The Effect of Mobilising the Lumbar 4/5 Zygapophyseal Joint on Hamstring Extensibility in Elite Soccer Players

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Objectives: The role of the lumbar spine to influence hamstring extensibility remains unclear. This study aimed to compare the immediate effects of L4/5 mobilisations on measures of neural and muscle hamstring extensibility in asymptomatic elite male soccer players.

Subjects: Twenty-five male soccer players from an English Premier League team with no current injury.

Methods: Players were randomly assigned to one of two groups, intervention or control. Neural hamstring extensibility was measured pre- and post-mobilisations by the straight leg raise test. The muscle biased component was measured by the passive knee extension test. Participants in the intervention group received specific lumbar mobilisations to the unilateral L4/5 zygapophyseal joint, 3 times for 1 minute, with each mobilisation separated by a 1-minute recovery, nominated by dominant kicking foot. The control group received no mobilisations between pre- and post-measures. Data were analysed using magnitude-based inferences.

Results: Lumbar mobilisations had a very likely small beneficial effect on the straight leg raise test (6.3%; 90% confidence limits ±2.7%) and a likely small beneficial effect on the passive knee extension test (-23%; ±14%).

Conclusion: Specific lumbar mobilisations have the ability to increase the neural and muscle extensibility of the hamstring muscle group in elite male soccer players in the immediate term.

Effect of neural mobilization and splinting on carpal tunnel syndrome

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Study objective: To evaluate the clinical benefit of neural mobilization and splinting compared with splinting alone in carpal tunnel syndrome (CTS).

Methods: Patients were randomized into two groups using Pre/Post-test experimental design. On day 0 and 21st (i.e. pre and post treatment), patients were administered Boston Questionnaire. Grip strength, pain intensity, and sensory testing were completed using validated outcomes measures. Both groups were advised to wear full-time neutral angle wrist splint for three weeks. Neuromobilisation technique for the median nerve was performed, the protocol included treatment of total three weeks, with six days per week management for only one group additionally and they were encouraged by the therapist to complete the self mobilisation home exercise program once a day. Independent t-test was used to compare VAS, sensory testing at three sites name as site 1(tip of the thumb), site 2(proximal index finger), site 3(tip of the index finger) and grip strength between the groups on 0 and the 21st day. Mann-Whitney Test was used to compare the score of Boston Questionnaire Symptom Severity Scale and Functional Status Scale between the groups on 0 and the 21st day.

Results: The data showed that with the use of three weeks protocol there was a significant difference (p<0.05) between post treatment values of VAS score, Boston Questionnaire Symptom Severity Scale , Functional Status Scale taken and Sensory testing at three sites i.e site 1,site 2 and site 3 on 21st day between group A and group B but more improvement was seen in the group B. The data of this study showed that there was non-significant difference between post treatment values of Grip strength on 21st day between group A and group B i.e. there was no improvement in grip strength.

Conclusion: This study demonstrated that patients suffering from CTS can have substantial improvement with the combined treatment of neural mobilisation and splinting.

Ultrasound evaluation of Achilles tendon thickness in asymptomatic’-s: A reliability study.

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Background: Achilles tendon disorders are among the most common maladies encountered in sports medicine. Increased tendon thickness is considered to be a risk factor for Achilles tendon disorders. Ultrasonography is currently the modality of choice that best demonstrate the Achilles tendon abnormalities. This study investigated Intra-rater reliability of ultrasound in Achilles tendon thickness measurements among asymptomatic’-s, performed by a qualified physiotherapist with limited ultrasound training.

Method: A test retest reliability design was used. 25 healthy participants were recruited from Sheffield Hallam University. Achilles tendon thickness measurements were performed on two occasions, approximately 30 minutes apart; by the same rater, under same testing conditions.

Results: The Intraclass correlation coefficient (ICC) for intra-rater reliability was found be excellent (ICC =0.935; 95% confidence interval, 0.88-0.96).
Implications: Ultrasound can be used in the field of physiotherapy as a clinical tool for prevention, assessment and monitoring rehabilitation of athletes.

Conclusion: Ultrasound evaluation of Achilles tendon thickness can be reliably performed by a qualified physiotherapist with limited ultrasound training. Further research is required to investigate inter rater reliability and among different patient populations with proper US training.

Physiotherapists’ perceptions of patient adherence to home exercises in chronic musculoskeletal rehabilitation.

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Background – Rehabilitation of chronic musculoskeletal conditions usually involves long-term home-based exercise programmes. Exercises have been shown to alleviate pain, improve joint mobility and stability, allow faster return to work and prevent progression of chronic conditions. Non-adherence of patients to unsupervised long-term exercise is a major problem that affects treatment outcome. This study explores UK physiotherapists’ perceptions of exercise adherence and their interventions to tackle it in clinical practice.

Method – A convenience sample of five experienced physiotherapists from Sheffield Hallam University were interviewed. Interviews were transcribed and analysed. Interpretative Phenomenological Analysis (IPA) was used to analyse data transcriptions.

Results – The identified themes revolved around issues of patient-therapist collaboration in chronic rehabilitation. The subordinate themes were: negotiating ownership and self management, education and pain, professional power and patient attitudes and communication.

Conclusion – Experienced physiotherapists recognised barriers and often critically viewed their practice. They undertook necessary interventions in their practice but persisting non-adherence made them question the patient’s role in the partnership.

