Journal of Back and Musculoskeletal Rehabilitation

Cupping therapy has been used to treat musculoskeletal impairments for about 4000 years. Recently, world athletes have provoked an interest in it, however, the evidence to support its use in managing musculoskeletal and sports conditions remains unknown.

To evaluate the evidence level of the effect of cupping therapy in managing common musculoskeletal and sports conditions.

2214 studies were identified through a computerized search, of which 22 met the inclusion criteria. The search involved randomized and case series studies published between 1990 and 2019. The search involved five databases (Scopus, MEDLINE (PubMed), Web of Science, Academic Search Complete PLUS (EBSCO), and CrossRef) and contained studies written in the English language. Three analyses were included: the quality assessment using the PEDro scale, physical characteristic analysis, and evidence-based analysis.

The results showed that most studies used dry cupping, except five which used wet cupping. Most studies compared cupping therapy to non-intervention, the remaining studies compared cupping to standard medical care, heat, routine physiotherapy, electrical stimulation, active range of motion and stretching, passive stretching, or acetaminophen. Treatment duration ranged from 1 day to 12 weeks. The evidence of cupping on increasing soft tissue flexibility is moderate, decreasing low back pain or cervical pain is low to moderate, and treating other musculoskeletal conditions is very low to low. The incidence of adverse events is very low.

This study provides the first attempt to analyze the evidence level of cupping therapy in musculoskeletal and sports rehabilitation. However, cupping therapy has low to moderate evidence in musculoskeletal and sports rehabilitation and might be used as a useful intervention because it decreases the pain level and improves blood flow to the affected area with low adverse effects.

Studies on the effects of performing short foot exercises (SFEs) on the medial longitudinal arch (MLA) have been inconclusive.

This study aimed to conduct a systematic review of the effects of SFEs.

‘SFE’ and ‘intrinsic foot muscle’ were keywords used to search for randomized controlled trials. One researcher screened relevant articles based on their titles and abstracts, and two independent researchers closely read the texts, accepting nine studies for inclusion. Outcomes, intervention duration, frequency, and the number of interventions were investigated.

Of 299 potential studies identified, the titles and abstracts of 211 studies were reviewed, and 192 were excluded. The full texts of 21 studies were obtained and evaluated according to inclusion and exclusion criteria. Nine studies met the inclusion criteria. Six studies concerning the MLA were identified, with four reporting MLA improvement. There was no consensus concerning the number and frequency of SFEs performed, and the mechanism of MLA improvement was unclear. MLA improvement was observed in participants who undertook ⩾ 5 weeks of interventions.

The results suggest that performing SFEs for ⩾ 5 weeks is effective in improving the MLA. Randomized controlled trials with details concerning the number and frequency of treatments are required.

Even though literature indicates presence of weak hip abductors and lateral rotators’ in Patellofemoral Pain (PFP), studies evaluating the effect of hip abductors and lateral rotators strengthening to improve knee function and quality of life in PFP are limited.

This study systematically reviews and meta-analyzes the best evidence on the therapeutic value of strengthening hip abductors and lateral rotators muscles for treating PFP with a presumptive hypothesis that strengthening hip muscles stabilizes the patellofemoral joint, relieves pain, and enhances knee functions.

Medline, EMBASE, CINAHL, PEDro and PubMed Central databases were searched between January 1994 and September 2019 using the PICOS tool. The methodological quality of the selected studies were appraised individually using the 20-item McMaster Critical Review Form for Quantitative Studies. Supplemental quality appraisal of randomized controlled clinical trials performed using the Cochrane Collaboration’s ‘Risk of bias’ quality criteria. Data on patient population demographics, interventions, duration of intervention, and outcome measures were extracted and summarized in evidence tables and descriptive analysis. Meta-analyses under both fixed and random-effects models determined pooled effects size from appropriate RCTs.

All fourteen studies demonstrated that hip muscle strengthening improved pain and knee function. All RCTs, except one, demonstrated that hip muscle strengthening is superior to quadriceps strengthening. Of the five RCTs assessing the additional effect of hip-quad versus quadriceps strengthening, four suggested that hip-quad strengthening is superior to standard quadriceps strengthening alone to improve PFP and knee function.

