days, and 100 patients to the control group, for 31 days without any type of therapy., Results: The study was conducted in post-Covid-19 patients for 5 months. Two hundred patients were divided into an intervention group ( n = 100) and a control group ( n = 100). The comparison between the groups showed significant differences in spirometric variables; forced vital capacity ( p < .001; Eta2 (0.439); Mean: 0,6135), the ratio between both FEV1/FVC ( p < 0.01; Eta2 (0.728); Mean:9,313), peak inspiratory pressure ( p < 0.01; Eta2 (0.906); Mean:4,526); changes were observed in dyspnoea measured with the modified Borg scale ( p < 0.01; Eta2 (0.811); Mean:1,481) and the modified Medical Research Council scale ( p < 0.01; Eta2 (0.881); Mean: 0.777); finally, changes were found in neurological variables, in the questions of the Singapore Smell and Taste Questionnaire, How was your sense of smell after treatment? ( p < 0.01; Eta2 (0.813); Mean: 1,721) and How is your sense of taste after treatment? ( p < 0.01; Eta2 (0.898); Mean: 1,088)., Conclusion: The implementation of a respiratory rehabilitation treatment plan with the Powerbreathe Plus® device, aerobic exercise and neurorehabilitation with olfactory and gustatory training, is a therapeutic option against respiratory and neurological sequelae in patients who have suffered such sequelae due to the SARS-CoV-2 virus. Clinicaltrials.gov: NCT05195099. First posted 18/01/2022; Last Update Posted 29/06/2022., 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.

Background: Therapeutic exercise (TE) recommendations for non-specific low back pain (LBP) are meant to support therapy choices for people who suffer from this condition. The aim of this study was to reach an agreement on the definition and use of TE in the care of people with LBP., Methods: A Delphi study was carried out with a formal consensus procedure and sufficient scientific evidence, using an established methodology. Four rounds of anonymous questionnaires were administered to create useful suggestions and instructions in terms of the therapeutic activity for patients with LBP, and a group consensus conference., Results: A consensus was reached on most of the questions after 35 physiotherapists completed the questionnaires. Participants agreed that proper TE requires correct posture, body awareness, breathing, movement control, and instruction. Patients with LBP were advised to participate in supervised sessions twice a week for 30 to 60 min for a period of 3 to 6 months. Participants added that tailored evaluation and exercise prescription, monitoring, and functional integration of exercise, as well as using specific equipment, would benefit patients with LBP., Conclusions: TE recommendations for patients with LBP should be dosed and customized based on their personal psychological needs, level of fitness, and kinesiophobia.

Background: Back pain is highly prevalent; in Spain, it produces a very high economic cost and the scientific evidence supporting treatments shows low to moderate evidence for exercise. Therefore, the aim of this study was to assess the effectiveness of a therapeutic group exercise protocol in reducing pain intensity and disability in patients with back pain in primary health care setting., Methods: A total sample of 149 patients who suffered from chronic non-specific back pain was selected. Patients received a therapeutic exercise protocol, including auto-mobilization exercises for the neck and lumbar regions, as well as core stabilization exercises. Pain intensity and disability were evaluated before and after the therapeutic exercise protocol., Results: Statistically significant differences ( p < 0.05) were shown in pain intensity and disability for patients with non-specific neck and low-back pain, with an effect size from moderate to large., Conclusions: A therapeutic exercise protocol may provide beneficial effects upon disability and pain intensity in patients with chronic non-specific back pain, including neck and low-back pain conditions In addition, It could be considered for inclusion as a back-pain-approach program in primary healthcare.

Background: The diaphragm is considered the main muscle involved in breathing and also linked to trunk stabilization functions. Up to date, rehabilitative ultrasound imaging (RUSI) has been the most used technique to evaluate unilaterally the transcostal diaphragm thickness. Nevertheless, the inspiratory activity of both hemi-diaphragms is bilaterally performed at the same time, and its simultaneous evaluation with a thoracic orthosis could improve its assessment as well as its re-education with visual biofeedback of both hemi-diaphragms at the same time. The purpose was to evaluate the reliability and repeatability of simultaneous thickness measurements of both hemi-diaphragms bilaterally during normal breathing using a thoracic orthosis that allowed bilateral fixation of both right and left ultrasound probes., Methods: The study was conducted in 46 healthy subjects, whose diaphragm thickness was measured bilaterally and simultaneously in the anterior axillary line during relaxed breathing with a designed thoracic orthosis and 2 ultrasound tools. Intra-examiner (same examiner), inter-examiner (2 examiners), intra-session (1 hour) and inter-session (1 week) reliability and repeatability between each pair of measurements of diaphragm muscle thickness were analyzed during normal breathing., Results: Reliability and repeatability for intra-session evaluations using the thoracic orthosis were excellent to evaluate simultaneous thickness of both hemi-diaphragms by bilateral probes fixation (intraclass correlation coefficient =0.919-0.997; standard error of measurement =0.002-0.007 cm; minimum detectable change =0.006-0.020 cm), without systematic errors (P>0.05) between each pair of measurements. Nevertheless, inter-session evaluations varied from good to excellent using the bilateral probes fixation (intraclass correlation coefficient =0.614-0.984; standard error of measurement =0.006-0.028 cm; minimum detectable change =0.017-0.079 cm), although some systematic errors were presented (P<0.05)., Conclusions: Good to excellent reliability and repeatability was shown for simultaneous thickness measurements of both hemi-diaphragms bilaterally during normal breathing. Despite systematic errors were presented for some inter-examiner assessments, the use of the thoracic orthosis that allowed bilateral fixation of ultrasound probes could be recommended for simultaneous hemi-diaphragms breathing re-education by visual biofeedback., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://qims.amegroups.com/article/view/10.21037/qims-23-329/coif). JLC, RBdBV, DRS, and CCL report competing financial interests due to a patent registry was carried out as a utility model for the bilateral thoracic orthosis including both right and left holding devices for 2 ultrasound probes in the Spanish Patent and Trademark Office (number of application: U202200045; publication number: ES1288519; issue date: 30 March, 2022). The other authors have no conflicts of interest to declare., (2023 Quantitative Imaging in Medicine and Surgery. All rights reserved.)

Background: Chronic neck pain (CNP) may be associated with latent myofascial trigger points (MTrPs) in the levator scapulae (LS), which can be treated with ischemic compression (IC) and dry needling (DN). Variables and elastography changes are evaluated to compare the short-term efficacy of two treatments with DN., Methods: A randomized clinical trial is conducted with 80 participants in two groups: the DN group ( n = 40) and IC group ( n = 40). The duration is 12 weeks, and mechanical heterogeneity index, pressure pain threshold (PPT), and pain intensity are measured at baseline, immediately after, 48 h after, and one week after treatment., Results: Statistically significant changes were immediately observed between the two groups: PPT decreased in the DN group ( p = 0.05), while it increased in the IC group. At 48 h and one week after treatment, these values increased in the DN group and remained higher than in the IC group. The heterogeneity index improved in both groups but more significantly in the DN group than in the IC group., Conclusions: In subjects with CNP who had latent plus hyperalgesic MTrPs in the LS muscle, DN outperformed IC in PPT, pain intensity, and mechanical heterogeneity index at 48 h and one week after initiating therapy.

