Journal of Back and Musculoskeletal Rehabilitation

Padel, a high-intensity overhead sport, poses significant shoulder injury risks due to repetitive motions and microtrauma. This study utilized an inertial motion unit (IMU) and surface electromyography (sEMG) to identify kinematic and muscle activation patterns distinguishing injury-prone and non-prone players, emphasizing prehabilitation's role in preventing shoulder injuries and enhancing performance.

Male padel players with ≥5 years of experience were assessed at the Rehabilitation Unit of the University Hospital “Renato Dulbecco” of Catanzaro, Italy, Participants were stratified into high-risk and low-risk groups based on prior shoulder tendinopathies. Surface electromyography (sEMG) and IMU were used to measure muscle activation and movement smoothness during flexion, abduction, and rotation movements.

The high-risk group exhibited increased mean jerk during abduction (p < 0.05), indicative of reduced movement smoothness. Muscle activation analysis showed significant overactivation of the biceps brachii and under-activation of the trapezius during shoulder movements. Infraspinatus activation was significantly lower during rotation in the high-risk group (p < 0.001). ROC analysis identified predictive cut-offs for injury risk: mean jerk >2.51, deltoid activation <46%, trapezius activation <30.6%, biceps brachii activation >13%, and infraspinatus activation >25.7%, with sensitivity and specificity exceeding 83% for most parameters.

This study highlights the utility of combining IMUs and sEMG for biomechanical and physiological evaluation in padel players. The findings suggested that decreased movement fluidity and muscle activation imbalances may increase the risk of shoulder injuries. Future longitudinal studies should focus on broader athletic motions, larger sample sizes to refine injury prevention and rehabilitation strategies for padel players.

Hamstring strain injuries (HSIs) are among the most common injuries in football, causing significant time-loss and impacting player performance. Despite various preventive strategies, the incidence of HSIs remains high, necessitating evidence-based approaches to reduce injury rates.

This scoping review aims to evaluate the effectiveness of the Nordic Hamstring Exercise (NHE) in reducing the incidence and recurrence of HSIs in football players and to provide practical recommendations for its implementation.

A comprehensive literature search was conducted in PubMed, Scopus, Web of Science, PEDro, and the Cochrane Library. Randomized controlled trials (RCTs) focusing on NHE interventions for football players were included. The primary outcomes were injury incidence, recurrence, and compliance with NHE programs.

The review found that NHE significantly reduces the incidence of new hamstring injuries by up to 60% and recurrent injuries by up to 85%. Players performing NHE demonstrated a 35% increase in eccentric hamstring strength. Compliance with NHE programs was a critical factor in achieving these outcomes, with higher adherence rates leading to better preventive effects.

The Nordic Hamstring Exercise is an effective, evidence-based intervention for preventing hamstring injuries in football. Its integration into regular training programs, combined with education to improve compliance, can significantly reduce injury rates and enhance player performance. Future research should focus on standardizing protocols and exploring long-term outcomes.

Electrotherapy is used to alleviate pain and improve muscle strength. However, its effect on stretching is unclear.

This research evaluates the effect of combining static stretching (SS) with transcutaneous electrical nerve stimulation (TENS) and neuromuscular electrical stimulation (NMES) on range of motion (ROM) and performance.

This randomized-controlled study included 45 sport sciences students (25 women-20 men). To evaluate the acute effects of SS with electrotherapy the participants were divided into 3 groups randomly and each group had one practice session. The first group received only SS. The second group performed SS and TENS, while the last group undertook SS and NMES. For the statistical analyses a 3 × 2 repeated measures ANOVA was conducted using the SPSS 21 software.

The analyses indicated a significant increase in ROM in all groups (P < 0.001, η2: 0.356). However, no significant differences were observed between the groups (P = 0.255, partial η2: 0.063). Performance analyses revealed no significant differences among intra (P = 0.100, partial η2: 0.063) and inter-groups (P = 0.062, partial η2: 0.124).

This study found SS effective in increasing ROM, but electrotherapy modalities added to stretching did not further enhance hamstring flexibility. Furthermore, different stretching techniques had no impact on performance.