In adult patients with PFP, strengthening hip abductors and lateral rotators’ have beneficial therapeutic effects than the conventional quadriceps exercises in improving knee pain and function both in the short- and long term. However, the present review data can be used to develop a standardized hip-quad protocol in the future.

Chronic neck pain is one of the main reasons for visiting a healthcare professional. In recent years, it has been shown that upper cervical restriction may be a factor involved in neck pain.

To compare the immediate effects of a real cervical mobilization technique versus a sham cervical mobilization technique in patients with chronic neck pain and upper cervical restriction.

This was a randomised, controlled, double-blind clinical trial. Twenty-eight patients with chronic neck pain were recruited and divided into two groups (14 = real cervical mobilization; 14 = sham mobilization). Both groups received a single 5-minute treatment session. Upper cervical range motion, flexion-rotation test, deep cervical activation and pressure pain threshold were measured.

In the between-groups comparison, statistically significant differences were found in favour of the real cervical mobilization group in upper cervical extension ( p = 0.003), more restricted side of flexion-rotation test ( p < 0.001) and less restricted side of flexion-rotation test ( p = 0.007) and in the pressure pain threshold of the right trapezius ( p = 0.040) and right splenius ( p = 0.049). No differences in deep muscle activation were obtained.

The real cervical mobilization group generates improvements in upper cervical spine movement and pressure pain threshold of right trapezius and right splenius compared to the sham group in patients with chronic neck pain and upper cervical restriction.

Acute central cord syndrome (ACCS) without fractures or dislocations is the most common form of incomplete spinal cord injury.

To evaluate the effectiveness of different surgical methods in the treatment of acute central cord syndrome without fractures or dislocations of the cervical spine.

A total of 164 patients with ACCS without fracture or dislocation of the cervical spine treated in our hospital from May 2012 to October 2019 were recruited and assigned to study group A and study group B according to different treatment modalities, with 82 cases in each group. Study group A underwent anterior cervical discectomy and fusion, and study group B was treated with posterior cervical laminectomy. The American Spinal Injury Association (ASIA) classification and motor scores of all cases at admission and at discharge were recorded, and the treatment outcomes of the two groups were compared.

No significant differences were found in the ASIA classification and ASIA motor scores between the two groups at admission ( P > 0.05). One year after surgery, the ASIA motor scores and sensory scores were not statistically significant between the two groups ( P > 0.05) but showed significant improvement compared to the preoperative scores ( P < 0.05).

Both anterior cervical discectomy and fusion and posterior cervical laminectomy can improve the ASIA classification, ASIA motor scores, and sensory scores of ACCS patients without fractures or dislocations of the cervical spine. Therefore, surgical methods should be adopted based on the patients’ conditions.

Patients with stroke have hypomobility in the facet joint of affected side. Lumbar joint mobilization could be used to maintain function and mobility of the joints.

This study aimed to investigate the effects of lumbar joint mobilization on trunk function, postural balance, and gait in patients with stroke.

Thirty patients with stroke were randomly assigned to two groups. Lumbar joint mobilization was provided for 15 min, 5 times a week for 6 weeks to patients who were allocated into the experimental group. Patients who were allocated into the control group received a sham intervention. Trunk function (trunk impairment scale), postural balance (weight distribution, Berg balance scale, and timed up and go test), and walking (10 m walk test, functional gait assessment, step length, and stride length) were evaluated before and after the experiment for all the patients.

Lumbar joint mobilization significantly improved trunk function, postural balance, and gait compared with pre-test values in the experimental group ( P < 0.05). Significant differences were seen in trunk function, postural balance, and walking between the two groups ( P < 0.05).

Lumbar joint mobilization might be an effective intervention for trunk function, postural balance, and walking in patients with stroke.

The multifidus muscle plays a major role in the growth and postural control of children. Therefore, the reference values of the cross-sectional area (CSA) of the lumbar multifidus muscle represent an important tool for assessing muscle development and the early monitoring of musculoskeletal disorders.

