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This study aimed to evaluate the effect of motivational interviewing (MI) and mindfulness (MF) added to neuromuscular (NM) exercises on improving pain, function, balance, and quality of life in patients with knee osteoarthritis (KOA). This randomized clinical trial was conducted on sixty patients who were randomly assigned to the MI + NM, MF + NM, and NM groups. The groups received four training sessions for six weeks. Physical function with Western Ontario and McMaster Universities Arthritis Index timed up and go, going up and down eight stairs, pain with visual analogue scale, quality of life with SF36, and balance with Biodex were evaluated before and after interventions. Within-group comparisons showed that NM + MI, NM + MF, and NM groups experienced significant improvement in all factors after six-week (p < 0.05). However, between groups, comparisons in the post-test revealed that the MI + NM group had a more significant effect on pain, function, and static balance than the MF + NM group. Nevertheless, the MF + NM group improved the quality of life better than the MI + NM and NM groups (p < 0.05). Adding psychological interventions to physical exercises had a better effect on improving the symptoms of patients. Additionally, the MI showed more effectiveness in improving the symptoms of patients. Adding motivational interviewing to neuromuscular exercises has shown to reduce pain intensity and improved function, balance and quality of life in adults with knee osteoarthritis. Adding mindfulness intervention to neuromuscular exercises has shown to reduce pain intensity and improved function, balance and quality of life in adults with knee osteoarthritis. Among the psychological interventions used, the motivational interviewing significantly showed more effectiveness in improving the pain, function, balance, and quality of life of patients with osteoarthritis. [ABSTRACT FROM AUTHOR]

BACKGROUND: Chronic low back pain (CLBP) is known as an important debilitating health condition among older women. OBJECTIVE: This study aimed to evaluate the effects of eight-week virtual reality training (VRT) exercises on postural sway and physical function performance (PFP) among older women suffering from CLBP. METHODS: Twenty-seven older women presenting with CLBP were randomized into experimental and control groups. The experimental group was instructed to perform 30-minute VRT exercises three times a week for eight weeks. Plantar pressure variables [sway velocity (SV) and anterior-posterior (AP) and medial-lateral (ML) fluctuations of the center of pressure (CoP)], 30-second chair stand test (30CST), and timed up and go (TUG) test were recorded. RESULTS: The VRT group exhibited significant decreases in SV (p = 0.002), AP (p = 0.008), and ML (p = 0.02) fluctuations. Also, the performance of the VRT group in the 30CST and TUG tests significantly improved after the exercises (P < 0.001). CONCLUSION: According to the results, VRT and the program used in this study should be used to enhance balance and PFP in older women with CLBP who mostly prefer activities that are accessible and feasible in low-risk environments. [ABSTRACT FROM AUTHOR]

Background and Aims This study evaluated the effects of neuromuscular training compared with neurofeedback and neuromuscular training on brain waves, foot and ankle ability, and pain intensity of table tennis players with chronic ankle instability. Methods This clinical trial study was conducted on 29 table tennis players with chronic ankle instability, which were randomly divided into combined neurofeedback+neuromuscular (Mean±SD age: 21.73±2.60 years, hieght: 173.42±5.57 cm, wieght: 77.10±10.42 kg) and neuromuscular groups (Mean±SD age: 22.14±2.53 years, Mean±SD height: 169.26±6.77 cm, Mean±SD weight:77.95±15.70 kg). ProComp Infiniti System and BioGraph Infiniti version 5 software were used to measure brain waves and perform neurofeedback protocol. The foot and ankle disability questionnaire and the visual analog scale were employed to assess foot and ankle ability and pain intensity, respectively. The rehabilitation protocol was performed for eight weeks. The paired t test and 1-way analysis of covariance were used for the data analyses. Results The paired t test results revealed a significant decrease in the amplitude of theta, alpha, and sensorimotor rhythm (SMR) waves in both groups (P<0.05) and an increase in the amplitude of the beta wave only in the combined group (P<0.05). In addition, ankle ability was significantly increased during daily activities and exercise in both groups (P<0.05). On the other hand, the results of a 1-way analysis of covariance indicated a significant difference between the two groups regarding theta and beta amplitudes and degree of ankle disability during exercise, and the improvement was greater in the combined group (P<0.05). Conclusion According to the results, combined exercises (neuromuscular and neurofeedback) can be used as rehabilitation in table tennis players with chronic ankle instability to correct brain waves, improve leg and ankle ability, and reduce pain. [ABSTRACT FROM AUTHOR]