Cross cultural adaptation of the Quebec Back Pain Disability Scale from English into Arabic

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Background – Back disability measures are considered important by stake-holders as they offer a means of evaluating the effect of low back pain. The Quebec Back Pain Disability Scale (QDS) is a commonly-used measure of back disability, but it has only been adapted into four languages.

Method – Using a combination of cross-cultural adaptation guidelines for self-reported measures, health professionals, methodologists and Arabic linguists voluntarily participated in cross cultural adaptation of the QDS. At least three different participants were included in each of four stages.

Results – A pre-final version of the Arabic QDS was developed. The equivalence of the adapted measure to the original QDS version was agreed by examining it from four perspectives: idiomatic, experiential, conceptual and semantic.

Implications – The pre-final version is ready to be tested in almost any Arabic speaking population. This will give the opportunity to gather data in the third most widely spoken language worldwide, representing a target population of more than 500 million people.

Conclusion – The QDS can be cross-culturally adapted into Arabic without losing any concepts of the original scale; this adapted scale is ready for further testing.

Effects of 4 weeks whole body vibration on electromechanical delay, rate of force development, and presynaptic inhibition.

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Long-term functional changes after whole-body vibration (WBV) training have been attributed to adaptations in the neuromuscular system. The present study examined the effect of four weeks of WBV training on muscle function outcome variables [rate of force development (RFD), electromechanical delay (EMD)], and spinal control mechanisms (pre-synaptic inhibition). Forty young individuals with no history of lower leg injuries were randomly assigned to an experimental or control group. The experimental group received WBV training (three bouts of two minutes, three times a week) for four weeks. During each of the training sessions, the subjects stood on the vibration platform with the knees slightly flexed. The control group performed periods of standing in the same position as the experimental subjects. After four weeks of WBV training, the experimental (WBV) group demonstrated a significant improvement in electromechanical delay (EMD). The results also showed a significant group × test interaction for RFD and intrinsic pre-synaptic inhibition (IPI) over the course of the study. Enhanced neuromuscular activation (EMD and RFD) and increased spinal reflex gain followed by 4 weeks of WBV training indicate that WBV training might be used not only for athletes engaged in sports that require explosive type of muscular activation, but also for the elderly individual who need to exert a rapid rise in muscle force in injury related situations.

Indian physiotherapists’ perceptions of factors that influence the adherence of Indian patients to physiotherapy treatment recommendations.

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Background: Non-adherence to treatment is common and costly. Outside western culture little is known about the reasons for non-adherence with physiotherapy. This qualitative, grounded theory, focus group study investigated physiotherapists’ perception of the factors affecting non-adherence of patients to physiotherapy treatment in India.

Method: Six practising physiotherapists from New Delhi, India, formed a focus group and were invited to discuss their views regarding factors influencing patient non-adherence and their strategies to cope with these factors. The dialogue was transcribed and analysed. Significant statements/ words describing non-adherence were identified and clusters of meaning developed and used to write a composite, thematic description presenting the essence of the discussion.

Results: The major factors identified were: poor awareness of physiotherapy and poor infrastructure, time, economic factors, social and cultural factors and poor communication. Patient and family education formed the basis for many of the strategies identified by physiotherapist to help them manage non-adherence.

Conclusion: Physiotherapists in India recognise some barriers to adherence and have strategies that they perceive as helpful in encouraging motivation that are unique to the Indian social context. Other barriers to adherence and strategies recognised as key to improving adherence in western countries were not recognised by this group.

Foot type and tibialis anterior muscle activity during the stance phase of gait: A pilot study

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Background – Normal functioning of the lower limb depends on correct functioning of the foot. It is hypothesized that abnormal foot biomechanics associated with different foot types, may lead to abnormal stresses on proximal muscular structures. These abnormal stresses may eventually result in musculoskeletal injuries.

Method – This experimental pilot study investigated tibialis anterior (TA) muscle electromyography (EMG) activity during stance phase of gait in healthy participants with supinated (n=8), normal (n=10) and pronated (n=10) feet. Subjects walked on a gait analysis treadmill and EMG activity of TA was recorded simultaneously. The total activity of TA during four phases of stance was compared between the three groups.

Results – No statistically significant differences were found in the EMG activity of TA during any of the stance phases of gait for subjects classified in supinated, normal and pronated groups (p>0.05).

Implications – There is no evidence to support the view that foot type will lead to lower limb injury as a consequence of altered TA muscle activity.

Conclusion – It seems that foot type may not be a factor in the development of TA related overuse injuries. However investigation of more severe groups of pronated and supinated subjects may be more revealing.

Measuring upper limb disability in non-specific neck pain: A clinical performance measure

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Clinically it is common for patients with non-specific neck pain to report problems with upper limb function. Yet the extent of upper limb deficits in patients with neck pain is not well known and there are few measures available to clinicians to help quantify upper limb capacity in patients with neck pain. This paper synthesises and presents the findings of several studies which attempt to quantify the extent of upper limb disability in patients with non-specific neck pain and describes the development, validation and limitations of the Single Arm Military Press (SAMP) test.

The SAMP test is an easy to conduct, brief, economical, performance based measure of upper limb disability which may prove beneficial for use in clinical practice in different cultural or socioeconomic communities, though further validation is required to confirm this.

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