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Introduction: This study compares the efficacy of routine treatment plus short foot exercises (SFE) with routine treatment alone on dynamic balance and pain in subjects with sub-acute ankle sprain. Materials and Methods: A total of 32 patients (18-45 years old) with primary ankle sprain were randomly enrolled into the control group performing routine treatment alone or the SFE group performing routine treatment plus SFE. The dynamic balance was assessed using the star excursion balance test. Pain and ankle dorsiflexion range of motion were assessed using the numeric pain rating scale and a goniometer. The outcomes were evaluated at the baseline and after the end of treatment. The groups were compared using the one-way analysis of variance/analysis of covariance test. The effect sizes also were calculated to determine the efficacy of the SFE. Results: Dynamic balance in the SFE group had a significant increase in the anterior, lateral, medial, and anteromedial directions compared to the control group (P=0.001, P=0.002, P=0.014, P=0.0001). No significant differences were observed between the groups in other directions of the star excursion balance test (P>0.05). Additionally, pain intensity was lower significantly in the SFE group than in the control group (P=0.0001). In the SFE group ankle dorsiflexion range was significantly more than the control group (P=0.025). The effect sizes also showed a high efficacy favoring SFE. Conclusion: The combination of routine treatment and SFE can be an effective intervention for managing ankle sprain.

Introduction: This study investigates the immediate effects of warm-up exercises, specifically static and dynamic stretches for the lower extremities, on strength, endurance, flexibility, motor control, and core stability function in young, healthy females. Materials and Methods: A total of 60 healthy, active women aged 19-30 years were randomly divided into three groups as follows: Static stretching (SS), dynamic stretching (DS), and a control group (CG), which received no exercises. Evaluation methods for core stability included strength, endurance, sit-and-reach, Y-balance, and bilateral squat tests. Meanwhile, these tests were conducted before and after the prescribed exercise protocols. Results: Both the SS and DS groups experienced significant increases in all core stability components compared to their baseline values (P0.05). In addition, dynamic exercises demonstrated a higher effectiveness than static exercises for most parameters (P

Introduction: Pes anserine bursitis (PAB) is a painful status inside the knee that may interfere with functional activities. Extracorporeal shockwave therapy (ESWƬ) may treat this disorder. Objective: Comparing the effects of low- versus middle-energy ESWƬ on pain and functional activity in patients with sub-acute PAB. Materials and Methods The study was a single-blind randomized trial. Twenty-eight patients with sub-acute PAB were randomly divided into two groups and received either low or middle-energy ESWƬ for three weeks. The numeric pain rating scale (NPRS), short-form McGill pain questionnaire (SF-MPQ), timed up and go (TUG) test, and Western Ontario and McMaster universities index (WOMAC) were evaluated before and 2 and 3 weeks after the intervention. Results: A significant improvement was observed for low-energy ESWT in terms of NPRS (P=0.001), SF-MPQ (P

Introduction: Blood flow restriction (BFR) training, in which an inflatable cuff partially occludes blood flow around the proximal portion of a limb, coupled with low-load resistance exercise (LLRE) has resulted in gains comparable with traditional progressive resistive exercise in healthy populations. The use of BFR with LLRE may help people with supraspinatus tendinopathy through proximal effects to improve strength and muscle size. The purpose of this case report is to describe the proximal effect of the LLRE+BFR program on a patient with supraspinatus tendinopathy. Materials and Methods: The patient was a 40-year-old man with a history of shoulder pain and weakness for the past months. He received an LLRE+BFR program for his right shoulder including rotator cuff and scapular strengthening exercises and lower limbs aerobic exercises based on protocols of strengthening and aerobic exercises of BFR. Outcomes measured at baseline and 4 weeks included the 4 items: 1) Strength of supraspinatus muscle and four scapular stabilizer muscles including serratus anterior strength, middle trapezius strength, and lower trapezius strength by dynamometer, 2) supraspinatus thickness by ultrasound, 3) pain pressure threshold of supraspinatus and deltoid muscles by algometer, and 4) pain reported bay in each session based on pain numeric scale. Results: After 6 weeks, the strength of supraspinatus and scapular stabilizers except for the lower trapezius increased. The supraspinatus thickness and pain pressure threshold in the supraspinatus and deltoid muscle also increased after 4 weeks. The mean of pain reported by the patient based on the pain numeric scale before and after each session was also decreased. Conclusion: The patient had measurable improvements following the use of an LLRE+BFR program. LLRE+BFR program may be an option for strength training in people with supraspinatus tendinopathy; however, more research is needed to determine effectiveness across the population of people with supraspinatus tendinopathy.