Purpose: Chronic non-specific low back pain (CNSLBP) is a common health issue caused by a mix of biological, psychological, and social factors. Cognitive functional therapy (CFT) is a comprehensive way to treat CNSLBP that focuses on changing negative thoughts and unhelpful habits through relaxation techniques. Since the evidence on the efficacy of CFT is still limited, it is essential to conduct clinical trials aimed at the effectiveness of CFT in the treatment of CNSLBP. This study aims to examine the effect of cognitive functional therapy on psychological variables in women with CNSLBP. Methods: Thirty women with CNSLBP were recruited for the clinical trial. They were randomly divided into two experimental and control groups (15 patients in each group). Our experimental group will have 18 individualized CFT sessions, each lasting an hour, over two months. The control group received no intervention. Pain intensity, disability, and kinesiophobia were assessed via the visual analog scale, Oswestry, and Tampa scale, respectively. Two-way repeated measures analysis of variance (ANOVA) was used to compare results between groups. Results: Two-way repeated measures ANOVA results showed that the experimental group compared to the control group in reducing pain (P=0.000, p 2=0.787), disability (P=0.005, p 2=0.457) and Kinesiophobia (P=0.000, p 2=0.561) had a significant difference. Conclusion: CFT reduced pain, disability, and kinesiophobia in patients with CNSLBP. Further evaluation of the efficacy of CFT in high-quality randomized clinical trials among patients with CNSLBP is recommended. [ABSTRACT FROM AUTHOR]

Diastasis recti abdominis (DRA) affects a significant number of women in the postpartum period. This study compared the effectiveness of suspension training system (STS) with that of isometric-isotonic (ISoM-ISoT) exercises in the treatment of DRA and its secondary complications. Thirty-six women with DRA participated in this study. They were divided into the three groups of STS, ISoM-ISoT, and control. Inter-recti distance (IRD), proprioception, lumbopelvic control, postural stability, low back pain, and disability were assessed using a digital caliper, a goniometer, a lateral step-down test, a Biodex balance system, a visual analogue scale (VAS), and the Oswestry Disability Index (ODI), respectively. Two intervention groups underwent training for 8-week and the control group resumed their normal lives. Positive effects were observed in the STS and ISoM-ISoT groups compared with the control group in: IRD (P =.001); lumbopelvic proprioception (P =.001); lumbopelvic control (P =.001); overall static balance (P =.010); overall dynamic balance (P =.012); low back pain (P =.001); and disability (P =.001). However, there was no significant difference between the training groups in: IRD (P =.12, MD = −2.76); lumbopelvic proprioception (P =.48, MD = −0.50); lumbopelvic control (P =.14, MD = 1.53); static balance (P =.62, MD = 0.07); dynamic balance (P =.27, MD = 0.33); pain (P =.25, MD = −0.52); and disability (P =.48, MD = −1.74). The results of the minimal clinically important difference (MCID) and minimal detectable change (MDC) suggested that the STS exercises outperformed ISoM-ISoT training regarding IRD, pain, disability, and proprioception, whereas ISoM-ISoT training had a better effect in lumbopelvic control and balance. The results of our study showed that the STS had a positive effect on women with DRA and like the ISoM-ISoT exercises can be used to treat this dysfunction. [ABSTRACT FROM AUTHOR]

This study was conducted to evaluate the effects of 8-week inspiratory muscle training on activity in the ankle muscles of athletes with chronic low-back pain. A randomized controlled trial involving 45 men and women with chronic low-back pain was carried out. Electromyography activity in the tibialis anterior, peroneus longus, gastrocnemius medialis, and gastrocnemius lateralis muscles of the dominant leg was recorded. Secondary outcomes included biopsychosocial indices, such as pain, disability, anxiety and depression, fear-avoidance beliefs, and fear of (re)injury. Static and dynamic overhead squat tests showed that inspiratory muscle training decreased activity in the tibialis anterior, peroneus longus, and gastrocnemius medialis muscles. In the static single-leg squat test and the descending phase of the dynamic equivalent, such a decrease was observed in all the 4 muscles. Inspiratory muscle training significantly reduced pain severity and activity in the tibialis anterior, peroneus longus, and gastrocnemius medialis muscles during the ascending phase of the dynamic single-leg squat test. On the basis of the findings, 8 weeks of inspiratory muscle training may constitute useful rehabilitation for reducing excessive activity in ankle joint muscles and aiding chronic low-back pain recovery. [ABSTRACT FROM AUTHOR]