The aim of this study was to provide percentile scores for the CSA of the lumbar multifidus muscle in eutrophic children aged 5 to 10 years.

This was a cross-sectional, observational study, involving 736 children. An anthropometric assessment was conducted and ultrasound (US) imaging was used to assess the CSA of the lumbar (vertebral level L5) multifidus muscle. The CSA was expressed as percentile scores.

The CSA in the boys ranged from 1.8 cm 2 to 5.3 cm 2 and in girls from 1.9 cm 2 to 5.9 cm. The CSA in the 50 th percentile scores of both sexes was 3.4 cm 2 . There was an increase in the CSA between 5 and 7 years old in both sexes. The CSA presented a greater variance in girls than in boys. After 8 years of age, the multifidus CSA increased in girls and decreased in boys.

The present study has provided percentile scores for the CSA of the lumbar multifidus muscle for eutrophic children aged 5 to 10 years. An increase was observed of the CSA of the multifidus muscle between the ages of 5 and 7 years and there were no differences in the CSA percentiles in relation to sex. An increase in the CSA after 8 years of age was only observed in the girls.

Osteoporotic vertebral compression fractures (OVCFs) are the most common complication of osteoporosis, a worldwide disease that disturbs the elderly.

The purpose of the study was to comprehensively compare the clinical efficacy of unilateral percutaneous kyphoplasty (UPKP) and bilateral percutaneous kyphoplasty (BPKP) when treating OVCFs and evaluate their ability to maintain the outcomes in a 2-year follow-up.

From January 2015 to December 2016 a total of 79 patients with OVCFs were included in the study. They were divided into UPKP group and BPKP group. Subsequently, perioperative data, radiological outcomes, clinical outcomes, and complications were compared between two groups. The follow-up consultation was 3 months, 1 year, and 2 years after the operation.

37 of patients (14 males, 23 females) were allocated to the UPKP group and 42 patients (13 males, 29 females) were treated with BPKP. The duration of operation and injected cement volume were significantly higher in the BPKP group than those of the UPKP group. BPKP achieved significantly higher improvement in middle height and volume of the fractured vertebral body than UPKP did. There were significantly higher losses of anterior, middle height and volume of the fractured vertebral body in the UPKP group at 2-year follow-up than in the BPKP group. At the final follow-up, Oswestry Disability Index (ODI) of BPKP group was lower than that of UPKP group.

Both UPKP and BPKP achieve satisfactory radiological and clinical outcomes when treating OVCFs. However, in a 2-year follow-up, BPKP maintains vertebral height restoration, volume of vertebral body, and ODI better than UPKP do.

Length of stay and functional outcomes after total knee arthroplasty (TKA) are related to the timing and intensity of post-operative rehabilitation.

To determine the effectiveness of early and high-intensity rehabilitation after simultaneous bilateral TKA.

Prospective cohort data of 156 patients (11 men and 145 women; average age 72.0 ± 5.6 years) who underwent simultaneous bilateral primary TKA were analyzed. The intervention group ( n = 82) underwent a high-intensity rehabilitation (phase II) after early postoperative standard rehabilitation (phase I) between June 2019 and May 2021. The control group ( n = 74) underwent a lower-intensity rehabilitation (phase II) after phase I rehabilitation between July 2017 and May 2019. The timed up-and-go (TUG) test, timed stair climbing test (SCT), 6-minute walk test, isometric knee extensor and flexor strength of both knees, knee flexion and extension range of motion, Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) for pain, stiffness, and functional levels, and the EuroQol five-dimension questionnaire were assessed preoperatively and 6 weeks after TKA.

The average length of hospital stay was shortened by 5.7 days ( p < 0.001). Phase II rehabilitation started earlier in the intervention group than in the control group (7.7 ± 1.3 vs 13.5 ± 2.0, p < 0.001). Compared with the control group, the intervention group showed significant improvements in the measures of mobility (WOMAC-function and SCT) and strength (isometric strength of both knee extensors and flexors) 6 weeks after TKA by statistically controlling for age and preoperative functional status.