Introduction: The purpose of the present study was to investigate the effects of single-session intramuscular electrical stimulation (IMES) on pain and dysfunction following active trigger points in the upper trapezius muscle. Materials and Methods: Volunteers (30 females) with active trigger points in the upper trapezius muscle were randomly divided into two IMES and placebo groups. For the IMES group, a needle was inserted into the trigger point, and electrical stimulation was applied to generate a pain-free contraction. For the placebo group, the intervention procedure was exactly the same, but there was no electrical stimulation. Pain by visual analog scale (VAS), pain pressure threshold (PPT), range of motion (ROM), and disability by neck disability index (NDI) were assessed as main outcome measures before, immediately after, and one week after conducting intervention by another blinded researcher. Results: The VAS scales were improved in both groups but were significantly lower in the IMES group one week after treatment. The PPT and ROM scores were substantially higher in the IMES group one week after the treatment. The NDI indexes significantly reduced for both groups, with no significant differences between them. Conclusion: IMES effectively improves pain, PPT, ROM, and NDI, following trigger points in the upper trapezius muscle. Further studies are required to investigate the IMES’s long-term effects.

Introduction: Chronic neck pain (CNP) is of the most common symptoms of musculoskeletal disorder. Diaphragmatic exercises can reduce pain, and disability, improve proprioception, and correct forward head posture (FHP) in patients with CNP. The present study aims to determine the effect of combining diaphragmatic exercises with physiotherapy on pain, disability, and active range of motions of cervical and FHP in individuals with CNP. Materials and Methods: Thirty women with CNP were randomly divided into two combined groups of diaphragmatic exercises and physiotherapy (DEPT) and PHYSIOTHERAPY ALONE (PT). Each person received ten sessions of treatment over two weeks. The results were assessed in the first and tenth sessions as well as two weeks later. Pain intensity was measured by visual analogue scale (VAS), disability by neck disability index (NDI), cervical active range of motions (CAROMs) by goniometry, and FHP by a lateral photograph. Results: The VAS, neck disability index (NDI), CAROMs, and FHP were improved after the tenth session and in a two-week follow-up (P

Introduction: Neck pain is the fourth leading cause of disability worldwide. This study aims to investigate the effects of Electro Acupuncture (EA) versus Laser Acupuncture (LA) on symptoms of women with chronic cervical myofascial pain syndrome. Materials and Methods: This is a single-blind randomized controlled clinical trial. Thirty women with chronic cervical myofascial pain syndrome were randomly divided into three groups: EA, LA, and sham. The EA group received electrical stimulation through needles at standard acupuncture points, while the LA group received low-intensity laser irradiation at the same points. The passive laser probe was applied for the sham group. The outcome measures were neck pain pressure threshold, neck pain severity, neck disability, and cervical range of motion Results: The pain severity and disability were significantly lower in the EA group than in the other two groups. The neck range of motion (cervical lateral flexion and rotation) and pain pressure threshold increased significantly in the EA group immediately and one week after the intervention. Conclusion: Both EA and LA interventions may be effective in alleviating the symptoms of cervical myofascial pain syndrome, but the EA can be more effective in reducing neck pain and disability in women with cervical myofascial pain syndrome.

Introduction: The use of High Power Laser (HPL) has recently been emphasized in physiotherapy. Previous studies suggest that the prophylactic use of laser has ergogenic effects on athletic performance by increasing the contractile function of skeletal muscles. Recently, muscle function improvement is a new research idea in the field of laser therapy. Based on our knowledge, there are only two studies on the effects of HPL on muscle performance although with contradictory results. The purpose of this study was to investigate the effects of HPL on quadriceps muscle performance in male football players. Materials and Methods: Sixteen healthy male football players (Mean±SD age=18.53±7.2 years, Mean±SD body mass index=22.8±4.4 kg/m2) participated in a pretest-posttest study. The subjects received one session of HPL (808 nm, 80 j, 2 w) on quadriceps muscles. The Isometric Peak Torque (IPT), Single-Leg Hop Test (SLHT), and Y-balance Test (YBT) were measured at baseline and immediately after HPL. For statistical analysis, we used the paired sample t test. Results: Immediately after HPL, the IPT (P=0.001), SLHT (P=0.02), and YBT scores (P=0.001) significantly increased. Conclusion: The results of our study showed that immediate application of one session of HPL can improve IPT as well as functional tests. Although the sessions of laser application and assessment were limited and the sample size was small, it seems that HPL could improve muscle performance. Therefore, further research is warranted with large sample size and follow-up.

