Journal of Back and Musculoskeletal Rehabilitation

Various tools have been created to measure physical function during intensive care unit (ICU) stay and after ICU discharge, but those have not been validated in coronavirus 2019 (COVID-19) patients. There is a need for a reliable, valid and feasible tool to define the rehabilitation needs of post-ICU COVID-19 patients entering the acute wards and then rehabilitation clinics.

This study aims to investigate the validity, inter-rater reliability and feasibility of Chelsea Physical Assessment Tool (CPAx) in assessing the functional status of COVID-19 patients after discharge from the ICU.

Demographic and clinical characteristics of the patients were recorded. Patients were evaluated using the modified Medical Research Council (MRC) dyspnea scale, Functional Oral Intake Scale, Glasgow Coma Scale, CPAx, Barthel Index, Katz Index and MRC sum score, measurements of grip strength obtained by dynamometer, the 5 time sit-to-stand test and 30 seconds and sit-to-stand test. CPAx and the other functional assessment tools were administered to 16 patients within 48 hours following ICU discharge. For inter-rater reliability, another physiatrist independently re-assessed the patients. MRC sum score, Barthel and Katz indexes were used to assess construct validity of CPAx. The discriminative validity of CPAx was determined by its ability to differentiate between patients with and without ICU acquired muscle weakness based on MRC sum score. The intra-class correlation coefficients (ICC) were calculated to determine inter-rater reliability for total scores of the functional assessment tools. Cohen’s Kappa ( κ ) coefficient and weighed Kappa ( κ w ) were calculated to determine inter-rater reliability of individual CPAx items. Ceiling and flooring effects were calculated by percentage frequency of lowest or highest possible score achieved. The number and percentages of the patients who were able to complete each tool were calculated to assess feasibility. The CPAx score was strongly correlated with MRC sum score (rho: 0.83), Barthel Index (rho: 0.87) and Katz Index (rho: 0.89) ( p < 0.001) showing construct validity. Area under the ROC curve demonstrated that cut off score for CPAx was ⩽ 12 to discriminate patients with MRC sum score < 48, with a sensitivity and a specificity of 100% and 63%, respectively (AUC = 0.859, p < 0.001). ICC was high for CPAx, MRC sum score, Barthel and Katz indexes, Glasgow Coma Scale, and hand grip strength measurement, with the highest value observed for CPAx (ICC, 0.96; 95% confidence interval (CI), 0.71–0.98). κ and κ w analysis showed good to excellent inter-rater reliability for individual CPAx items. No floor or ceiling effect was observed at CPAx while floor effect was observed at Barthel Index scores (25%) and Katz Index scores (37.5%). All patients could be evaluated using CPAx while less were physically able to complete the 5 time sit-to-stand, 30 seconds sit-to-stand tests ( n = 4) and MRC sum score ( n = 14).

CPAx is a valid, reliable, and feasible tool to assess the physical functional state in COVID-19 patients following discharge from the ICU.

Although the number of new cases of coronavirus 2019 (COVID-19) has been drastically reduced worldwide, patients who demonstrate long-term symptoms need more attention from health systems, as these symptoms can negatively affect functionality and quality of life.

To evaluate muscle function and quality of life at 3, 6, 9 and 12 months in patients with post-acute COVID-19 syndrome and to assess their associations with general fatigue and lung function.

This observational and longitudinal study evaluated patients with post-acute COVID-19 syndrome. Participants were subjected to the following evaluations: Short Form-36; handgrip strength; Functional Assessment of Chronic Illness Therapy-Fatigue scale; and spirometry.

Among the 350 participants who were evaluated in the third month, 74.6%, 61.4% and 45.4% reported general fatigue, dyspnoea and cough, respectively. In the comparisons between the third month and the sixth month, there were significant increases in Functional Assessment of Chronic Illness Therapy-Fatigue scale, pulmonary function and several Short Form-36 domains. In the comparisons between the sixth month and the ninth month, there was a significant increase only in the social functioning domain of the Short Form-36. In the comparisons between the ninth month and the twelfth month, there was an increase only in some Short Form-36 domains. Significant correlations were observed between the Short Form-36 domains with Functional Assessment of Chronic Illness Therapy-Fatigue scale, handgrip strength and pulmonary function.