Chronic ankle instability (CAI) is a widespread condition in athletes, characterized by recurrent episodes of ankle “giving way,” diminished neuromuscular control and balance deficits. Traditional rehabilitation programmes typically emphasize strength and posture control, while more effective strategies incorporate balance training, including open chain exercises, vestibular training and multi-planar movements. In addition, novel approaches such as Dynamic Neuromuscular Stabilization (DNS) present an innovative method that aims to restore functional stability by activating the brain's natural movement control mechanisms.

This study aimed to determine and compare the impacts of balance and DNS training on functionality, instability severity, stabilization, balance, reaction time and performance in amateur athletes with CAI.

This single-blind randomized controlled trial was conducted with 36 amateur athletes (DNS training group: n = 12, balance training group: n = 12, conventional training group: n = 12) over a 6-week period. The DNS training group participated in exercises based on DNS principles, while the balance training group focused on training to enhance postural stability and vestibular function, and the conventional training group underwent conventional rehabilitation. The primary outcomes were measured using the Cumberland Ankle Instability Tool (CAIT) and Y Balance Test (YBT). Secondary measures were assessed through the Foot and Ankle Ability Measure (FAAM), Foot Lift Test (FLT), Balance Error Scoring System (BESS) and BlazePod™ Reaction Time (RT) Test. Assessments were carried out at three distinct time points: at baseline (pre-test), following 6 weeks of training (post-test), and at 12 weeks (follow-up test).

DNS and balance training significantly improved all measures compared to conventional therapy (p < 0.05). DNS training showed significant superiority in FLT score, while balance training demonstrated significant performance increase in foam surface single-leg stance and foam surface tandem stance subscales of the BESS, with the high effect sizes (ranging from 0.95 to 1.00).

Innovative and effective interventions, such as DNS and balance training, play a crucial role in the rehabilitation processes of amateur athletes with CAI, with these effects being sustained in the long term.

The effects of yoga on pain, functional limitations, and biomechanical/impairment deficits in knee osteoarthritis (KOA) remain inconclusive.

To conduct a three-level meta-analysis that retains all eligible effect sizes to evaluate the effects of yoga on KOA and examine potential moderators.

Five Chinese- and English-language databases were searched from inception to 28 August 2025. Risk of bias was assessed with RoB 2, and certainty of evidence with GRADEpro. Pooled effects were estimated using R (metafor). Influence diagnostics, sensitivity analyses, moderator analyses, and publication-bias tests (Egger's test, funnel plots) were performed.

Fourteen studies (n = 1183) were included. Low-certainty evidence showed that yoga improved pain (g = -0.79, 95% CI −1.24 to −0.35) and physical function (g = -0.39, 95% CI −0.57 to −0.21). Very-low-certainty evidence indicated benefits for biomechanical/impairment outcomes (g = -0.56, 95% CI −0.85 to −0.26). Weekly session frequency moderated pain outcomes, with 4–7 sessions/week producing the largest effects (g = -1.53). Programs lasting ≥8 weeks were required for consistent analgesic benefit.

Yoga may provide beneficial effects on pain, physical function, and biomechanical/impairment outcomes in individuals with KOA. Evidence suggests that programs delivered on most days of the week (≥4 sessions/week) and lasting at least 8 weeks are associated with greater pain reduction. Yoga may serve as a feasible and acceptable adjunct to pharmacologic care and established exercise therapies; however, these conclusions should be interpreted cautiously in light of study quality and heterogeneity.

Integrative neuromuscular training (INT) is increasingly incorporated into football conditioning programs to improve neuromuscular function and athletic performance. However, its overall effectiveness across various aspects of physical fitness and sport-specific skills remains unclear.

To systematically review and meta-analyze the effects of INT on physical fitness and football-specific performance outcomes in football players.

Following PRISMA guidelines, this review was prospectively registered in PROSPERO (CRD420251052631). Comprehensive research was conducted in Web of Science, PubMed, SCOPUS, Embase, and CNKI up to May 2025. Methodological quality was evaluated using the TESTEX and ROB 2 tools, while the GRADE framework assessed evidence certainty. Where appropriate, random-effects model meta-analyses were applied.

Twelve randomized controlled trials involving 276 football players of varying ages and competitive levels were included. INT produced significant improvements in lower-limb muscle strength (ES = 1.065; p < 0.001), power (ES = 0.453; p < 0.001), sprint speed (ES = −0.341; p = 0.001), agility (ES = −0.398; p < 0.001), balance (ES = −0.897; p < 0.001), and dribbling performance (ES = −1.028; p < 0.05). In contrast, shooting performance showed no significant improvement (ES = 0.324; p = 0.181). Notably, all effect estimates were supported by low-certainty evidence according to the GRADE assessment.