Background: The myofascial induction technique (MIT) has been shown to increase shoulder range of motion (ROM) in breast cancer survivors and decrease pain pressure threshold over the radial nerve in patients with epicondylalgia. To the authors' best knowledge, no study on trigger points and MIT has been published to date. The effect on ROM of latent trigger points is also unknown., Methods: A total of 20 twins with one latent trigger point of the gastrocnemius muscle were evaluated pre- and post-MIT in the calf. We measured static footprint variables in a pre-post study., Results: We found differences in PPT ( p = 0.001) and no differences in ROM with knee flexed ( p = 0.420) or stretched ( p = 0.069)., Conclusions: After Calf MIT, latent myofascial trigger points improve PPT but no change in ankle dorsiflexion with knee bent or knee flexed were found in non-restriction healthy subjects.

Background: The coronavirus 2019 (COVID-19) pandemic has prompted several changes in the learning methods of students. The purpose of this study was to establish whether a relationship between levels of resilience, self-esteem, anxiety, depression, and academic stress in both hybrid and virtual learning education exist., Methods: A descriptive and observational case-control study was carried out in universities that offer nursing designation. A total sample of 140 freshman nursing students was recruited. Concretely, 70 participants were recruited from an university receiving hybrid education and 70 participants were recruited from another university receiving virtual learning education. Nursing students self-reported the following questionnaires: the Rosenberg Self-Esteem scale, the 10 CD-Risk Connor-Davidson Risk Resilience Scale, the Beck Anxiety Inventory, the Beck Depression Inventory and the Academic Stress Coping Scale., Results: Significant differences (P = 0.001) showed higher depression levels for students who received virtual education versus received hybrid education. Differences in Rosenberg test for self-esteem and Beck Anxiety Inventory for anxiety (P > 0.05) were not found., Conclusion: Students who received online education presented higher depression levels which could be due to they had not face-to-face relationships with teachers or classmates, whereas the hybrid education group received a different type of direct interaction with teachers and peers., (© 2023. BioMed Central Ltd., part of Springer Nature.)

There are studies that show the better balance after dry needling in lumbar pain. However, the postural control effects after foot dry needling are unknown. Our objective was to check if dry needling reduces postural control. Eighteen subjects with flexor digitorum brevis (FDB) muscle Myofascial trigger point were evaluated pre- and post-deep dry needling. We measured stabilometric variables in a pre-post study. We have found significant differences in three stabilometric variables: surface with eyes closed (29.36-53.21 mm 2 ) (p = 0.000), medium speed of the laterolateral displacement with eyes closed (1.42-1.64 mm/s) (p = 0.004), and medium speed of the anteroposterior displacement with eyes closed (1.30-1.53 mm/s) (p = 0.025). Dry needling therapy application in FDB muscle reduces standing postural control with eyes closed., (© 2023 The Authors. Journal of Anatomy published by John Wiley & Sons Ltd on behalf of Anatomical Society.)

Background This study aimed to check the diagnostic accuracy of a new test to identify Achilles tendinopathy., Study Design: Observational study., Methods: Seventy patients recruited from a private medical centre met the diagnostic criteria for unilateral Achilles tendinopathy (age, 45.1 ± 12.7 years; weight, 75.00 ± 10 kg; height, 1.75 ± 0.1 m) and were tested based on both Achilles tendons. Seventy patients with a unilateral Achilles tendinopathy ultrasound diagnosis were tested using David's test., Results: Most (86%) subjects demonstrated Kager's fat pad asymmetry in relation to the Achilles tendon in the complete passive dorsiflexion in the prone position (David's sign). No healthy tendons had David's sign., Conclusions: The presence of asymmetry in Kager's fat pad in relation to the Achilles tendon during complete passive dorsiflexion is strongly indicative of ultrasound-diagnosed tendinopathy. David's test demonstrated a sensitivity of 85.71% (95% CI, 77.51% to 93.91%) and a specificity of 100% (95% CI, 100% to 100%), while noting the lack of blinding of the assessors and the uncertainty of the diagnostic measures (95% CI). Asymmetry of the fat pad could potentially serve as a characteristic marker for patients with Achilles tendinopathy.

Chronic ankle instability (CAI) is a common pathology in handball. The role of the intrinsic musculature of the foot in these players in relation to proprioception and stability has not been stablished. The objective of this study was to compare the ultrasound morphology of the heel fat pad of the foot in professional handball players to CAI in healthy players and establish relationships between CAI and physical and psychological variables. The study has been a descriptive observational case-control study in which 20 professional handball male players over 18 years of age were divided into 8 cases (CAI) and 12 controls (healthy). An ultrasound evaluation, the thickness and/or cross-sectional area at rest and the contraction measurement of the Abductor Digiti Minimi, Abductor Hallucis, Flexor Digitorum Brevis and Quadratus Plantae muscles were analyzed. Moreover, the compressibility index of the heel fat pad and the activation of the abdominal wall musculature (ultrasound), the flexion strength of the hallux and lesser toes (dynamometry), the foot functionality (Bristol Foot Score (BFS) questionnaire) and the psychological variables (self-reported questionnaires) were measured. There were no significant differences between the activation capacity values of the foot muscles of healthy and CAI athletes. Significant differences were found between groups regarding the BFS score ( p = 0.007), d = 1.404), and significant correlations were also found between hallux flexion strength and lesser toes flexion strength in the total sample. Although there were no differences between the two groups, the identification of the activation pattern of these muscles in handball athletes is essential to the improvement of performance and preventing injuries such as CAI.

Deep dry needling (DDN) and percutaneous electrolysis (PE) provide the benefit of the mechanical effect of the needle, and PE adds the potential advantages of the galvanic current it incorporates in myofascial trigger points (MTrPs) therapy. The aim of this study was to compare the short-term efficacy between PE and DDN on active MTrPs of the levator scapulae by considering pain intensity. A simple-blind randomized controlled trial was carried out, recruiting patients suffering from non-specific neck pain lasting more than 3 months and with active MTrPs in the levator scapulae muscle (n = 52). Patients were divided into intervention (PE; n = 26) and control (DDN; n = 26) groups and received one treatment session on the active MTrPs of the levator scapulae. Patients were assessed for pain intensity, pressure pain threshold (PPT), cervical range of motion (CROM), neck disability and post-needling soreness, immediately after treatment, at 72 h and at 14 days. In addition, pain during treatment was recorded after the procedure. There were no significant differences for pain intensity, post-needling soreness and PPT. We found significant differences in CROM, immediately after treatment ( p = 0.043), and at 72 h ( p = 0.045), in favor of the PE group. Significant differences were found for neck disability ( p < 0.047), immediately post-treatment, in favor of the DDN group. Moreover, there were significant differences for pain during the intervention ( p < 0.002), in favor of the DDN group (4.54 ± 2.21) versus the PE group (6.54 ± 2.27). PE and DDN appear to have similar short-term effects. PE proved to be a more painful treatment than DDN. Clinical trial registry: NCT04157426.