This study demonstrated that early and high-intensity rehabilitation could achieve functional improvement and shorten the length of hospital stay.

Lower back pain (LBP) is a principal cause of disability worldwide and is associated with a variety of spinal conditions. Individuals presenting with LBP may display changes in spinal motion. Despite this, the ability to measure lumbar segmental range of motion (ROM) non-invasively remains a challenge.

To review the reliability of four non-invasive modalities: Video Fluoroscopy (VF), Ultrasound imaging (US), Magnetic Resonance Imaging (MRI) and Radiography used for measuring segmental ROM in the lumbar spine in-vivo.

The methodological quality of seventeen eligible studies, identified through a systematic literature search, were appraised.

The intra-rater reliability for VF is excellent in recumbent and upright positions but errors are larger for intra-rater repeated movements and inter-rater reliability shows larger variation. Excellent results for intra- and inter-rater reliability are seen in US studies and there is good reliability within- and between-day. There is a large degree of heterogeneity in MRI and radiography methodologies but reliable results are seen.

Excellent reliability is seen across all modalities. However, VF and radiography are limited by radiation exposure and MRI is expensive. US offers a non-invasive, risk free method but further research must determine whether it yields truly consistent measurements.

Acupoints are considered a dynamic functional area, which can reflect the internal condition of the body. In pathological states, disease-related acupoints are believed to be activated, which is known as acupoint sensitization.

This study aimed to investigate the major manifestations of acupoint sensitization in patients with chronic low back pain (cLBP) to provide better understanding of acupoint sensitization phenomena in the context of cLBP.

This study was a matched-sample cross-sectional study 16 participants diagnosed with cLBP and 16 healthy controls matched in age, sex, and ethnicity were included. The following aspects of sensitization phenomena of targeted points were compared: pressure pain threshold (PPT), skin temperature, surface electrical conductance, receptive field, and morphological change of skin.

PPT at points of interest were significantly lower in cLBP participants compared with healthy controls ( P < 0.05); in addition, receptive field was found to be larger at left BL 23 in cLBP participants ( P < 0.05). There was no statistically significant difference in skin temperature, electrical conductance, or morphology between the two groups.

Reduced PPT at all detected points and enlarged receptive field at left BL 23 were found in cLBP participants. These two features appear key in defining acupoint sensitization in cLBP, and provide evidence for selecting and locating acupuncture points in future clinical studies.

Periprosthetic joint infection (PJI) is one of the worst complications following total joint arthroplasty (TJA). Unfortunately, effective prevention strategies to reduce the burden of PJI have not been fully determined in hip replacement patients with fracture and non-fracture.

This study aimed to analyze and compare the demographic characteristics, microbiological profiles and antibiotic resistance of PJI after hip replacement between patients with fracture and non-fracture.

We retrospectively analyzed the data of 132 patients who treated PJI. There were divided into two groups: non-fracture group (64 patients infected after hip replacement for fracture) and non-fracture group (68 patients infected after hip replacement for non-fracture). Microorganisms were obtained from the synovial fluid and infected necrotic tissue in the joint capsule, medullary cavity, or acetabulum in all patients, and microbiological profiles and antibiotic resistance were evaluated.

Coagulase-negative staphylococci (CoNS) were the most common pathogenic microorganisms in all patients. Methicillin-resistant Staphylococcus (MRS) accounted for 25% in all pathogenic microbes. Staphylococci showed high drug resistance rates to clindamycin, levofloxacin, and all of the first- and second-generation cephalosporins. MRS isolates in non-fracture group had higher drug resistance rates to clindamycin and levofloxacin than than those in fracture group. Gram-negative bacilli (GNB) showed high drug resistance rates to Aztreonam, gentamicin and all of the third- and fourth-generation cephalosporins. Furthermore, GNB isolates in the non-fracture group showed higher resistance rates to gentamicin and all of the third- and fourth-generation cephalosporins.