In patients with post-acute COVID-19 syndrome, there was a progressive improvement in quality of life, general fatigue and pulmonary function during the 12 months of follow-up, with this improvement being more pronounced in the first 6 months. There was a relationship between functionality and quality of life in these patients.

Frozen shoulder (FS) is characterized by progressive shoulder pain and a limited range of motion. Recently, platelet-rich plasma (PRP) injection is a newly developed treatment option for patients with FS and its efficacy needs to be examined.

By conducting a systematic review and meta-analysis, this study attempted to evaluate the efficacy of PRP injection in the treatment of patients with FS.

PubMed, EMBASE, Web of Science, Elsevier, The Cochrane Library, WanFang Data and CNKI databases were searched up to May 31, 2020. This study included randomized controlled trials as well as prospective cohort studies. Two reviewers independently screened the title, abstract and full text in order to extract data from qualified studies. The main outcome was pain visual analogue score (VAS) while the secondary outcome was range of motion (ROM) of the shoulder joint that consists of four parts: internal rotation, flexion, external rotation and abduction.

Three randomized controlled trials and one prospective cohort study met the inclusion criteria. Accordingly, a total of 359 cases were analyzed and followed up to 3 months. The control group included corticosteroids (CS), ultrasound therapy, and stellate ganglion block. Compared to other groups, VAS was statistically significant after 1 month and 3 months of treatment (SMD: - 0.46, 95% CI: - 0.75 to - 0.18, P = 0.002; I = 2 43.2%), (SMD: - 0.87, 95% CI: - 1.23 to - 0.50, P = 0.00, I = 2 61.9%). Compared to the control group, only flexion of the patients treated with PRP demonstrated no significant improvement at 1 month, whereas internal rotation, flexion, external rotation and abduction of the shoulder were found to be improved following 3 months of treatment.

The corresponding findings illustrate that compared to other non-operative treatments, local injection of PRP can effectively improve pain and shoulder motion in patients with FS. However, due to the short follow-up time and limitations regarding the quantity and quality of studies, the above conclusions require further elucidation by performing additional high-quality studies.

Complex regional pain syndrome (CRPS) is a clinical diagnosis and an umbrella term for a heterogeneous group of states associated with pain disproportionate to any inciting event, together with a number of signs and symptoms that are manifested mainly in the limbs. There are often concerns among clinicians and patients about the potential harms caused by pain provocation during physiotherapy of CRPS, even though clinical guidelines de-emphasize pain-contingency.

The objective of this narrative review is to summarize current evidence regarding potential harms due to pain provocation during so-called exposure-based therapies in individuals with CRPS.

Six studies evaluating exposure-based approach were included ( n = 6).

Although only one included study focused primarily on safety and in the rest of the included studies the reporting of harms was insufficient and therefore our certainty in evidence is very low, taken together with outcome measures, available data does not point to any long-term deterioration in symptoms or function, or any major harms associated with pain provocation during physiotherapy of CRPS.

There is a great need for higher-quality studies to determine which therapeutic approach is the most appropriate for whom and to evaluate the risks and benefits of different approaches in more detail.

Despite the fact that weaning from mechanical ventilation (MV) is one of the main rehabilitation goals in patients with spinal cord injury (SCI), controversies are still open about the optimal rehabilitation approach.

This systematic review aimed at characterizing the rehabilitation interventions currently available to optimize weaning from MV in SCI patients.

On April 12 nd , 2022, a systematic literature search was performed in PubMed, Scopus, Web of Science, Cochrane, and PEDro, identifying studies assessing MV patients with SCI undergoing pulmonary rehabilitation. The primary outcomes were weaning duration, MV duration, and weaning success rate. Secondary outcomes were pulmonary function, extubation or decannulation time, length of stay, and safety.