Background: Infrared thermography devices have been commonly applied to measure superficial temperature in structural composites and walls. These tools were cheaper than other thermographic devices used to measure superficial human muscle tissue temperature. In addition, infrared thermography has been previously used to assess skin temperature related to muscle tissue conditions in the triceps surae of athletes. Nevertheless, the reliability and repeatability of an infrared thermography device designed for materials, such as the Manual Infrared Camera PCE-TC 30, have yet to be determined to measure skin temperature of the triceps surae muscle tissue of athletes., Objective: The purpose was to determine the procedure's intra- and inter-session reliability and repeatability to determine skin temperature within the Manual Infrared Camera PCE-TC 30 thermography device in the triceps surae muscle tissue of athletes, which was initially designed to measure the superficial temperature of materials., Methods: A total of 34 triceps surae muscles were bilaterally assessed from 17 healthy athletes using the Manual Infrared Camera PCE-TC 30 thermography device to determine intra- (at the same day separated by 1 h) and inter-session (at alternate days separated by 48 h) reliability and repeatability of the skin temperature of the soleus, medial and lateral gastrocnemius muscles. The triceps surae complex weas measured by a region of interest of 1 cm 2 through five infrared thermography images for each muscle. Statistical analyses comprised intraclass correlation coefficient (ICC), standard error of measurement (SEM), minimum detectable change (MCD), systematic error of measurement, correlation ( r ), and Bland-Altman plots completed with linear regression models ( R 2 )., Results: Intra- and inter-session measurements of the proposed infrared thermography procedure showed excellent reliability (ICC (1,2) = 0.968-0.977), measurement errors (SEM = 0.186-0.232 °C; MDC = 0.515-0.643 °C), correlations ( r = 0.885-0.953), and did not present significant systematic error of measurements ( P > 0.05). Adequate agreement between each pair of measurement moments was presented by the Bland-Altman plots according to the limits of agreement and non-significant linear regression models ( R 2 = 0.000-0.019; P > 0.05)., Conclusions: The proposed procedure to determine skin temperature within the Manual Infrared Camera PCE-TC 30 thermography device presented excellent intra- and inter-session reliability and repeatability in athletes' triceps surae muscle tissue. Future studies should consider the SEM and MDC of this procedure to measure the skin temperature of soleus, medial, and lateral gastrocnemius muscles to promote triceps surae muscle prevention and recovery in athletes., Competing Interests: César Calvo-Lobo, David Rodríguez-Sanz and Ricardo Becerro-de-Bengoa-Vallejo declare conflict of interest due to the Contract 83 between the Complutense University and PCE Ibérica S.L. (Reference number: 6-2020) was specifically carried out to study the reliability of the Manual Infrared camera PCE-TC 30 thermography device., (© 2023 Calvo-Lobo et al.)

Worldwide, healthcare systems had to respond to an exponential increase in COVID-19 patients with a noteworthy increment in intensive care units (ICU) admissions and invasive mechanical ventilation (IMV). The aim was to determine low intensity respiratory muscle training (RMT) effects in COVID-19 patients upon medical discharge and after an ICU stay with IMV. A retrospective case-series study was performed. Forty COVID-19 patients were enrolled and divided into twenty participants who received IMV during ICU stay (IMV group) and 20 participants who did not receive IMV nor an ICU stay (non-IMV group). Maximal expiratory pressure (PEmax), maximal inspiratory pressure (PImax), COPD assessment test (CAT) and Medical Research Council (MRC) dyspnea scale were collected at baseline and after 12 weeks of low intensity RMT. A greater MRC dyspnea score and lower PImax were shown at baseline in the IMV group versus the non-IMV group (p < 0.01). RMT effects on the total sample improved all outcome measurements (p < 0.05; d = 0.38−0.98). Intragroup comparisons after RMT improved PImax, CAT and MRC scores in the IMV group (p = 0.001; d = 0.94−1.09), but not for PImax in the non-IMV group (p > 0.05). Between-groups comparison after RMT only showed MRC dyspnea improvements (p = 0.020; d = 0.74) in the IMV group versus non-IMV group. Furthermore, PImax decrease was only predicted by the IMV presence (R2 = 0.378). Low intensity RMT may improve respiratory muscle strength, health related quality of life and dyspnea in COVID-19 patients. Especially, low intensity RMT could improve dyspnea level and maybe PImax in COVID-19 patients who received IMV in ICU.

Background: The presence of latent myofascial trigger points (MTrPs) in the gluteus medius is one of the possible causes of non-specific low back pain. Dry needling (DN) and ischemic compression (IC) techniques may be useful for the treatment of these MTrPs., Methods: For this study, 80 participants were randomly divided into two groups: the dry needling group, who received a single session of DN to the gluteus medius muscle plus hyperalgesia ( n = 40), and the IC group, who received a single session of IC to the gluteus medius muscle plus hyperalgesia ( n = 40). Pain intensity, the pressure pain threshold (PPT), range of motion (ROM), and quality of life were assessed at baseline, immediately after treatment, after 48 h, and one week after treatment., Results: Statistically significant differences were shown between the two groups immediately after the intervention, showing a decrease in PPT ( p < 0.05) in the DN group and an increase in PPT in the IC group. These values increased more and were better maintained at 48 h and after one week of treatment in the DN group than in the IC group. Quality of life improved in both groups, with greater improvement in the DN group than in the IC group., Conclusions: IC could be more advisable than DN with respect to UDP and pain intensity in the most hyperalgesic latent MTrPs of the gluteus medius muscle in subjects with non-specific low back pain, immediately after treatment. DN may be more effective than IC in terms of PPT, pain intensity, and quality of life in treating latent plus hyperalgesic gluteus medius muscle MTrPs in subjects with non-specific low back pain after 48 h and after one week of treatment.