Purpose: Altered movement patterns and spine instability are crucial factors in the etiology of chronic non-specific low back pain (CNSLBP). The faulty recruitment pattern of core muscles causes poor support and increased loading on the lumbar spine, ultimately leading to postural instability. This study aims to examine the effect of core stability exercises (CSE) combined with abdominal hollowing (AH) on postural balance in patients with CNSLBP. Methods: The present study is a double-blind clinical trial. Thirty women with CNSLBP were recruited for the clinical trial. Patients were randomly assigned to experimental and control groups (15 patients in each group). The experimental group followed CSE with AH for 8 weeks. The control group received no intervention. Primary outcomes included pain (10 cm visual analogue scale), disability (Oswestry questionnaire), and proprioception (goniometer). Secondary outcomes included static and dynamic balance (biodex balance system). Analysis of covariance (ANCOVA) was used to compare the results and confidence intervals between groups. Results: The experimental group compared to the control group with a high effect size had a significant difference in reducing pain (P=0.021, ηp²=0.183), disability (P=0.007, ηp²=0.237), and postural reconstruction error (P=0.000, ηp²=0.566). Also, the experimental group compared to the control group with a high effect size had a significant difference in the improvement of static (P=0.008, ηp²=0.367) and dynamic balance (P=0.008, ηp²=0.757). Conclusion: The CSE combination with AH affects three active, passive, and nervous systems. It seems that the CSE combination with AH can modify the faulty movement control in local muscles, proprioception restoration, and subsequently lead to postural stability. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the effects of the 8-week FIFA 11+ Kids program on kinematic risk factors for ACL injury in preadolescent female soccer players during single-leg drop landing. For this, 36 preadolescent female soccer players (10–12 years old) were randomly allocated to the FIFA 11+ Kids program and control groups (18 players per group). The intervention group performed the FIFA 11+ Kids warm-up program twice per week for 8 weeks, while the control group continued with regular warm-up. Trunk, hip, and knee peak angles (from initial ground contact to peak knee flexion) were collected during the single-leg drop landing using a 3D motion capture system. A repeated measure ANOVA was used to analyze groups over time. Significant group × time interactions were found for the peak knee flexion, with a medium effect size (p = 0.05; effect size = 0.11), and peak hip internal rotation angles, with a large effect size (p < 0.01; effect size = 0.28). We found that the FIFA 11+ Kids program was effective in improving knee flexion and hip internal rotation, likely resulting in reducing ACL stress during single-leg drop landing in young soccer players. [ABSTRACT FROM AUTHOR]

Context: People with chronic low back pain (CLBP) suffer from weaknesses in their core muscle activity and dysfunctional breathing. Inspiratory muscle training (IMT) was recently developed to treat this condition. Objectives: The present study was conducted to investigate the effect of IMT on core muscle activity, pulmonary parameters, and pain intensity in athletes with CLBP. Design: This study was designed as a single-blind, randomized, controlled trial. Setting: Clinical rehabilitation laboratory. Participants: A total of 23 male and 24 female athletes with CLBP were randomly divided into the experimental and control groups. Main Outcome Measures: The experimental group performed IMT for 8 weeks, 7 days per week and twice daily, using POWERbreathe KH1, beginning at 50% of maximum inspiratory pressure with a progressively increasing training load. The surface electromyography muscle activity of the erector spinae, multifidus, transverse abdominis and rectus abdominis, respiratory function and Visual Analogue Scale score were also measured before and after the intervention in both groups. The repeated-measures analysis of variance and 1-way analysis of covariance were further used to compare the intragroup and intergroup results following the intervention. Results: The findings of the study revealed that multifidus and transverse abdominis activity, as well as respiratory function, increased significantly in the IMT group (P <.05). Moreover, a descending trend was observed in the Visual Analogue Scale score in the experimental group (P <.05). Conclusion: The results showed that IMT can improve respiratory function, increase core muscle activity, and, consequently, reduce pain intensity in athletes with CLBP. [ABSTRACT FROM AUTHOR]