Introduction: Musculoskeletal disorders are important causes of pain. Trigger points are one of the common reasons for myofascial pain. This study aimed to compare a single session of dry needling versus a single session of shock wave therapy on the level of pain and Range of Motion (ROM) in the people with Myofascial Pain Syndrome (MPS) of the upper trapezius muscle. Materials and Methods: Sixteen men with active trigger points of upper trapezius muscle were voluntarily attended in this study. They were randomly assigned into two groups. The patients were under a single session treatment of either dry needling or shock wave therapy. Level of pain (by Visual Analog Scale [VAS]) and active ROM of neck lateral flexion (by goniometer) were evaluated once before the treatment and immediately after the intervention. Results: The VAS scores and the neck ROMs were substantially improved at both groups of study immediately after the treatment (P0.05). Conclusion: Both dry needling and shock wave therapy can improve neck pain and ROM in patients with active trigger points in the upper trapezius muscle.

Introduction: This study aimed to compare the effects of Low-Level Laser Therapy (LLLT) combined with Dry Needling (DN) with DN alone on pain and neck disability index following myofascial pain syndrome. Materials and Methods: Sixteen women with active Trigger Points (TrPs) in their upper trapezius muscles participated in this study. They were divided into two groups: Experimental and control. The experimental group received one session of the DN plus the LLLT with 6 j/cm2 energy at their TrPs. The patients in the control group were under a similar procedure, but they did not receive any energy by the LLLT (placebo). The pain score was assessed before, immediately, and 48 hours after the treatment. Neck Disability Index (NDI) was assessed before and 48 hours after the treatment. Results: There was a significant improvement in pain intensity and NDI scores 48 hours after the treatment in both groups compared with the baseline scores (P

Introduction: Musculoskeletal disorders are among the main causes of disability in modern life. Myofascial trigger points are very common among musculoskeletal disorders and may occur through ordinary common activities. This study aimed to determine the combined effects of laser therapy and Ischemic Compression (IC) on the treatment of Myofascial Trigger Points (MTrPs) at the upper trapezius muscle. Materials and Methods: Twenty men with at least one active trigger point at their upper trapezius muscle voluntarily participated in this study. Trigger points were under treatment of laser irradiation (6 Joules per point) and also ischemic compression. Treatment approaches were applied over the pain point every other day for 5 sessions in 10 days. Neck disability index, pain intensity by visual analog scale, pressure pain threshold by algometry, and cervical lateral flexion by goniometer were assessed and recorded before the intervention, and immediately after the last session. Results: At the end of treatment, statistically significant improvements were seen in the neck disability index, VAS value, pressure pain threshold, and cervical lateral flexion. VAS values of the treatment and control groups were compared with the baseline (P

Introduction: Plantar fasciitis (PF) is an overuse syndrome as it develops over time. It is most frequently seen in both the non-athletic and athletic populations. PF is a multifactorial and self-limiting disorder that several factors are involved in its onset. Many well-established treatments are available for plantar heel pain. The purpose of this review is to determine the effectiveness of dry needling for the management of PF. Materials and Methods: This article is a review study, in which we present the studies that compare dry needling with other treatments for the management of plantar heel pain. We included all of the studies on patients with plantar heel pain and plantar fasciitis that investigated the effects of dry needling. Finally, seven articles were included in this review. The study designs were randomized controlled, quasi-experimental, and case-control. The Physiotherapy Evidence-based Database (PED) scale was used to measure the methodological quality of the studies. Results: The PEDro scoring of the articles ranged between 2.10-7.10. The results of this review show that dry needling may be useful in improving the pain of individuals with plantar heel pain and plantar fasciitis. Conclusion: Further high-quality research studies are needed to determine the effectiveness of dry needling in the management of plantar heel pain. Because a variety of protocol treatments of dry needling were used in the studies, we cannot recommend dry needling schedule prescriptions for the management of individuals with plantar heel pain and plantar fasciitis.