(1) Background: Introducing ultrasound-guided dry needling to neurorehabilitation treatments increases the beneficial effects of therapy. The aim of this study was to compare the effects of including an ultrasound-guided dry needling session in neurorehabilitation treatment on spasticity and gait-balance quality versus neurorehabilitation treatment in subjects who had suffered a stroke. (2) Methods: A single-blind, randomized clinical trial was conducted. Thirty-six patients who had suffered a stroke in the right middle cerebral artery signed the informed consent for participation in the study. Twenty patients finally participated and were randomly assigned to the control group (neurorehabilitation treatment) or experimental group (neurorehabilitation treatment plus ultrasound-guided dry needling). Pre-treatment and post-treatment data were collected on the same day. The experimental group (n = 10) first underwent an ultrasound-guided dry needling intervention on the tibialis anterior and tibialis posterior musculature, followed by neurorehabilitation treatment; the control group (n = 10) underwent their corresponding neurorehabilitation without the invasive technique. Pre-treatment and post-treatment measurements were taken on the same day, assessing the quality of balance-gait using the "Up and Go" test and the degree of spasticity using the Modified Modified Ashworth Scale. (3) Results: The patients who received neurorehabilitation treatment plus ultrasound-guided dry needling showed a greater decrease in spasticity in the tibial musculature after the neurorehabilitation treatment session ( p < 0.001), improving balance and gait ( p < 0.001). (4) Conclusions: An ultrasound-guided dry needling session combined with neurorehabilitation treatment reduced spasticity and improved balance and gait in stroke patients.

Background: Knee examination guidelines in minors are intended to aid decision-making in the management of knee instability., Clinical Question: A Delphi study was conducted with a formal consensus process using a validated methodology with sufficient scientific evidence. A group consensus meeting was held to develop recommendations and practical guidelines for use in the assessment of instability injuries in children., Key Findings: there is a lack of evidence to analyse anterior cruciate ligament injuries in children and their subsequent surgical management if necessary. Diagnostic guidelines and clinical assessment of the patient based on a thorough examination of the knee are performed and a guide to anterior cruciate ligament exploration in children is developed., Clinical Application: In the absence of a strong evidence base, these established guidelines are intended to assist in that decision-making process to help the clinician decide on the most optimal treatment with the aim of benefiting the patient as much as possible. Following this expert consensus, surgical treatment is advised when the patient has a subjective sensation of instability accompanied by a pivot shift test ++, and may include an anterior drawer test + and a Lachman test +. If these conditions are not present, the conservative approach should be chosen, as the anatomical and functional development of children, together with a physiotherapy programme, may improve the evolution of the injury., Competing Interests: Conflict-of-interest statement: All the authors declare that they have no conflict of interest., (©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.)

Background: Osteoarthritis of the knee is one of the most common ailments worldwide, and pain management of this condition is critical. Methods: A multicentre randomized controlled trial RCT with three months of follow-up, conducted in parallel groups: hyaluronic acid (HA), dry needling (DN) and ultrasound (US) and isometrics of quadriceps. 60 participants took part in the RCT who were diagnosed with osteoarthritis (Grade 3) of the knee by MRI and active adults (age: 23.41 ± 1.68 years; height: 1.79 ± 0.08 m; body mass: 78.33 ± 9.03 kg; body mass index (BMI): 24.14 ± 1.45 kg/m 2 ). After the assigned intervention, VAS, WOMAC, IPAQ and the Star Excursion Balance test were measured at baseline. At 24 h, 15 days, 30 days, 90 days and 180 days follow-up, all variables were measured again. Results: Comparing statistically significant differences between groups, VAS scores were significant at post-test measurement (HA vs. US + isometric and DN vs. US + isometric) at 24 h (HA vs. DN), at 15 days (HA vs. US + isometric and DN vs. US + isometric) and at 1 month (US + isometric vs. HA and US + isometric vs. DN). Conclusions: There is an improvement in pain intensity in knee osteoarthritis in the short term in patients undergoing DN and conventional US + isometric treatment, but in the long term the HA group shows an improvement in pain intensity. There is also a significant difference in the improvement of knee function at different phases of the study in the various intervention groups. The combination of DN and HA in clinical practice is the best option for the treatment of osteoarthritis.

Diaphragmatic weakness and thickness reduction have been detected in athletes with lumbopelvic pain (LPP). Strength training of inspiratory muscles may be necessary for athletes with LPP. Inspiratory muscle training (IMT) and visual biofeedback by rehabilitative ultrasound imaging (RUSI) have been proposed as possible interventions. Here, we determine the effectiveness of visual biofeedback by RUSI with a proposed novel thoracic orthotic device to facilitate diaphragmatic contraction in conjunction with high-intensity IMT in athletes with non-specific LPP. A single-blinded, parallel-group, randomized clinical trial was performed (NCT04097873). Of 86 participants assessed for eligibility, 64 athletes with non-specific LPP (39 males and 25 females; mean age, 33.15 ± 7.79 years) were recruited, randomized, analyzed and received diaphragm visual biofeedback by RUSI in conjunction with high-intensity IMT (RUSI+IMT; n = 32) or isolated high-intensity IMT (IMT; n = 32) interventions for 8 weeks. Diaphragmatic thickness during normal breathing, maximum respiratory pressures, pain intensity, pressure pain threshold on lumbar musculature, disability by the Roland−Morris questionnaire, quality of life by the SF-12 questionnaire and spirometry respiratory parameters were assessed at baseline and after the 8-week intervention. There were significant differences (p = 0.015), within a medium effect size (Cohen’s d = 0.62) for the forced expiratory volume in 1-s (FEV1), which was increased in the RUSI+IMT intervention group relative to the IMT alone group. Adverse effects were not observed. The rest of the outcomes did not show significant differences (p > 0.05). Diaphragm visual biofeedback by RUSI with the proposed novel thoracic orthotic device in conjunction with high-intensity IMT improved lung function by increasing FEV1 in athletes with non-specific LPP., Competing Interests: Authors declared a conflict of interest due to a patent being registered as a utility model, providing a holding device for the ultrasound probe at the Spanish Patent and Trademark Office (Number of application: U202000080; Number of publication: ES1245754; Issue Date: 24 August 2020).

Background: Intensive care units (ICUs) may produce stress on the relatives of patients that have long-term physiological and psychological implications., Objectives: This study aimed to evaluate the effects of the relatives´ visit prior to hospital admission(s) on the patient's scheduled cardiac surgery regarding depression, anxiety, and satisfaction of the patient's family in an ICU., Methods: A randomized clinical trial [NCT03605420] was carried out according to the CONSORT criteria. Thirty-eight relatives of ICU patients were recruited at an ICU and randomized into study groups. Experimental group participants ( n  = 19) consisted of relatives who received 1 ICU visit prior to the patient's admission. Control group participants ( n  = 19) consisted of patients' relatives who received standard care alone. A self-report test battery, including the Impact of Event Scale-Revised (IES-R) and the Hospital Anxiety and Depression Scale (HADS), was completed by the patient's relative prior to the patient's ICU admission and again three and 90 days after ICU discharge. Furthermore, the Family Satisfaction with Care in the Intensive Care Unit (FS-ICU) and Critical Care Family Needs Inventory (CCFNI) were administered to help determine the respondents' satisfaction three days after the patient's ICU discharge., Results: Statistically significant differences in FS-ICU results were found between control and experimental groups; no statistically significant differences were found in IES-R, HADS, and CCFNI results. Thus, members in the control group were more satisfied with the time elapsed to raise their concerns ( p =0.005), emotional support provided ( p =0.020), quality of care ( p =0.035), opportunities to express concerns and ask questions ( p =0.005), and general satisfaction with the ICU's decision-making ( p =0.003)., Conclusions: Relatives' satisfaction during patients' ICU admission may be impaired after their prior visit to the hospital admission. Relative's anxiety and depression scores did not seem to be significantly affected. Relatives´ visit prior to elective cardiac surgery hospital admission impaired their satisfaction in an ICU and may not be advisable for healthcare practice., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2022 Sara González-Martín et al.)