Out of 413 records, 14 studies were included (2 randomized controlled trials, 7 observational studies, and 5 case reports). Most of the studies assessed a comprehensive rehabilitation approach, including high tidal volume ventilation, positioning, mechanical lung recruitment maneuvers, secretion management strategies, respiratory muscle training, and electrical stimulation.

Our findings suggested that a comprehensive rehabilitation intervention might have a role in reducing MV duration in patients with SCI. Further studies are needed to better characterize the optimal rehabilitation strategies for enhancing functional recovery of patients with SCI.

Choosing measurement tools for diagnostic, prognostic, or evaluative purposes in a chronic musculoskeletal pain (CMP) population is challenging for rehabilitation practice. Implementation of measurement tools for clinical practice is impaired by gaps in knowledge about measurement properties.

Identifying evidence about the measurement properties of tools frequently used in Dutch pain rehabilitation practice.

A mapping review was conducted of eligible studies that investigated reliability, validity, or responsiveness, and interpretability, as defined by the COSMIN taxonomy, of original versions or Dutch translations of predefined Patient-Reported Outcome Measures (PROMs) in a CMP population. MEDLINE, PsycINFO, EMBASE, and CINAHL were searched in March 2021. Results were visually mapped.

Thirty-five studies were included. The results show many knowledge gaps in both original and translated versions. In general, aspects of validity were most frequently reported. The Pain Disability Index, Pain Catastrophizing Scale, and the 12-Item Short Form Health Survey were the most studied measurement tools. No results were found for the Checklist Individual Strength, Illness Perception Questionnaire, and Utrecht Coping List.

Little evidence of the measurement properties of PROMs used in rehabilitation of patients with CMP in the Netherlands was found. PROMs need to be used and interpreted with caution in daily practice.

Diagnostic imaging (DI) studies are useful resources for examining musculoskeletal (MSK) conditions. When DI is used appropriately, it is an important tool for physical therapists (PTs).

The purpose of this study was to explore the attitudes, beliefs, and barriers to PTs’ practices in referring to DI in Saudi Arabia (SA).

For this quantitative cross-sectional study, an online self-reported questionnaire was designed and distributed. A total of 138 PTs participated in the study.

Although most PTs had access to DI, few reported being able to order DI. The PTs demonstrated positive attitudes regarding their ability to refer patients for DI. Nevertheless, some PTs have adopted several beliefs and awareness of PTs regarding the clinical appropriateness of referring to DI, which may increase the unnecessary utilisation of DI requests. More than half of the PTs in this study reported that they were unfamiliar with the clinical rules used for prescribing imaging.

This study highlights recommendations to improve PTs’ practices towards DI in SA, such as providing more DI courses targeting PTs and including clinical rules within DI education in undergraduate studies. Furthermore, a clear governmental policy is needed to permit PTs to refer to DI when specific criteria are met.

The hamstring muscles have a great tendency to decrease their extensibility, a phenomenon that presents a distinct clinical entity called short hamstring syndrome (SHS), in addition to problems with adjacent structures.

The objective of this study was to evaluate the immediate effect of lumbar fascia stretching on the flexibility of the hamstring musculature.

A randomized controlled trial was carried out. Forty-one women between 18 and 39 years old were divided into two groups: the experimental group received a technique of fascial stretching in the lumbar area while the control group participated in a magnetotherapy machine that was turned off. Hamstring flexibility in both lower limbs was measured by the straight leg raising test (SLR) and the passive knee extension test (PKE).

The results showed statistically significant improvements ( p < 0.05) in the SLR and the PKE for both groups. There was a large effect size (Cohen’s d) for both tests. There was a statistically significant correlation between the International Physical Activity Questionnaire (IPAQ) and the SLR.

The inclusion of lumbar fascia stretching might be an effective part of a treatment protocol to increase the flexibility of the hamstring muscle observing an immediate result in healthy participants.

Pole vaulting involves trunk flexion, extension, and rotation, which may place the lumbar spine under stress. Repeated pole vaulting may cause lumbar disc degeneration (DD) and lumbar spondylolysis (LS); however, this phenomenon is yet to be established.