Purpose: Pronation distortion syndrome is one of the most common physical abnormalities causing abnormalities in the lumbar pelvic and lower limb structures. This research was conducted to determine the effect of eight weeks of selected corrective games on balance, proprioception, and changes in the arch of the foot in adolescent girls with pronation distortion syndrome. Methods: In this quasi-experimental study and clinical trial, 40 girls with pronation distortion syndrome with an age range of 7-12 years participated and were randomly divided into two equal control and experimental groups. The people of the experimental group played selected corrective games for 8 weeks (3 sessions per week, 60 minutes each session); however, the control group did their normal and daily activities. The modified star or Y balance test was used to measure the dynamic balance index, a goniometer to measure proprioception and measure navicular bone loss index using the method described by Brody (Brody) in the pre-test and posttest. To analyze the data, the combined repeated measure statistical test was used (P<0.05). Results: The results of the present study showed a significant improvement in dynamic balance (P<0.001), proprioception (P<0.001), and a reduction in flat foot (P<0.001) after playing eight weeks of games. Correction in girls with pronation distortion syndrome. Conclusion: Considering the favorable impact of corrective games and the greater compatibility of these programs with the physical-psychological characteristics of children, it is suggested to use corrective games for this age period. [ABSTRACT FROM AUTHOR]

Purpose: Increased patellofemoral joint reaction force is the main cause of patellofemoral pain syndrome. Foot pronation causes faulty joint coupling of the lower limb and increases the patellofemoral joint reaction force; accordingly, this study aims to systematically review the effect of the distal interventions on the clinical symptoms and kinematics of patients with patellofemoral pain. Methods: The search strategy was applied to Google Scholar, PubMed, Science Direct, Medline, Web of Science, and Scopus databases. The search was limited to the English language. The studies were from 2000 to 2022. In 4 stages, the selected articles were screened for systematic review. The quality of the study was evaluated by the Downs and Black scale. Meanwhile, the articles were classified into 3 categories as follows: High, medium, and low quality. Results: A total of 12 articles were screened for this systematic review. The quality of the study was medium. Meanwhile, 5 articles had medium quality and 7 articles had high quality. The results of the systematic review showed that distal interventions are effective in improving clinical symptoms and correcting the faulty kinematics of the lower limb. Conclusion: Distal interventions by correcting the faulty joint coupling reduce the patellofemoral joint reaction force and pain. As a result, distal interventions in combination with proximal exercise have a better effect on clinical symptoms. [ABSTRACT FROM AUTHOR]

Objectives: Children aged 10 to 12 years often show dangerous maneuvers during landing, which include increased knee valgus, placing them at higher risk of anterior cruciate ligament (ACL) injuries. The study aimed to investigate the relation of the trunk and hip kinematics with the peak knee abduction angle during single-leg landing among preadolescent female soccer players. Methods: Thirty-six preadolescent female soccer players aged 10 to 12 years attended the study. Participants did a static trial and after that performed landing trials. A single-leg landing was applied to assess the landing kinematics. A three-dimensional motion capture system was applied to analyze trunk, hip, and knee kinematics. Results: Pearson correlation coefficient demonstrated a significantly positive relationship between peak hip internal rotation angle (r=0.361) (P=0.03) and peak knee abduction angle. Furthermore, no significant relationship was identified between peak hip adduction (r=-0.102) (P=0.55), peak trunk rotation (r=0.239) (P=0.16), peak trunk lateral flexion (r=0.052) (P=0.76), and peak valgus knee. Discussion: Peak hip rotation angle was correlated with the valgus knee with a weak correlation value among preadolescent female soccer players. Future studies should consider kinematic risk factors related to ACL injuries in combination with neuromuscular control trunk and hip during more demanding tasks. [ABSTRACT FROM AUTHOR]

Purpose: Sensorimotor impairment in the elderly leads to increased postural sway and plantar pressure distribution asymmetric. The plantar pressure distribution asymmetrical can cause secondary problems, such as forefoot pain, neuropathic plantar ulcers, and metatarsal stress fractures. Therefore, this study aims to examine the effect of sensorimotor training on the plantar pressure distribution symmetry in healthy elderly women. Methods: Forty healthy elderly women participated in this study and were randomly assigned to two experimental and control groups (20 people in each group). Pressure distribution was evaluated during standing with double-legs and eyes closed. The experimental group performed sensorimotor training for eight weeks, and the control group did not receive any intervention during this period. The statistical method of analysis of covariance (ANCOVA) was used to compare the results between the two groups. Results: Analysis of covariance (ANCOVA) test showed that after eight weeks of sensorimotor training, the plantar pressure distribution in the forward and backward of the right (P=0.000) and left (P=0.000) foot was balanced with a high effect size. In addition, the plantar pressure distribution symmetry of the inter-limb was balanced after eight weeks of sensorimotor training with a high effect size (P=0.015). Conclusion: Sensorimotor training by adjusting balance strategies and increasing the impulse sent from mechanical receptors cause sensorimotor integration and facilitates muscle activity. As a result, posture sway is reduced and plantar pressure distribution symmetrical. [ABSTRACT FROM AUTHOR]