Coronary artery disease (CAD) may be considered a main cause of mortality and the prevalence of CAD is increasing nowadays, leading to high health costs in many countries. Despite the fact of the regression of the atherosclerotic plaque, the decrease in blood viscosity and the growth of collateral vessels have been proposed as improvements that CAD patients may obtain under exercise performance. Thus, the present narrative review aimed to carry out a brief specific analysis of the results achieved when performing endurance, strength or inspiratory muscle training. Exercise attenuates certain pathophysiological processes of this disease, such as endothelial dysfunction or the vulnerability of atherosclerotic plaques, and produces improvements in functional capacity and muscle strength, among others. Within the different exercise modalities, the most important parameter to be considered seems to be the total caloric expenditure, and not so much the modality itself. As such, in cardiac rehabilitation, when prescribing exercise, we should possibly focus on the modality that obtains more adherence in patients. To conclude, it must be highlighted that total caloric expenditure is not being taken into account when comparing interventions and this relevant information should be considered in future studies.

Metatarsus adductus (MA) is a congenital foot deformity often unrecognized at birth. There is adduction of the metatarsals, supination of the subtalar joint, and plantarflexion of the first ray. The aims of this study were to assess the intra and inter-reader reliability of the radiographic MA measurement angles used in the literature. Methods: All consecutive recreational football players who practice activity more than 5 h/week over 21 years of age with MA by roentgenographic evaluation on weight-bearing dorsoplantar images were included in a cross-sectional study. Controls were matched to cases according to age and gender. We assess all radiographic measurements to evaluate metatarsus adductus with the different measurements frequently used in the literature: Sgarlato, modified Sgarlato, Rearfoot, Root, Engel, modified Engel, Kite, Kilmartin, modified Kilmartin, Simons, and Laaveg & Ponseti. Results: The variables measured in 80 weight-bearing dorsoplantar foot radiographs show excellent reliability ranging p > 0.900 in Sgarlato and modified Sgarlato with low SEM, CV, and MCD. Rearfoot, Root, Engel, modified Engel, Kite, Kilmartin, Simons, Laaveg & Ponseti, and modified Kilmartin’s angles showed intra or inter reliability with ICC lower than <0.900, systematic differences between intersession or inter observers, or high MCD value. Conclusion: It is more suitable to measure the MA angle with the Sgarlato and modified Sgarlato techniques to show higher reliability and repeatability for intra and inter-observer.

Background: Harderness insoles decrease plantar pressure and reduce the foot injury incidence in sport. The purpose of our study was to analyze the plantar pressure variation in moto riders after riding in a real speed circuit with a custom foot 52 0 Shore EVA insole., Methods: A crossover randomized trial study was performed (consent no. #050520165316). Riders were assessed by an expert motorsport senior podiatry. The participants' mean age was 35 ± 3.29. Participants completed a 20 min training riding with their own motorcycle in a real speed circuit. Plantar pressures were registered with a baropodometric platform evaluating an Ethyl Vinyl Acetate custom foot insole (CFI) manufactured with 3 mm thickness and 52° Shore A hardness. The Plantar pressures were registered before riding, after riding without EVA insole, and after riding with EVA insole., Results: Total Plantar pressures in right and left foot, and total surface area decrease after riding with EVA insoles., Conclusion: The use of an EVA insole with 52 0 shore A hardness riding on a motorcycle in speed circuit decreased the total plantar pressures and surface areas values.

Background: This study aimed to compare the effectiveness of cervical lateral glide (CLG) added to median nerve neural mobilization (MNNM) in patients with neck pain (NP)., Methods: A single-blinded randomized controlled clinical trial was carried out in a Pain Management Unit from a Hospital. A total sample of 72 patients with NP was recruited from a hospital. Patients were randomized to receive isolated CLG ( n = 36) or CLG + MNNM ( n = 36). Bilateral elbow extension range of motion (ROM) on upper limb neurodynamic test 1 (ULNT1), bilateral pressure pain thresholds (PPT) on the median nerve at elbow joint, C 6 zygapophyseal joint and tibialis anterior, Visual analogue scale (VAS), body chart distribution of pain, active cervical ROM (CROM), Neck Disability Index (NDI), and Tampa Scale of Kinesiophobia (TSK-11) were measured at baseline as well as immediately, 15 days, and 1 month after treatment., Results: There were no statistically significant interactions ( p > 0.05) between treatment and time for median nerve mechanosensitivity outcomes, pain intensity, symptom distribution, and PPT of the widespread pain assessment, as well as cervical function, and kinesiophobia., Conclusions: MNNM gave no additional benefit to CLG in patients with NP regarding pain intensity, symptom distribution, mechanosensitivity, functionality, and kinesiophobia. Only two treatment sessions and the short follow-up are important issues, therefore, justifying further studies to answer the research question with better methodology.

Background: Chronic low back pain (LBP) has been stated as one of the main health concerns in the XXI century due to its high incidence., Objective: The objective of this study was to determine the effects of an 8-week program of hypopressive abdominal gymnastics (HAG) on inspiratory muscle strength, diaphragm thickness, disability and pain in patients suffering from non-specific chronic LBP., Methods: A total of 40 patients with chronic LBP were randomly divided into two groups. The experimental group carried out an 8-week supervised program of HAG (two sessions/week), whereas the control group did not receive any treatment. Outcomes were measured before and after the intervention, comprising diaphragm thickness during relaxed respiratory activity, maximal inspiratory pressure (PI max ), pain intensity (NRS), pressure pain threshold and responses to four questionnaires: Physical Activity Questionnaire (PAQ), Roland-Morris Disability Questionnaire (RMQ), Central Sensitization Inventory (CSI) and Tampa Scale of Kinesiophobia-11 Items (TSK-11)., Results: Statistically significant differences ( p < 0.05) were observed for greater thickness of the left and right hemi-diaphragms at inspiration, as well as higher PI max and decreased NRS, CSI and RMQ scores in the intervention group. After treatment, the increases in the thickness of the left and right hemi-diaphragms at inspiration and PI max , as well as the decrease in the NRS and RMQ scores, were only predicted by the proposed intervention ( R 2 = 0.118-0.552)., Conclusions: An 8-week HAG intervention seemed to show beneficial effects and predicted an increase in diaphragm thickness and strength during inspiration, as well as a reduction in pain intensity, central sensitization and disability, in patients suffering from chronic non-specific LBP with respect to non-intervention.