This study aimed to determine the difference in the maximum joint angles of the shoulder, hip, and trunk during pole vaulting between male pole vaulters with and without lumbar DD or LS.

This retrospective study included 17 male pole vaulters. Four high-speed cameras were used to record the pole vaulters at 240 Hz. Radiography and magnetic resonance imaging were used to examine the lumbar spine in all athletes. Differences in the data between two sets of groups were analyzed using the unpaired t-test or the Mann-Whitney U test.

There was a significant difference in the maximum joint angle of hip flexion between pole vaulters with and without lumbar DD ( p = 0.03).

Pole vaulters with lumbar DD may use lumbar flexion instead of hip flexion during the rock-back movement. Moreover, LS may occur due to repeated failed vaulting. Therefore, trunk stability and functional movements should be prioritized to prevent organic changes in the lower back.

Although several studies have been conducted to determine the cause of low back pain (LBP), a sufficient correlation has not been found between research findings and symptoms. Therefore there seems to be a need for studies to explain the relationship between pain and morphological changes in the paraspinal muscles of patients with LBP through comparisons with healthy control subjects.

The aim of this study was to examine degeneration in the lumbar musculus multifidus (LMF) and lumbar musculus erector spinae (LES) muscles in patients with chronic LBP with non-radiculopathy lumbar disc herniation (LDH), patients with mechanical LBP, and healthy individuals.

The study included 35 patients with mechanical LBP, 38 patients with non-radiculopathy LDH, and a control group of 36 healthy participants. In all patients and the control group, evaluations were made on axial magnetic resonance imaging slices at L3-S1 level of the LMF and LES cross-sectional areas (CSA), total CSA (TCSA = LMF + LES), fat infiltrations and asymmetries.

The mean CSA values of the right and left LMF and LES showed significant differences between the groups ( p < 0.001, p = 0.002, p = 0.002, p = 0.010, respectively). Fat infiltrations showed a difference between the right-left LMF and left LES groups ( p = 0.007, p < 0.001, p = 0.026, respectively). Asymmetry was not observed between the CSA and TCSA of the right and left sides.

A correlation was found between fat infiltration in the LMF and mechanical LBP and LDH. However, no significant correlation was determined between LBP and the CSA and TCSA of the LMF and LES. This was thought to be due to an incorrect result of CSA and TCSA in the evaluation of muscle mass. Therefore, for a more accurate evaluation of muscle mass, it can be considered necessary to measure muscle atrophy associated with fat infiltration or functional CSA.

There is a sex-related difference in strength and endurance in trunk muscles: males have more strength while females have more endurance.

Investigate sex-related differences in motor control strategies in back muscles during isometric contractions (IC) in the Sorensen test posture.

Thirty-six healthy and young volunteers performed different tasks: three maximal voluntary contraction (MVC) tests recorded with a bio-feedback force sensor, and followed by five loaded IC (LIC) tests using bodyweight and loads of 0 to 8 kg with a 2-kg step. Surface electromyography was used to measure the activity of bilateral lumbar paravertebral (LP) and quadratus lumborum (QL) muscles.

Sex-related and load-related differences in EMG amplitudes were highlighted during LIC tests. Females showed significantly ( p -value = 0.02) greater EMG amplitude for the highest load (8 kg) than males. Besides, significant differences between low (2 and 4 kg) and high (6 and 8 kg) loads for both LP and QL muscles and for both sexes were observed. Finally, for MVC tests, males produced significantly ( p -value = 1.02e-4) greater strength during MVC tests (4.25 ± 1.37 N/kg vs 2.60 ± 0.78 N/kg).

The results were clinically relevant to bring attention to load strategy during rehabilitation, particularly in females who seemed to recruit the QL muscle more.

Sway-back posture in the sagittal profile is a commonly adopted poor standing posture. Although the terms, definitions, and adverse health problems of sway-back posture are widely used clinically, few studies have quantified sway-back posture.

To investigate spinal sagittal alignment in sway-back posture while standing based on global and regional angles using inertial measurement units (IMUs).