INT may be associated with small-to-moderate improvements in strength, sprint speed, power, agility, balance, and dribbling compared with regular training; however, these findings are supported by low-certainty evidence and should be interpreted with caution. Future high-quality studies with standardized protocols are warranted to clarify its impact on advanced technical skills and optimize its integration into football training programs.

Chronic ankle instability (CAI) affects approximately 46% of individuals after ankle sprains, disrupting ligaments, muscles, and joint receptors, and impairing postural control. Percutaneous tibial nerve stimulation (PTNS) is a minimally invasive neuromodulation technique that may enhance neuromuscular function. This study aimed to evaluate the acute effects of ultrasound-guided PTNS on postural control in individuals with CAI compared to healthy controls.

This non-randomized controlled study included 28 participants: 14 with CAI (mean age 22.85 ± 5.02 years; BMI 24.83 ± 4.28) and 14 healthy controls (mean age 21.86 ± 3.44 years; BMI 22.8 ± 3.29). CAI diagnosis was confirmed by scores <24 on the Spanish Cumberland Ankle Instability Tool. Postural control was assessed via force platform during single-leg stance with eyes open and closed at baseline, immediately post-intervention, and at 2, 24, and 48 h post-PTNS. PTNS delivered biphasic current (10 Hz, 250 µs pulse width) at maximum tolerable intensity for 1.5 min under ultrasound guidance. Controls received no intervention.

Baseline postural control did not differ significantly between groups (p > 0.05). Post-PTNS, no significant intergroup differences were observed, except a reduction over time in anteroposterior center of pressure amplitude (ACPap) in the CAI group with eyes closed (p = 0.023). No significant intragroup changes occurred.

Although PTNS did not produce general improvements in postural control, the reduction in anteroposterior sway with eyes closed suggests a targeted neuromodulatory effect. These preliminary results support further research into PTNS as a complementary approach for managing CAI.

Trial registration: ISRCTN177653522

Employing telecommunication systems and digital platforms, athletes can continuously access tailored injury prevention protocols, receive real-time feedback on exercise performance.

This study aimed to assess the feasibility, adherence, and benefits of a digitally administered adaptation of the FIFA 11 + protocol in professional football players.

This multicenter randomized prospective controlled study involved football players aged 15–40 from Italy and Switzerland, recruited between May 2023 and February 2024. Participants were randomly assigned to either the Intervention group (FIFA 11 + protocol administered digitally) or the Control group (traditional in-person FIFA 11 + protocol). Both groups performed the protocol twice a week for six months. Primary outcomes included the Illinois Agility Test, Slalom Dribbling Test, Multistage 20 m Shuttle Run Test (MSRT), and muscle strength tests for the hamstrings.

Fifty-five players participated: 27 in the Intervention group (mean age 20.63) and 28 in the Control group (mean age 20.25). Both groups showed significant improvements in hamstring strength, sprint performance, and MSRT outcomes (p < 0.05). No significant differences were observed between the groups in terms of strength, heart rate response, perceived exertion, or agility (p > 0.05).

FIFA 11 + protocol has been shown to be effective as the in-person version for improving physical performance and preventing injuries in football players. Further research is needed to explore this approach in broader settings.

: Sports injuries can be an important health problem that is difficult to compensate for athletes. Anterior cruciate ligament injury (ACLI) is a soft tissue injury frequently faced by both athletes and sedentary individuals. In early studies on ACLI, it was reported that these injuries were mostly hormonal, biomechanical and genetic. However, the inconsistencies in these studies are still not fully explained. It is also known that differences in the protein levels of collagen structures play a critical role in non-contact soft tissue injuries. In this sense, it is thought that gene variants may cause sensitivity on ACLI by affecting collagen tissues.

The aim of the study is to systematically examine the relationship between ACLI and genes. In addition, the current study aims to reveal that some genes that are frequently studied in the literature may be related to the structure of the ACL.

Studies on the subject were examined in PubMed and PubMed-Central databases registered with The National Center for Biotechnology Information. Preferred Reporting Items for Systematic Reviews and Meta-Analyses were used in data selection and evaluation.