In response to the current state of the COVID-19 pandemic, healthcare providers are using common surgical masks and filtering respirators in conjunction with the presence of facial hair, which could lead to a large number of particles passing into their respiratory system. The purpose of this study was to determine the fit factor effectiveness of filtering respirators and surgical masks in bearded versus non-bearded healthcare providers. A controlled randomized clinical trial (NCT04391010) was carried out, analyzing a sample of 63 healthcare providers. The fit factors of surgical masks and FFP3 filtering respirators for healthcare providers with ( n = 32) and without ( n = 31) facial hair were compared. Fit factors were measured during an exercises protocol in which healthcare providers wore surgical masks and FFP3 filtering respirators. Surgical mask fit factor comparisons did not show significant differences ( p > 0.05) between healthcare providers with and without facial hair. In contrast, filtering respirator fit factor comparisons showed statistically significant differences ( p < 0.01) between both groups, indicating that healthcare providers with facial hair showed lower fit factor scores, which implies a worse fit factor with respect to healthcare providers without facial hair. The fit factor effectiveness of filtering respirators was reduced in healthcare providers with facial hair. The authors of this paper encourage healthcare providers to trim their beards during filtering respirator use or wear full-mask filtering facepiece respirators, especially during the COVID-19 pandemic.

Aims: To determine the fit factor and compliance with American Industrial Hygiene Association (AIHA) and Occupational Safety and Health Administration (OSHA) requirements of surgical masks and filtering respirators in male versus female nurses., Design: A case-control gender study performed from 2016 to 2019., Methods: A gender and age matched-paired sample of 74 nurses was recruited and divided into men (n = 37) and women (n = 37). FFP3 filtering respirators and surgical masks fit factors were compared between male and female nurses by Mann-Whitney U tests. These measurements were tested to pass or fail according to the OSHA (≥100) and AIHA (≥50) criteria by Fisher exact tests for a 95% confidence interval., Results: Global fit factor mean (standard deviation) was 2.86 (2.73) and 3.55 (6.34) for male and female nurses wearing surgical masks (p = .180), respectively, and nobody passed neither OSHA nor AIHA criteria (p = 1.00). Nevertheless, global fit factor were 30.82 (28.42) and 49.65 (43.04) for male and female nurses wearing FFP3 respirators, respectively, being significantly lower and worse in male nurses (p = .037). According to OSHA criteria, only 2.70% and 13.51% of male and females nurses, respectively, passed with non-significant difference (p = .199), meanwhile 21.62% and 48.64% of male and female nurses, respectively, passed AIHA criteria showing significant differences (p = .027) wearing FFP3 respirators., Conclusions: All male and female nurses wearing surgical masks failed to pass OSHA and AIHA criteria. Global fit factor of the proposed FFP3 filtering respirators was decreased and worse in male than female nurses., Impact: Our recommendation is to avoid surgical masks use for protective purposes and use the proposed FFP3 filtering respirators among nurses. Each nurse should be fit tested for its own respirator with special caution in male nurses due to their lower fit factor achieved and most of them failed to pass OSHA and AIHA criteria, especially during COVID-19 pandemic., (© 2021 John Wiley & Sons Ltd.)

The use of rehabilitative ultrasound imaging (RUSI) to evaluate diaphragm thickness during breathing in athletes who suffer from non-specific lumbopelvic pain presents some measurement errors. The purpose of this study was to evaluate intra- and inter-sessions, intra- and inter-rater reliabilities, and concurrent validity of diaphragm thickness measurements during breathing using transcostal RUSI with a novel thoracic orthotic device that was used to fix the US probe versus those measurements obtained using manual fixation. A total of 37 athletes with non-specific lumbopelvic pain were recruited. Intra- (same examiner) and inter-rater (two examiners) and intra- (same day) and inter-session (alternate days) reliabilities were analyzed. All measurements were obtained after manual probe fixation and after positioning the thoracic orthotic device to fix the US probe in order to correctly correlate both measurement methods. Both left and right hemi-diaphragm thickness measurements were performed by transcostal RUSI at maximum inspiration, expiration, and the difference between the two parameters during relaxed breathing. Intra-class correlation coefficients (ICC), standard errors of measurement (SEM), minimum detectable changes (MCD), systematic errors, and correlations ( r ) were assessed. Orthotic device probe fixation showed excellent reliability (ICC = 0.852-0.996, SEM = 0.0002-0.054, and MDC = 0.002-0.072), and most measurements did not show significant systematic errors ( p > 0.05). Despite manual probe fixation with a reliability ranging from good to excellent (ICC = 0.714-0.997, SEM = 0.003-0.023, and MDC = 0.008-0.064 cm), several significant systematic measurement errors ( p < 0.05) were found. Most significant correlations between both orthotic device and manual probe fixation methods were moderate ( r = 0.486-0.718; p < 0.05). Bland-Altman plots indicated adequate agreement between both measurement methods according to the agreement limits. The proposed novel thoracic orthotic device may allow ultrasound probe fixation to provide valid and reliable transcostal RUSI measurements of diaphragmatic thickness during relaxed breathing thus reducing some measurement errors and avoiding systematic measurement errors. It may be advisable to measure diaphragm thickness and facilitate visual biofeedback with respect to diaphragm re-education during normal breathing in athletes with non-specific lumbopelvic pain.

Several studies have shown that gastrocnemius is frequently injured in triathletes. The causes of these injuries are similar to those that cause the appearance of the myofascial pain syndrome (MPS). The ischemic compression technique (ICT) and deep dry needling (DDN) are considered two of the main MPS treatment methods in latent myofascial trigger points (MTrPs). In this study superficial electromyographic (EMG) activity in lateral and medial gastrocnemius of triathletes with latent MTrPs was measured before and immediately after either DDN or ICT treatment. Taking into account superficial EMG activity of lateral and medial gastrocnemius, the immediate effectiveness in latent MTrPs of both DDN and ICT was compared. A total of 34 triathletes was randomly divided in two groups. The first and second groups ( n = 17 in each group) underwent only one session of DDN and ICT, respectively. EMG measurement of gastrocnemius was assessed before and immediately after treatment. Statistically significant differences ( p = 0.037) were shown for a reduction of superficial EMG measurements differences (%) of the experimental group (DDN) with respect to the intervention group (ICT) at a speed of 1 m/s immediately after both interventions, although not at speeds of 1.5 m/s or 2.5 m/s. A statistically significant linear regression prediction model was shown for EMG outcome measurement differences at V1 (speed of 1 m/s) which was only predicted for the treatment group ( R 2 = 0.129; β = 8.054; F = 4.734; p = 0.037) showing a reduction of this difference under DDN treatment. DDN administration requires experience and excellent anatomical knowledge. According to our findings immediately after treatment of latent MTrPs, DDN could be advisable for triathletes who train at a speed lower than 1 m/s, while ICT could be a more advisable technique than DDN for training or competitions at speeds greater than 1.5 m/s.