This cross-sectional study recruited 30 asymptomatic young adults. After measuring the sway angle while standing, the participants were divided into sway-back and non-sway-back groups (normal thoracic group). Each participant stood in a comfortable posture for 5 seconds with IMUs at the T1, T7, T12, L3, and S2 levels. Then, we measured the global and regional lumbar and thoracic angles and sacral inclination in the standing position.

Although there was no difference in the global lumbar angle, there was a difference in regional lumbar angles between the two groups. The normal thoracic group had balanced lumbar lordosis between the upper and lower lordotic arcs, whereas the sway back group tended to have a flat upper lumbar angle and increased lower lumbar angle.

It is useful to assess the global and regional angles in the spinal sagittal assessment of individuals with sway-back posture.

The extent of asymmetry in the muscle tissue composition ratios with hip fractures has not been clarified.

To determine whether there is a difference in the muscle tissue composition ratios between the fractured and non-fractured sides of the trunk and thighs immediate measurement.

Forty-four patients (84.6 ± 7.0 years) were included. Computed tomography images were used for measurements. The muscle tissue composition ratio was measured using muscle cross-sectional area (CSA) and attenuation coefficient (Hounsfield units; HU). Defined each HU attenuation range as follows: low-density muscle (LDM), low-quality muscle tissue with fat infiltration, normal-density muscle (NDM), muscle contractor tissue, and intramuscular adipose tissue (IMAT), fat infiltration tissue. The CSA of each muscle tissue was expressed as a percentage: %LDM, %NDM, and %IMAT. A paired t -test was performed for comparison.

The %LDM on the fractured side was higher in the thigh and erector spinae. The %NDM on the fractured side was lower in the thigh. There was no significant difference in the %IMAT for all muscles.

The thigh on the fractured side showed asymmetry with low %NDM and high %LDM. This characteristic captures a characteristic of muscle tissue that may have importance in hip fracture etiology.

The effectiveness of the muscle energy technique (MET) on postpartum meralgia paresthetica (MP) affecting the lateral femoral cutaneous nerve is unknown.

To investigate the effectiveness of the MET on postpartum MP affecting the lateral femoral cutaneous nerve.

In this randomized controlled trial, 30 patients with postpartum MP were randomly allocated to study and control groups. The study group received the MET with conventional therapeutic exercises and the control group received the conventional exercises alone for four weeks (thrice a week, for 30–40 minutes duration). Lateral femoral cutaneous nerve distal latency, pain intensity, response to the prone knee bend (PKB) test and pelvic compression test were assessed.

Patients allocated to the MET group had improvements compared to the controls in pain intensity (MD: - 1.66, 95%CI - 2.39 to - 0.94), distal latency (MD: - 0.66, 95%CI - 0.94 to - 0.36), and knee range of motion in the PKB test (MD: 19.5 ∘ , 95%CI 13 to 26.1) with high treatment effects, Cohen’s d –ES = 1.71, 1.86 and 2.24 respectively. However, there was no between-group difference for the pelvic compression test ( p = 0.41).

The MET can reduce pain, distal latency, and increase the prone knee range of motion in women with MP affecting the lateral femoral cutaneous nerve.

To maximize the ball velocity in the tennis sever, the shoulder plays a key role in the kinetic chain. But shoulder inefficiency leads to shoulder injuries such as shoulder impingement syndrome (SIS). Thus, to verify the scapular movements during the tennis serve could help prevent shoulder injury in tennis players.

This case-control study aimed to verify the scapular movements during flat first serve for elite tennis players with shoulder impingement syndrome compared to those without it.

Eight elite tennis players (4 males and 4 females) with SIS and 8 elite healthy players (4 males and 4 females) performed flat first serves, and the three-dimensional scapular kinematic data was recorded using the Qualisys motion capture system through spherical reflective markers including the acromion marker cluster.

The scapula was more internally rotated (median difference: 10.40 ∘ ) in the male players with SIS than in those without it at the maximally externally rotated humerothoracic joint during flat first serve, and female players with SIS (median difference: 7.16 ∘ and 11.28 ∘ , respectively) had more internally rotated scapula at the maximally externally rotated humerothoracic joint and ball impact.