MRS isolates in the non-fracture group showed higher drug resistance rates to clindamycin and levofloxacin, and GNB isolates in non-fracture group showed higher drug resistance rates to gentamicin and all of the third- and fourth-generation cephalosporins.

When a patient with a prior history of malignancy and radiotherapy develops progressive weakness as a presentation of plexus involvement, the differential diagnosis usually rests between radiation-induced plexopathy and invasion from recurrent tumor. The presence of myokymic discharges is helpful in differentiating radiation-induced from neoplastic plexopathy.

To present a case report of a patient with chordoma, a locally aggressive tumor, who was diagnosed with recurrent tumor accompanied by the occurrence of myokymia in needle electromyographic examination.

A 55-year-old male patient with a history of chordoma and radiotherapy presented to our outpatient clinic with complaints of foot drop, and impaired walking for two months. His latest magnetic resonance imaging (MRI) which was performed three months earlier did not show recurrence. Upon electromyographic evaluation, myokymia, the pathognomic electromyography abnormal wave for radiation plexopathy was detected supporting a diagnosis of radiation plexitis rather than recurrent neoplastic invasion. One month later he presented with more severe pain and was re-evaluated by an MRI, on which a mass was detected indicating relapse.

With this case report, we would like to emphasize that the behaviour of the tumor should be considered and imaging should be repeated when tumors display aggressive or recurrent behaviour.

There is no consensus about which training methods will give better early outcomes after total hip arthroplasty (THA).

To investigate the short-term effects of cross trainer exercise on physical function and walking ability following THA.

Fifty patients who underwent THA were randomly allocated into two groups. The intervention program was started 3 days after surgery. The main physical function results were pain, hip range of motion, knee extensor strength, single-leg stance time, and walking performance test. In addition, the number of days of requiring to walk and the length of hospital stay were recorded.

In the comparison between groups at discharge, the patients in the cross trainer group had significantly less hip pain while walking, improvement in knee extensor strength, increased single-leg stance time, as well as increased walking speed and stride length at discharge. The number of days required to walk and length of stay were also significantly lower in the intervention group.

Conclusions: Cross trainer exercise commencing 3 days postoperatively improves physical function and walking ability after THA.

Several biomechanical outcomes are being used to monitor the risk of injuries; therefore, their reliability and measurement errors need to be known.

To measure the reliability and measurement error in lower limb 3D gait analysis outcomes during a 90 ∘ and 135 ∘ change of direction (COD) manoeuvre.

A test re-test reliability study for ten healthy recreational players was conducted at seven-day intervals. Kinematics (Hip flexion, adduction, internal rotation angles and knee flexion abduction angles) and kinetics (Knee abduction moment and vertical ground reaction force) data during cutting 90 ∘ and 135 ∘ were collected using 3D gait analysis and force platform. Five trials for each task and leg were collected. Standard error of measurement (SEM) and the intraclass correlation coefficient (ICC) were calculated from the randomised leg.

The ICC values of the kinematics, kinetics, and vertical ground reaction force (VGRF) outcomes (90 ∘ and 135 ∘ ) ranged from 0.85 to 0.95, showing good to excellent reliability. The SEM for joint angles was less than 1.69 ∘ . The VGRV showed a higher ICC value than the other outcomes.

The current study results support the use of kinematics, kinetics, and VGRF outcomes for the assessment of knee ACL risk in clinic or research. However, the hip internal rotation angle should be treated with caution since the standard measurement error exceeded 10% compared to the mean value. The measurement errors provided in the current study are valuable for future studies.

Inclined walking is associated with multiple musculoskeletal benefits and is considered a therapeutic exercise. Various patterns of increased and decreased muscle activation with inclined surfaces have been observed in normal muscles, with more focus on the proximal lower limb musculature.

The aim of this study was to assess the differences in electromyographic activation of gastrocnemius, soleus, and tibialis anterior at various inclined surfaces during gait.

Fourteen healthy male participants aged between 17–30 years walked at a self-selected speed at motor driven treadmill on 0, 2 and 4 degrees of inclination. EMG activity of the muscles was recorded using the Delsys Trigno surface EMG system.