Background: Chronic ankle instability (CAI) is a condition defined by certain structural and functional deficits in the ankle joint complex after acute ankle injury. These deficits include pathological joint laxity, impaired postural control, and decreased strength and neuromuscular control., Purpose: To compare an eyes-open versus an eyes-closed balance training protocol in professional soccer players with CAI., Study Design: Cohort study; Level of evidence, 2., Methods: For this study, we evaluated 19 players from 2 professional soccer teams in Madrid, Spain, all of whom had CAI. Participants from both teams were randomly assigned to an eyes-open group (n = 9) or eyes-closed group (n = 10). All participants completed 4 weeks of a supervised exercise protocol consisting of 3 sessions per week. Members of both the eyes-open and eyes-closed groups performed the same exercise protocol in the same order of execution. At the end of the protocol, the participants were assessed for pain (visual analog scale), ankle dorsiflexion range of motion (weightbearing lunge test), dynamic stability (Star Excursion Balance Test), and fear of movement and reinjury (Tampa Scale for Kinesiophobia). We compared results both before and after balance training and between the eyes-open and eyes-closed balance training groups., Results: Statistically significant differences were found for all of the assessed variables before and after balance training. No statistically significant differences were found between the eyes-closed and eyes-open groups on any variable., Conclusion: In the current study, eyes-closed balance training was not more effective than eyes-open balance training for CAI in professional soccer players., Competing Interests: The authors have declared that there are no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2021.)

Background: A literature review did not reveal any studies concerning the intramedullary transfer of the flexor digitorum brevis tendons (FDB) technique with a single longitudinal incision through the proximal phalanx of the toes. The main goal of this investigation was to demonstrate whether the FDB tendons of the toes are long enough to enable intramedullary transfer to the dorsal area of the proximal phalanx., Methods: We examined whether the technique would allow the surgeon to transfer the FDB tendons through the proximal phalanx of the toes. The technique transfers the FDB tendons through the proximal phalanx dorsal area of the toes using an intramedullary transfer of the FDB tendons. The intramedullary transfer of the FDB tendons was performed through a single dorsal incision., Results: The FDB tendons for the second, third, and fourth toes were performed in 100% of the feet. No ruptures in any toe in which the surgical technique was performed was noted, and no proximal phalanges of the second, third, and fourth toes were fractured., Conclusions: Transfer of FDB tendons via the intramedullary approach of the proximal phalanx of the second, third, and fourth toes is possible. The FDB tendons have sufficient length for transfer via an intramedullary transfer and were carried out in 100% of the second toes. For a successful transfer, it is essential to perform a thorough resection of the extensor digitorum longus aponeurosis since it has expansions intimately attached to the plantar base of the proximal phalanx of the toe., (Copyright © 2020 Elsevier GmbH. All rights reserved.)

Exercise intolerance may be considered a hallmark in patients who suffer from heart failure (HF) syndrome. Currently, there is enough scientific evidence regarding functional and structural deterioration of skeletal musculature in these patients. It is worth noting that muscle weakness appears first in the respiratory muscles and then in the musculature of the limbs, which may be considered one of the main causes of exercise intolerance. Functional deterioration and associated atrophy of these respiratory muscles are related to an increased muscle metaboreflex leading to sympathetic-adrenal system hyperactivity and increased pulmonary ventilation. This issue contributes to increased dyspnea and/or fatigue and decreased aerobic function. Consequently, respiratory muscle weakness produces exercise limitations in these patients. In the present review, the key role that respiratory muscle metaboloreceptors play in exercise intolerance is accurately addressed in patients who suffer from HF. In conclusion, currently available scientific evidence seems to affirm that excessive metaboreflex activity of respiratory musculature under HF is the main cause of exercise intolerance and sympathetic-adrenal system hyperactivity. Inspiratory muscle training seems to be a useful personalized medicine intervention to reduce respiratory muscle metaboreflex in order to increase patients' exercise tolerance under HF condition.

Worldwide, the burden of musculoskeletal disorders is increasing with great variations between-countries, which makes it difficult for policymakers to provide resources and adequate interventions in order to provide for their appropriate management [...].

Background: In 1973, Dr. Kenzo Kase developed Kinesio taping from the hypothesis that this external component could aid the functions of muscles and other tissues. There are different studies on this issue, but none has completely clarified the research question., Objective: To study the application of Kinesio taping in the variation of isometric muscle strength of the hand extension and grip, isokinetic strength of the pronation and supination movements, and the time it takes to reach that strength in patients with lateral epicondylalgia., Methods: An analytical, experimental, randomized study was carried out with 104 subjects with lateral epicondylalgia. The subjects were randomly distributed among two groups: one received Kinesio taping and the other a placebo material. A pre- and post-intervention measurement was performed. The post-measurement was carried out 24 hours later so as to completely eliminate the fatigue effect produced by the first day measurements, as well as to ensure that the intervention was effective, and not immediate. The measurements were made using a dynamometer., Results: No significant differences were found between the application of Kinesio taping and placebo material in subjects with lateral epicondylalgia regarding the variation of muscle strength in any of the study variables (p> 0.05 for all studied variables)., Conclusions: Kinesio taping produces no change in strength after application and exerts an effect similar to that of a placebo.

Background: The lateral ankle ligament complex is the most frequently injured ligament secondary to strong ankle inversion movement during lateral ankle sprains (LAS). Among these injuries, anterior talofibular ligament (ATFL) injury is the most frequent condition (present in 66-85% of such injuries). The purpose of this research was to use magnetic resonance imaging (MRI) to determine the association between ankle tendon, ligament, and joint conditions and ATFL injuries., Methods: A case-control MRI study was carried out to compare the presence of ankle muscle, tendon, ligament, and joint conditions in patients with injured ATFLs (case group; n=25) and non-injured ATFLs (control group; n=25)., Results: Achilles tendinopathy was present in 1/25 (4%) patients with injured ATFLs and 7/25 (28%) non-injured ATFL subjects (P=0.048). Injured calcaneofibular ligaments (CFLs) were present in 19/25 (76%) patients with injured ATFLs and 1/25 (4%) non-injured ATFL subjects (P<0.001). Finally, injured tibiotalar joints were present in 16/25 (64%) patients with injured ATFLs and 5/25 (20%) non-injured ATFL subjects (P=0.002). Other musculoskeletal structure injuries occurred at similar rates between patients with injured ATFLs and those with non-injured ATLFs (P≥0.05)., Conclusions: Patients with ATFL injuries showed a greater presence of CFL and tibiotalar joint injuries than subjects with non-injured ATFLs., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/qims-20-5). The authors have no conflicts of interest to declare., (2021 Quantitative Imaging in Medicine and Surgery. All rights reserved.)