Increased scapular internal rotation may be something that affects shoulder injuries in the overhead sports, and it may help to prevent and rehabilitate overhead injuries including SIS.

In the motor rehabilitation of individuals with neurological disorders, including cerebral palsy (CP), Neurodevelopmental treatment (NDT) one of the most used approaches worldwide.

To verify muscle activation in NDT handling in individuals with severe CP using electromyography.

This was a controlled, cross-sectional, quantitative clinical trial. The individuals were evaluated using electromyography to analyze the muscular activation of the spinal erector, gluteus medius, rectus abdominis and multifidus during different NDT handling. We evaluated 59 individuals: 39 with spastic quadriparesis CP (Gross Motor Function Classification System, level IV–V) and 20 typically-developing individuals (control group). These groups were homogeneous with respect to age and gender.

There was a significant difference in muscle activation of the spinal erector, gluteus medius, rectus abdominis and multifidus in the six NDT handling used in this study: side-sitting for kneeling; supine for lateral decubitus, prone position for lateral decubitus, “sitting on horseback”, sitting on the roll, and proprioceptive stimulation sitting on the ball.

The results show that all NDT handling analyzed in this study were effective for muscle activation of the spinal erector, gluteus medius, rectus abdominis and multifidus in individuals with severe spastic quadriparetic CP.

A higher prevalence of cardiovascular risk was observed in spondyloarthritis (SpA). The relationship between disease-related factors structural damage and subclinical atherosclerosis is still unknown.

The aim of our study was to evaluate the association of subclinical atherosclerosis with radiographic structural damage in patients with SpA.

Forty-seven SpA patients who fulfilled the ASAS criteria were enrolled in a case-control study conducted over 12 months and compared with 47 age and sex-matched healthy controls. None of the subjects had a previous history of cardiovascular diseases or cardiovascular risk factors. Demographic and disease characteristics were recorded. Structural lesions were evaluated using plain radiography, and two scoring tools were used to spine (BASRI and mSASSS). Subclinical atherosclerosis was assessed using ultrasound measurements of flow-mediated dilation (FMD) and carotid intima-media thickness (cIMT).

The median age of patients was 36 years. The sex ratio was 2.35. The median BASRI total score was 3 (IQR 2–4), median mSASSS score was 10 (IQR 415). cIMT was significantly increased in SpA patients compared to controls ( p < 0.0001), and FMD was significantly lower in patients than in healthy subjects ( p = 0.008). cIMT was significantly associated with ankylosis of the facet joints ( p = 0.035) and Romanus spondylitis ( p = 005). FMD was negatively associated with vertebral squaring ( p = 0049), bridging syndesmophytes ( p = 0031) and mSASSS score ( p = 0.047).

Our result supports the association of radiographic structural damage and subclinical atherosclerosis assessed using cIMT and FMD. This finding highlights the importance of earlier treatment in order to prevent radiographic damage progression and atherosclerotic events.

For the treatment of single-level lumbar degenerative disc disease (DDD), oblique lateral interbody fusion (OLIF) has clinical advantages. Whether internal fixation needs to be combined for treatment has been the subject of debate.

To compare the early clinical effects of standalone oblique lateral interbody fusion (S-OLIF) versus OLIF combined with lateral screw fixation of the vertebral body (F-OLIF) on single-level lumbar DDD.

A retrospective analysis was performed on the data of 34 patients for whom the OLIF technique was applied to treat single-level lumbar DDD from August 2018 to May 2021. Patients were divided into the S-OLIF ( n = 18) and F-OLIF groups ( n = 16). Intraoperative blood loss, operative time, and length of hospital stay were recorded. The pain visual analogue scale (VAS) and Oswestry disability index (ODI) before and after the operation were evaluated. The disc height (DH), foraminal height (FH), fused segment lordosis (FSL), lumbar lordosis (LL), cage subsidence, and fusion by CT examination were measured before and after the operation.