Results showed that muscular activation of tibialis anterior significantly decreased with increase in the level of inclination ( p < 0.05). However, soleus, gastrocnemius medialis and gastrocnemius lateralis showed no significant differences ( p > 0.05) in their muscular activation, and no noticeable trends were found. Furthermore, no significant difference was found between all the muscles at ground level and inclined level 2 and 4.

These differences in activation patterns found in distal extremity can be useful for designing rehabilitation protocols in sports training and for patients with neurological and musculoskeletal pathologies.

Accuracy studies of biophotogrammetry protocols require standardization similar to radiography.

To estimate the diagnostic accuracy of a biophotogrammetric assessment protocol for cervical hyperlordosis, compared to radiography, and its intra- and inter-examiner reliability for measuring the cervical lordosis angle.

A study of diagnostic accuracy in women complaining of cervical pain. Two photos were taken using the CorelDraw biophotogrammetric protocol and one radiograph using the Cobb C1-C7 method. The Intra- and Inter-examiner reliability was calculated using the Kappa index and the intraclass correlation coefficient (ICC). The Bland-Altman plot and the ROC curve were presented.

The sample consisted of 19 women. The accuracy of biophotogrammetry was 94.73% and the reliability between biophotogrammetry and radiography presented an ICC of 0.84 and a Kappa of 0.87. The excellent intra (ICC = 0.94) and inter-examiner (ICC = 0.86) reliability of the biophotogrammetry was confirmed. The area under the ROC curve was 93.5%. The Bland-Altman plot indicated differences between the two instruments close to the mean (1.5 ∘ ).

The biophotogrammetric protocol proved to be accurate in diagnosing cervical hyperlordosis, with excellent reliability between the biophotogrammetric and radiographic assessments. It also demonstrated excellent intra- and inter-examiner reliability in measuring the cervical lordosis angle.

Both spinal manipulation (SM) and Integrated Neuromuscular Inhibition Technique (INIT) have a positive effect in individuals with chronic neck pain (CNP), especially when they are combined with therapeutic exercise (TE). However, it has not been determined which of the above combinations is more effective in patients with CNP.

To compare the efficacy of two different manual techniques (SM and INIT), when combined with the same TE program in the management of CNP.

Eighty women with CNP, allocated into four groups of 20 persons each. The first group followed a 10-week TE program, the second TE and INIT, the third TE and SM, and the fourth was the control group. The Visual Analogue Scale (VAS) for pain, Neck Disability Index (NDI), Pressure Pain Threshold (PPT) of the neck muscles, neck active Range of Motion (ROM), Maximum Isometric Strength (MIS) of the neck muscles, craniocervical flexion test (CCFT) and SF-36 questionnaire scores were evaluated before, during and after the treatment period, with a six-month follow-up.

There was between groups differences between the three intervention groups and the control group ( p < 05), with the positive effects being maintained until the six-month follow-up. However, this improvement occurred earlier in the “TE + INIT” and “TE + SM” groups than in the “TE” group. Differences between the “TE + INIT” and the “TE + SM” groups were noticed only in the neck muscles PPT values, in which the “TE + INIT” group showed greater improvement. Furthermore, some non-statistically significant indications for further improvement of “TE + SM” were noted in the left lateral flexion ROM.

The addition of INIT as well as SM in the same TE program can further increase the beneficial effect of exercise in women with CNP. In most measurements both combinations seem to be equally effective. However, INIT improved more local muscle tenderness, whereas SM aided more in the neck lateral flexion ROM.

Patients’ knowledge about low back pain (LBP) negatively influences LBP prognosis. Studying the extent of patients’ knowledge about LBP may help clinicians design effective LBP treatment strategies.

To explore the level of LBP knowledge and its associated factors in patients with LBP.

A cross-sectional study with a representative sample. Participants with acute or chronic LBP completed a self-administered questionnaire including sociodemographic and clinical characteristics. We used the Low Back Pain Knowledge Questionnaire (LBP_KQ) to assess knowledge, the Fear-Avoidance Beliefs Questionnaire for LBP (FABQ_LBP) to assess fear of movement, the Oswestry Disability Index (ODI) to assess functional disability, Depression Anxiety Stress Scales (DASS 21) to assess mental health status, and the Numeric Pain Rating Scale (NPRS) to assess pain intensity.