Introduction: The rate of football-related traumas is high. However, greater levels of fitness may decrease the probability of these injuries. Researchers believe that plyometric training can have significant short-term results. This study aimed to investigate the effects of plyometric exercises on athletic performance (speed, balance, and vertical jump ability) of male amateur futsal players. Materials and Methods: Thirty male amateur futsal players were randomly divided into control and plyometric groups. All participants went through 15 minutes of standard warm-up activity, and then they were asked to perform the tests. The athletes of the plyometric group also completed three rounds of plyometric jumps and then were assessed 3, 10, 15 and 20 minutes after the warm up. The athletes of the control group were evaluated 3, 10, and 15 minutes immediately after the standard warm-up activity. Results: The study findings indicated an overall improvement in balance and vertical jump scores of amateur futsal players following plyometric exercises (P

Introduction: Myofascial Pain Syndrome (MPS) is a common muscular disorder characterized by a referral pain to a particular area after irritating the myofascial trigger point. This study aimed to determine the combined treatment effect of laser therapy and ischemic compression of an active myofascial trigger point in the upper trapezius muscle. Materials and Methods: This is a clinical trial study conducted on 15 subjects with Active Trigger Points (ATPs). In one session, 15 subjects received laser therapy and ischemic compression. The assessment was done immediately after the treatment. We used the visual analog scale for the measurement of pain intensity, algometry (FG-5020, Taiwan made) for pressure pain threshold, and goniometer for cervical lateral flexion. Results: The cervical lateral flexion after the intervention was significantly higher than that before the intervention (P

Introduction: Osteoarthritis (OA) is one of the common causes of disabilities in adults. The prevalence of Knee Osteoarthritis (KOA) is approximately 4.9% among people over 26, 16.7% among people over 45, and 12.1% among people over 60 years old. This study aims to determine the effects of Low-Level Laser Therapy (LLLT) and laser acupuncture in decreasing pain and increasing functional activity in patients with subacute and chronic KOA. Materials and Methods: In this randomized, single-blind, controlled study, the patients with grades 2 and 3 primary KOA were assigned into two experimental groups (active low-level laser and acupuncture laser) and one control group (infrared & exercise). The patients in the experimental group I (n=23) were under low-level Ga-Al–As diode laser, 830-nm continuous waves, and received laser irradiation of 30 mW/cm2 power density, 3 mW output power, 0.1 cm2 spot size, with a total dose of 18 J and for 10 minutes on 6 acupuncture points (SP10, ST34, ST35, GB34, Xiyan, SP9) around the knee in each session. The patients in the experimental group II (n=23) received 3 J power irradiation in each cm2 in a gridding technique over a triangle-like surface of 15 cm2 over the medial, lateral, and anterior sides of the knee with a total energy density of 45 J/15 cm2 for each session. Laser therapy was applied 5 times per week for a period of two weeks (10 sessions in total). The patients in the control group (group III) were under conventional physiotherapy (superficial heat therapy and isometric knee exercises for 15 minutes every day for a similar period (10 sessions in 2 weeks). The outcome study measures were pain level at rest rated by Numeric Rating Scale (NRS), Western Ontario and McMaster Universities Osteoarthritis index (WOMAC), and Short Form of McGill Pain Questionnaire (SF-MPQ). In addition, active knee flexion and extension Range of Motions (ROMs) were measured too. These variables were evaluated at the baseline time, before the intervention, and after the intervention, on the final day of the intervention. Results: Based on statistical outcomes, a significant pain reduction by NRS and McGill, an increase in functional activity by WOMAC as well as an increase in the Range of Motion of the knee were observed in three study groups after 10 sessions. However, the result of ANOVA test showed significant difference in pain reduction among three groups and the post hoc Least Significant Difference (LSD) test showed the significant difference between laser acupuncture and conventional laser groups with the control group; the largest improvement was found in Group I. In terms of functional activity, the post hoc LSD test showed the significant difference between conventional laser and laser acupuncture groups with the control group; the largest improvement was found in Group II. No significant difference was observed among the three groups with regard to the mean values of active knee flexion and extension. Conclusion: Laser acupuncture and conventional laser are more effective in reducing pain and increasing functional activity in patients with KOA compared to conventional treatment. Clinically, laser acupuncture would appear to be superior in pain reduction.