The S-OLIF group experienced a shorter operative time and less intraoperative blood loss than the F-OLIF group, and the differences were statistically significant ( p < 0.05), but the difference in the length of hospital stay was not statistically significant. The postoperative VAS score and ODI of the two groups were significantly lower than those before the operation, but the postoperative differences between the two groups were not statistically significant. Differences were not statistically significant in postoperative FH, DH, FSL and LL of the two groups. Both groups were followed up for no less than 12 months. In the two groups, fusion was achieved at the last follow-up visit.

According to short-term follow-up results, both S-OLIF and F-OLIF can achieve reliable and stable fusion and good clinical effect in the treatment of single-level lumbar DDD.

Gluteus medius (GM) is a segmented muscle involving three muscular subdivisions. Rehabilitation exercises has been suggested to strengthen specific subdivisions.

This study aimed to evaluate muscular activation of the anterior, middle, and posterior subdivisions of the GM during two different exercises.

A total of 28 healthy active subjects participated in this study. Muscle activity using surface electromyography was recorded for the three GM subdivisions during figure-of-four position (FFP) and wall press (WP). Non-parametric Kruskal-Wallis test was used to detect differences between GM subdivisions on each exercise and the Mann-Whitney U test was used to compare muscular activation across exercises.

There were statistically significant differences ( P < 0.001) in all GM subdivision during FFP and WP exercises. Both exercises showed greater activation of the posterior subdivision than the middle and anterior subdivisions, with the WP causing highest activation of the posterior subdivision.

In line with the WP exercise, the FFP produces sufficient activity to provide potential strength gains on the posterior subdivision and could be a viable option to include in the early stages of the rehabilitation process. Clinicians may use this information to make more informed decisions about exercise selection for strengthening specific GM subdivision.

Hemiplegic shoulder pain (HSP) is a common morbidity of stroke. Different treatment modalities can be used for optimizing the results and limiting the possible side effects. This research compares the effects of two therapies used to reduce the pain and improve the quality of life of the patients with HSP.

This study aimed to compare the effects of transcutaneous electrical nerve stimulation (TENS) and suprascapular nerve blockage (SSNB) in patients with HSP.

In this clinical research, 24 patients with HSP who participated in a conventional rehabilitation program were randomized into TENS or SSNB treatment groups. A 100 mm visual analogue scale was used to assess the severity of pain. Passive range of motion (ROM) of the shoulder was measured. The Modified Ashworth Scale (MAS) was used to evaluate spasticity of the upper extremities, and the Modified Barthel Scale was used to assess activities of daily living (ADL). Quality of life was measured using the Stroke-specific Quality of Life (SS-QoL) questionnaire.

The pain scores of the SSNB group decreased more significantly ( p < 0.05) than in the TENS group. SS-QoL scores at the 3rd week in both groups were significantly higher than before treatment ( p < 0.05). MAS scores and Barthel scores after treatment did not differ significantly between the groups.

TENS and SSNB were beneficial in relieving pain and increasing passive shoulder ROM and ADL in all patients. The alleviating of pain was faster in patients who underwent SSNB.

Lumbar intervertebral disc height loss has been associated with spinal height change (SHC) and low back pain (LBP), including stenosis. Non-invasive methods to improve disc height loss require forms of lying down, which are unconducive to computer work.

Intermittent vertical traction (VT) integrated with seated computer work may provide ergonomic alternatives for increasing SHC to promote LBP relief. The primary aim was to develop and introduce a safe VT prototype and dosage to induce and measure SHC. Prototype comfort and LBP ratings were exploratory secondary aims.

Forty-one participants were stadiometry-measured for pre- and post-intervention SHC from seated VT at 35% body weight removed, supine lying (SL), and sitting at a computer (SIT) without VT. Pain ratings were recorded for those self-reporting LBP. VT prototype evaluations were compiled from a 3-question, 7-point Likert-style survey.