A total of 271 individuals with LBP completed the study. The mean age of participants was 39.86 ( ± 11.27), the LBP chronicity median was 18 (IQR = 44) months, and 56.5% of the participants were females. The mean LBP_KQ score was 9.29 ( ± 3.89)/24. An educational level higher than high school (diploma education ( β = 1.202 [95%CI: 5.633 to 11.498], p < 0.001), bachelor or higher education ( β = 2.270 [95%CI: 1.107 to 3.433], p < 0.001)), and using pain killers ( β = 1.180 [95%CI: 0.140 to 2.221], p = 0.026) were significantly associated with higher LBP_KQ score. While being employed ( β = - 1.422 [95%CI: - 2.462 to - 0.382], p = 0.008) and having higher DASS Anxiety score ( β = - 0.144 [95%CI: - 0.240 to - 0.048], p = 0.003) were significantly associated with lower LBP_KQ score.

Individuals with chronic LBP in Jordan demonstrated relatively low levels of LBP knowledge related to their condition. Rehabilitation personnel, healthcare stakeholders, and policymakers should carefully monitor the level of LBP knowledge and its associated factors.

Adhesive capsulitis (AC) is a common musculoskeletal disease characterized with shoulder pain, limitation of range of motion (ROM) and disability. Although physical therapy is used in the treatment of AC, studies on its effectiveness are continuing.

This study aimed to assess the effectiveness of ultrasound (US) and high-intensity laser therapy (HILT) in the treatment of AC.

Sixty patients were randomized into two groups. Group I received US (15 sessions) and Group II received HILT (9 sessions) for 3 weeks. In addition, all patients received physical therapy program (hot pack, TENS and exercises). Assessments were made using VAS-pain, Shoulder Pain and Disability Index (SPADI), range of motion (ROM) at baseline and in post-treatment 3 rd , 8 th and 24 th weeks.

There was no statistically significant difference between the groups in terms of all pre-treatment values. In intragroup assessment, statistically significant difference was identified in all the values of Groups 1 and 2 in all assessment periods compared with the pre-treatment values ( p < 0.05). There was no significant difference between groups in all assessment periods.

According to results, US therapy and HILT were effective on the improvement of pain, ROM and functional conditions of patients in the treatment of AC.

Andersson lesion (AL) is a rare complication of ankylosing spondylitis (AS). Its clinical outcome of surgical treatment needs further exploration.

To evaluate the clinical and radiological outcomes of transforaminal thoracolumbar intervertebral fusion (TTIF) in the treatment of AS patients with thoracolumbar AL.

Fourteen patients with thoracolumbar AL who suffered from back pain, spinal instability or kyphotic deformity were retrospectively recruited. The clinical outcomes were evaluated with Visual Analog Scale (VAS) and Oswestry Disability Index (ODI). Radiological outcomes were measured with local kyphotic (LK) angle and general kyphotic (GK) angle.

Before surgical treatment for the AL patients, their VAS score and ODI score was 8.0 ± 0.2 and 64.0 ± 6.9, respectively. After TTIF surgery, VAS score of the patients was improved to 2.4 ± 0.5 ( p < 0.01) and ODI score was decreased to 17.0 ± 3.7 ( p < 0.01). One patient with neurological deficit showed an improvement in the Frankel grade from C to D and all others were grated E-level before and after surgery. For radiological outcomes, patients’ LK angle was reduced from 18.5 ± 7.2 to 11.0 ± 6.4 ( p < 0.01) and GK angle was reduced to 38.6 ± 8.8 from 42.8 ± 10.4 ( p < 0.01) at the 1-year follow-up.

For AS patients with thoracolumbar AL, we propose that TTIF is an effective and safe operative treatment, which can achieve good fusion, satisfactory radiological and clinical outcomes.