Introduction: Nonspecific Chronic Low Back Pain (NSCLBP) is one of the most common musculoskeletal disorders among different societies. Manual therapists use different approaches for NSCLBP management and or treatment. Comparing manual techniques is a considerable controversial debate among treatment approaches. This study aimed at comparing the immediate effects following Maitland mobilization technique and Mulligan Sustained Natural Apophyseal Glide (SNAG) on flexion and extension in patients with the NSCLBP. Materials and Methods: Eighteen volunteers with NSCLBP were randomly divided into three groups: Posteroanterior (PA) mobilization, SNAG, and Sham SNAG. The PA mobilization techniques (Grade III) were performed on prone lying position (four sets of four repetitions; last 30 seconds for each technique). The SNAG techniques were performed accompanying with active flexion in sitting position (four sets of six repetitions). The sham SNAG technique was applied in sitting position while therapist touched gently patients’ backs (three sets of four repetitions). Flexion and extension Range of Motions (ROMs) were measured before and immediately after applied interventions (by inclinometer). Results: Within group analysis showed significant changes of flexion and extension in ROMs in SNAG and PA mobilization groups. Between groups analysis pointed out significant difference between the SNAG and placebo groups after interventions. Conclusion: Our results revealed increased flexion ROM following the SNAG technique and increased extension ROM after Maitland PA mobilization. However, our limited sample size might influence final results. More studies with larger sample size will be suggested.

Introduction: Tennis elbow (Lateral Epicondylitis) is one the most common elbow and arm musculoskeletal disorders. About 1% to 3% of active population in modern societies suffer from tennis elbow. Tennis elbow is usually caused by repetitive activities of hand and wrist, especially wrist extension and forearm supination. This research aimed to study high and also medium power gallium arsenide (Ga-As) laser irradiation on improving pain and grip strength (functional mobility) in patients with tennis elbow. Material and Methods: Thirty female [Mean(SD) age: 49(2.3) y] patients with acute tennis elbow were recruited for this study. The patients were randomly divided into two groups based on random allocation table. Group A (15 patients) had been received 10 J/cm2 under a 0.5 W beam medium power Ga-As laser irradiation of 980 nm wave length. Group B (15 patients) had been received same energy density under 2 W beam high Ga-As laser irradiation with the same wavelength. Laser irradiation was performed on a 9 cm2 surface of lateral elbow epicondyle based on Grid laser application technique. The patients were under treatment for 10 sessions every other day. The outcome measures of pain at rest and ring finger extension against loading, grip strength and hand function were recorded and analyzed in a pre- and post-setting. The pain severity was measured by VAS (Visual Analog Scale) and McGill questionnaire and upper extremity function was measured by DASH questionnaire. Results: Significant pain reduction was observed in resting position and ring finger extension against loading after application of both high and medium power (980 nm, 0.5-2 W) laser therapy (P

Introduction: Myofascial Pain Syndrome (MPS) is a common disorder of musculoskeletal system. About one third of the people with musculoskeletal disorders have been diagnosed as having MPS. It is a painful condition caused by trigger points. A variety of treatment approaches are used to cure MPS and its associated disorders. This study aimed to investigate the effects of single session Intramuscular Electrical Stimulation (IMES) through dry needling on pain and Range Of Motion (ROM) following trigger points in upper trapezius. Material and Methods: Sixteen volunteers with active trigger points in upper trapezius were randomly divided into two groups: 1) the IMES treatment group (8 females) and 2) placebo group (8 females). In the IMES group, trigger points of the affected side were injected through dry needling, then a burst current (2 Hz) was applied on the muscle while the electrical stimulation steadily increases to form a pain free contraction for the patient. In placebo group, the procedure was exactly the same but there was no applied electrical stimulation through dry needling. Pain sensation by Visual Analog Scale (VAS) and cervical flexion ROM were measured before treatment, immediately after treatment and one week later by another blinded researcher. Results: VAS scores showed improvement in both groups at the end of the treatment session and also one week later. There was no significant difference between the groups; IMES and placebo in terms of the VAS after treatment session. However, the pain scores were substantially decreased in the IMES group one week after the intervention. The ROMs were significantly lower in placebo group one week after treatment. There was no significant correlation between improvement and duration of symptoms. Conclusion: Both IMES and placebo methods might be effective in relieving symptoms of patients with the MPS in upper trapezius; however, patients following the IMES treatment showed higher level of improvement during one week after the intervention. Further relevant studies with higher number of volunteers and different treatment protocols are necessary to get high quality evidence.