SHC increased by 3.9 ± 3.4 mm in VT, 1.7 ± 3.4 mm in SIT, and 4.3 ± 3.1 mm in SL ( P < 0.000). Post hoc findings were significant between VT and SIT ( P < 0.000), and SL and SIT ( P < 0.000). VT and SL LBP ratings both decreased, but not SIT.

Intermittent seated VT is a promising alternative for postural relief during seated computer work, producing SHC similar to lying down without compromising workflow.

The effects of axial extension on pelvic floor displacement and abdominal muscle activity during pelvic floor muscle (PFM) exercises are not well known.

To clarify the effect of sitting axial extension on pelvic floor displacement and abdominal muscle activity during a PFM task.

Pelvic floor displacement, abdominal muscle activity, and subjective kinesthesia of the PFM were compared between the resting and axial-extended sitting positions during a pelvic floor task in 34 healthy young men.

No significant difference in pelvic floor displacement was observed between the resting and axial extension sitting position. Subjective kinesthesia was significantly easier to perform in axial extension than in resting sitting position during pelvic floor depression. Abdominal oblique muscle activity was higher in axial extension than in resting sitting position during pelvic floor depression. The changes in axial extension were significantly greater in the internal oblique muscles during elevation and in the internal and external oblique muscles during depression than in the lower rectus abdominis muscles.

Axial extension in the sitting position does not change pelvic floor displacement during the PFM task. However, axial extension may be effective in facilitating subjective kinesthesia of PFM and in increasing oblique abdominal muscle activity.

Pelvic floor muscles (PFM) are important for lumbar stability. However, the relationship between lumbar and hip motion angle changes (MAC) caused by PFM contraction and each PFM’s function remains unclear.

To clarify the lumbar spine and hip motion changes produced by PFM contraction and the relationship between MAC and PFM function.

In 21 healthy females, motion angle was measured for prone hip extension movement using natural movement (NM), PFM contracting movement (PM), and reducing lumbar movement (RM) methods. The PFM functional indices were bladder base elevation distance, continuous bladder base elevation time, and pelvic floor location.

The PM showed no significant difference in lumbar motion angle but had significantly smaller hip motion than the NM (NM; 26.1 ± 8.3, PM; 29.2 ± 11.0). MAC was significantly greater in RM (lumbar spine; 4.4 ± 3.2, hip; 5.9 ± 8.7) than in PM (lumbar spine; 0.4 ± 4.4, hip; 3.1 ± 5.1) for both the lumbar spine and hip. Lumbar spine and hip MAC of PM was significantly correlated with pelvic floor location (lumbar spine; r = - 0.44, hip; r = 0.54).

PFM contraction does not attenuate lumbar spine motion but reduces hip motion. MAC due to PFM contraction during lumbar movement tasks is related to the PFM functional index.

Neck pain is a common complaint seen amongst patients from all ages. When common causes of neck pain have been ruled out, it is important to investigate further. A careful physical exam can help identify the painful structures. An ultrasound of the area can also be helpful to identify possible structures involved. Neuromas can be treated with oral medications as well as more invasive techniques, such as pulsed radiofrequency (PRF).

In this case report, we discuss a 67-year-old female who presented with left anterior neck pain after developing a cervical mass who was later diagnosed as non-Hodgkin lymphoma. A small neuroma of the left transverse cervical nerve was found on ultrasound and ultimately was treated with PRF with a complete resolution of her symptoms at two months follow-up.

PRF seems to be a useful tool for controlling neuropathic pain caused by a neuroma.

Neer type II/bilateral distal clavicular fracture is an extremely rare injury combination, with few cases having been reported.

This paper reports a case of polytrauma in a 16-year-old female following a road traffic accident. The radiographs revealed distal fractures of the bilateral clavicles (Neer type II), and an open reduction and internal fixation procedure was performed. Initially, the distal fracture of the right clavicle was fixed with a six-hole hook plate before the fracture of the left clavicle was fixed using a pre-contoured lateral locking plate following reduction. At the two-year follow-up, the patient had an excellent constant score in terms of the bilateral shoulder joints.

It is important to achieve stability and to aim for excellence in terms of full shoulder function in this rare combination injury.