Background: Anterior cruciate ligament (ACL) reconstruction is performed as the gold standard of care for patients with ACL rupture. ACL reconstruction provides successful clinical outcomes, however, it cannot repair faulty lower limb mechanics. The loading asymmetry between right and left limbs during movement is often used to measure the effectiveness of surgical interventions and the potential risks of re-injury. Objectives: This study aims to evaluate the interlimb asymmetry of vertical ground reaction in patients with ACL reconstruction. Methods: An online search was done in the following databases: Science Direct, Scopus, PubMed, and Google Scholar. Then, studies from 2000 to 2022 were extracted. Selected articles were screened in a 4-step process according to the inclusion and exclusion criteria. Two researchers evaluated the methodological quality of the articles with the modified Downs and Black checklist. Finally, studies were classified into 3 categories: low (< 40%), medium (40% - 69%), and high quality (= 70%). Results: Finally, 9 studies were selected for the systematic review. The average methodological quality was 68.33% (range 54% - 80%), which shows the medium quality of the studies. A total of 4 articles had high methodological quality and 5 articles had medium quality. The results of 8 studies reported asymmetric vertical ground reaction force after ACL reconstruction. Only 1 study reported no significant difference in the asymmetrical vertical ground reaction force. Conclusion: Patients undergoing ACL reconstruction have knee flexion limitation and decreased quadriceps muscle strength. Eventually, this mechanism of energy absorption by the active tissue decreases, and mainly the shock absorption by the passive tissue increases. As a result, this mechanism leads to ACL re-injury and tibiofemoral joint cartilage damage. [ABSTRACT FROM AUTHOR]

Background: Core muscles play an important role during sports activities and these muscles control trunk stability via appropriate contraction. This study aimed to investigate the effect of immediate respiratory muscle sprint-interval training (RMSIT) on the activity of the selected trunk muscles and lumbopelvic motor control in athletes with chronic low back pain (CLBP). Methods: A double-blind randomized controlled trial design was used for this study. The study population, 48 young athletes aged 18-25 years with CLBP, was randomly divided into training (n = 24) and control groups (n = 24). The study procedure was explained to the subjects. RMSIT was performed by the training group using a spirometer. The training program included six sets of 30-second breathing exercises. Surface electromyography of the selected local (transverse abdominis, multifidus) and global (erector spinae, rectus abdominis) muscles of the trunk and lumbopelvic motor control and patients’ perceived low back pain in pre- and post-tests were recorded in both groups. Results: The results showed that the activity of the transverse abdominis and co-contraction of local muscles significantly increased (P ≤ 0.05) in the training group during static and dynamic overhead squat and single-leg squat. In addition, lumbopelvic stability in the right and left side significantly improved in the training group. Conclusion: RMSIT can improve local muscle activity and co-contraction of local muscles activity in athletes with CLBP. Moreover, these training can improve lumbopelvic stability. [ABSTRACT FROM AUTHOR]

Purpose: Higher loading rates have been associated with injuries, plantar fasciitis, tibia bone stress injuries, knee osteoarthritis, and patellofemoral pain (PFP). The aim of this study is to evaluate the loading rate in PFP patients compared to healthy individuals during weight bearing tasks. Methods: Search strategy was conducted in databases: Science Direct, Scopus, PubMed and Google Scholar. The outcome measuring: loading rate were during weight bearing tasks. The quality of the studies was evaluated by Down and Black index and it was divided into three groups: low quality (LQ), medium quality (MQ) and high quality (HQ). The standardized mean difference between PFP patients and healthy individuals was used to calculate the effect size. Results: Seven articles were included of that 4 studies was HQ and 3 MQ were classified. The no significant difference between PFP patients and healthy individuals in the loading rate (p=0.52) ; But strong evidence with medium effect size (SMD=0.50; 95% CI=[-1.01 to 2.00]) indicates a tendency to increase loading rates in PFP patients compared to healthy individuals. Conclusion: The compensatory mechanism in PFP patients, decrease of active shock absorption which finally leads to higher loading rates that can have effect on the tibiofemoral joint that correlating to the development of pain and knee osteoarthritis. [ABSTRACT FROM AUTHOR]