A significant increase in the dorsiflexion range of motion (DFROM) after calf muscle stretching has been widely studied. However, it has been shown that the upper body is connected to the ankle joint by passive connective tissues.

The purpose of this study was to examine the effect of upper-back stretching on the mobility of the contralateral ankle.

In the supine position, DFROM in the contralateral leg was measured. In the sitting position with and without trunk rotation, DFROM was measured in both legs. In the sitting position with trunk rotation, dorsiflexion was measured only in the contralateral leg. Static diagonal stretching combining trunk rotation with slight trunk flexion was performed in the sitting position with a neutral pelvis.

After stretching, DFROM in contralateral and ipsilateral legs were measured in the sitting position with a neutral pelvis. In the contralateral leg, significant differences in Δ DFROM were observed between the sitting position with trunk rotation and the supine position and between the sitting position with trunk rotation and the sitting position after stretching.

In clinical settings, diagonal stretching of the unilateral posterior trunk causes a significant increase in the DFROM of the contralateral lower limb.

Pain is a complex experience with both sensory and affective dimensions, and the affective dimension can increase the risks of chronic pain development. It is thus critical to identify factors influencing the affective dimension of pain.

This study aimed to identify the relationship between the affective dimension of pain and disorder site (primary pain source).

Study participants were recruited from patients referred for physical therapy at an orthopedic outpatient clinic. Pain quality including the affective dimension, disorder site from descriptive medical diagnosis, pain intensity, duration from pain onset, and demographic data, was collected. A multivariable logistic regression model was constructed to analyze the relationship between the affective dimension of pain and the disorder site.

A total of 282 participants were included. Cervical and lumbar spine disorders were significantly associated with an affective dimension of pain compared to limbs disorders when adjusted for age, sex, pain intensity, and duration from the onset in the regression model.

Regardless of duration from the onset and other confounding factors, disorder site is correlated with the affective dimension of pain. Multidimensional pain assessment is crucial when clinicians evaluate patients with cervical and lumbar spine disorders, even in the acute phase.

Patellofemoral pain syndrome (PPS) is defined as a condition in the patellofemoral joint that can present with pain, functional deficit, crepitus, and instability. Its etiology appears to lie in excessive loading of the patellofemoral joint due to mispositioning of the patella. The application of taping has recently increased, to manage PPS. However, the level of scientific evidence in this sense is unknown.

To determine the effect of different types of taping in subjects with PPS.

A bibliographic search was carried out in January and February 2021 in Scopus, Web of Science, PubMed, Medline, SPORTDiscus, PEDro and CINAHL.

A total of 13 studies were included for qualitative analysis. The mean score on the PEDro scale was 5.30 points. Most of the articles reflect a decrease in pain after the taping intervention, while variables such as functionality, muscle activity and biomechanical modification do not show positive effects.

Taping appears to have positive effects on pain in subjects with PPS. However, the evidence is contradictory with the rest of the variables studied.

Whiplash injury-related neck pain frequently hinders daily life activities, resulting in poor quality of life. Recovery time is prolonged in many patients. Long-term outcomes of refractory whiplash injury-related neck pain remain poorly understood.

This study aimed to evaluate the long-term prognosis of chronic whiplash injury-related neck pain.

We evaluated the prognosis of 38 patients with whiplash injury-induced neck pain via phone interviews. We investigated the data on current presence and degree of neck pain, current pain medication, physical modality or injection procedures, and difficulty performing daily life activities or occupational duties.

At least 5 years after the whiplash injury, 34 patients (89.5%) experienced whiplash injury-related neck pain. The average numeric rating scale (NRS) score on the initial visit to our spine center was 5.3 ± 1.7 and that at the follow-up interview was 4.3 ± 2.6. Twenty-six (68.4%) patients had pain scores ⩾ 3 on the NRS. Additionally, 26 (68.4%) patients were receiving at least one of the following pain-management treatments: oral pain medications, physical modality, and injection procedures. Twenty-eight (73.7%) patients encountered difficulty performing daily life activities and occupational duties.

The long-term prognosis of patients with whiplash injury-related neck pain was found to be poor.