San-Antolín, M, Rodríguez-Sanz, D, Becerro-de-Bengoa-Vallejo, R, Losa-Iglesias, ME, Martínez-Jiménez, EM, López-López, D, and Calvo-Lobo, C. Neuroticism traits and anxiety symptoms are exhibited in athletes with chronic gastrocnemius myofascial pain syndrome. J Strength Cond Res 34(12): 3377-3385, 2020-Common psychological factors, such as anxiety or neurotic personality traits, seem to be associated with pain suffered by athletes. Gastrocnemius muscles present a high prevalence for injury in athletes. These muscles are a region in which myofascial pain syndrome (MPS) frequently develops. Myofascial pain syndrome is characterized by the presence of active myofascial trigger points (MTrPs). This study compared different personality and anxiety symptoms between athletes with and without active MTrPs in the gastrocnemius. A case-control study was conducted in an outpatient clinic. Athletes who performed moderate or vigorous physical activity according to the International Physical Activity Questionnaire were included. Fifty paired-matched athletes with and without active MTrPs in their gastrocnemius muscles (n = 25 in each group) were recruited. Different personality traits (neuroticism, extraversion, psychoticism, and sincerity) and anxiety (state and trait) were evaluated by the Eysenck Personality Questionnaire and State-Trait Anxiety Inventory, respectively. Statistically significant differences (p < 0.01) with an effect size from moderate to large (d = 0.75-1.29) were found for greater neuroticism and sincerity traits in addition to state and trait anxiety in athletes with gastrocnemius MPS compared with healthy controls. In conclusion, athletes with gastrocnemius active MTrPs exhibited higher neuroticism and anxiety symptoms compared with healthy athletes. Mental health may play a key role in athletes with myofascial pain, and future studies should be performed to determine whether neuroticism-related and anxiety-related psychological care could be a key intervention in athletes with gastrocnemius active MTrPs to improve athletic performance and rehabilitation or prevent injuries.

Perineal trauma (PT) may be considered as a very common injury during the childbirth. The incidence of PT was estimated in 30% to 85%, with 60% to 70% requiring suture. The present study was a prospective, single-blinded, randomised, clinical trial carried out from January 2015 to January 2016. For this study, 49 secundigravida women diagnosed with gestational oedema were recruited and randomly divided into two groups (A and B). Group A (n = 30) received the conventional treatment plus perineal massage and group B (n = 19) the conventional treatment plus manual lymphatic drainage (MLD). Visual analogue scale (VAS) and King Health's Questionnaire (KHQ) were performed to assess pain intensity and quality of life-related with urinary incontinence (UI). Pain intensity measurements showed statistically significant differences for a decrease after 30-weeks (P = .037), after 36-weeks (P = .000), and at the end of puerperium (P = .014) for MLD with respect to perineal massage group. Moreover, inter-groups repeated measures ANOVA for the values related statistically significant differences to the interaction of each applied treatment (perineal massage and MLD group, separately) over the pain intensity variable. MLD treatment reduced pain intensity with respect to perineal massage in secundigravida women with gestational oedema from 25-weeks of gestation to the end of puerperium., (© 2020 Medicalhelplines.com Inc and John Wiley & Sons Ltd.)

Background: Usually, physicians use filtering respirators in clinical settings to a lesser extent than other simpler surgical masks. The study aim was to determine the fit factor of surgical and other types masks commonly used in clinical settings compared with FFP3 filtering respirators. Materials and Methods: A cross-sectional study was carried out recruiting a total sample of 78 physicians. Fit factor was measured to determine particles count into masks compared to particles count outside of the masks meanwhile physicians carried out a protocol composed by 8 exercises as well as the global fit factor total scores. First, fit factor was analyzed with the usual surgical masks used by physicians in clinical settings. Second, fit factor was determined with the proposed FFP3 filtering respirators. Results: Most participants (97%) used surgical masks. Statistically significant differences ( P <0.001) with an effect size from moderate to large ( d =0.61-1.00) were shown for fit factors in the different exercises and total scores between surgical and other masks (3.2±5.0) and FFP3 filtering respirators (40.7±37.8). Generally, FFP3 filtering respirators showed a higher fit factor in the different exercises and total scores compared to the commonly used surgical and other types masks in clinical settings. Conclusions: Despite most physicians used surgical masks in clinical settings, filtering FFP3 masks showed a higher fit factor in the different exercises and total scores compared with the used surgical masks and filtering respirators such as FFP1, FFP2 and other types in clinical settings., Competing Interests: Competing Interests: The authors have declared that no competing interest exists., (© The author(s).)

Background: Ankle sprain is one of the most common musculoskeletal injuries in sports, at work, and at home. Subjects who suffer from this injury may develop ankle instability. Functional instability has been associated with a high rate of resprain and impaired neuromuscular control in patients with ankle instability., Objective: Measurement of neural and muscular mechanosensitivity after ankle sprain injury and establishment of the relationship between these variables., Methods: A cross-sectional case-control study was performed with a sample of 58 students from Alcalá de Henares University (21 males and 37 females, mean age ± SD = 21 ± 3.7 years). Subjects were divided into two groups: a case group (N = 29, subjects with unstable ankle) and a control group (N = 29, healthy subjects). The pressure pain threshold (PPT) of the tibialis anterior, peroneus longus, and peroneus brevis muscles and mechanosensitivity of the common peroneus and tibial nerves were evaluated in all subjects through a manual mechanical algometer., Results: Neuromuscular PPTs showed significant differences (P < 0.05) between both groups, such that, compared with the control group, the case group exhibited significantly lower PPT levels. In the case group, a strong positive correlation was observed between neural and muscular homolateral mechanosensitivity in both lower limbs., Conclusions: Participants with chronic ankle instability showed higher neuromuscular mechanosensitivity in muscles and nerves surrounding the ankle joint than healthy subjects. These findings indicate that low PPT values may be associated with symptoms that characterize this disease., (© The Author(s) 2019. Published by Oxford University Press on behalf of the American Academy of Pain Medicine.All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Frailty is a condition that can increase the risk of falls. In addition, foot pain can influence older adults and affect their frail condition. The main objective was to measure the frailty degree in older adults in a Spanish population with foot pain from moderate to severe., Method: This is a cross-sectional descriptive study. A sample of people older than 60 years ( n = 52), including 26 males and 26 females, were recruited, and frailty disability was measured using the 5-Frailty scale and the Edmonton Frailty scale (EFS)., Results: Spearman's correlation coefficients were categorized as weak (rs ≤ 0.40), moderate (0.41 ≤ rs ≥ 0.69), or strong (0.70 ≤ rs ≥ 1.00). There was a statistically significant correlation for the total score ( p < 0.001) and most of the subscales of the 5-Frailty scale compared with the EFS, except for Mood ( p > 0.05). In addition, females and males showed similar 5-Frailty and Edmonton Frail scales scores with no difference ( p > 0.05)., Conclusion: Foot pain above 5 points, i.e., from moderate to severe, does not affect the fragility more in one sex than another.