11 articles that met the criteria were subjected to bias analysis. It was reported that 7 studies were at a critical level in terms of overall risk. Additionally, statistically significant differences were reported in 6 of the 11 studies.

The genes COL1A1, COL5A1, MMP3, TGFBR3, TGFBI, VEGFA, β-fibrinogen and COL12A1 can protect individuals against ACLI by affecting the formation of soft tissues.

Nonspecific low back pain (NSLBP) is a leading cause of disability, and effective non-pharmacological treatments remain limited. Traditional Chinese Exercises (TCE) are increasingly used for NSLBP, but their effectiveness has not been fully established.

To evaluate the effects of Traditional Chinese Exercises on pain, functional disability, and trunk muscle endurance in patients with nonspecific low back pain.

A systematic review and meta-analysis of randomized controlled trials was conducted according to PRISMA guidelines. Chinese and English databases were searched up to 2025. Pain, disability, and trunk muscle endurance were synthesized using random-effects models.

Eighteen randomized controlled trials involving adults with NSLBP were included. Traditional Chinese Exercises were associated with improvements in pain, functional disability, and trunk muscle endurance compared with control interventions. Higher intervention frequency and shorter duration were associated with greater effects, although heterogeneity was substantial.

Traditional Chinese Exercises may improve pain, function, and trunk muscle endurance in patients with nonspecific low back pain. However, due to heterogeneity and methodological limitations, the findings should be interpreted with caution.

The study protocol was registered in PROSPERO, the international prospective register of systematic reviews, under registration number CRD42025632131.

Remote myofascial manual therapy (RMFMT) is increasingly applied to improve flexibility and pain in musculoskeletal practice, yet evidence regarding its clinical efficacy remains inconclusive.

This meta-analysis evaluated the effectiveness of RMFMT applied along the superficial back line on flexibility and pain intensity.

This meta-analysis included randomized controlled trials (RCTs) on RMFMT retrieved from four databases (from inception to January 2026). A random-effects model was used to calculate pooled Hedges’ g. Subgroup analyses were conducted according to assessment regions (or pain origins), intervention protocols, and control group types. In addition, the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was applied to assess the certainty of evidence and inform the strength of clinical recommendations.

Nine RCTs (mean age: 20–40 years old; participants with pain-related symptoms and asymptomatic) demonstrated that RMFMT significantly improved flexibility (Hedges’ g = 0.525, p < 0.001, I²= 49.014%), with favorable trends observed in both the cervical and lumbo-pelvic-hip regions, particularly when RMFMT was applied alone and compared to inactive control condition. Additionally, four RCTs suggested a borderline significant reduction in pain intensity (Hedges’ g = −0.906, p = 0.070, I² = 87.420%) with similarly positive trends across both anatomical regions.

RMFMT applied along the superficial back line improved flexibility and showed a trend toward pain reduction compared with controls. Evidence certainty was moderate for flexibility and low for pain, supporting a conditional recommendation for RMFMT as an adjunctive intervention. Further high-quality RCTs are needed to strengthen the evidence.

Osteoarthritis is a public health issue in an aging society with no radical cure. Complementary therapies such as Tai Chi might be beneficial for patients with osteoarthritis.

The present meta-analysis summarized current evidence on the effectiveness of Tai Chi in patients with osteoarthritis. PubMed, Embase, and Cochrane Library databases were systematically searched for RCTs published from inception up to March 2020. The primary outcome was the pain score on the Western Ontario and McMaster Universities Arthritis Index (WOMAC). For pooled outcomes, standardized mean differences (SMDs) and 95% confidence intervals (CIs) were calculated.

We identified 13 trials with data from 817 patients. The results indicated that patients who practiced Tai Chi exercise showed more significant improvements in pain (SMD, −1.40; 95% CI, −2.17 to −0.63; P < 0.001), physical function (SMD, −1.54; 95% CI, −2.28 to −0.81; P < 0.001), and stiffness (SMD, −1.19; 95% CI, −1.94 to −0.44; P < 0.001) than the control group. Subgroup analysis data were consistent with the overall findings. Meta-regression showed that Tai Chi sessions, publication year, sample size, and Jadad score did not affect the therapeutic effects of Tai Chi. Tai Chi had a significant impact on the physiological and psychological health of patients with knee osteoarthritis.

This meta-analysis provides moderate-to-high quality evidence that Tai Chi has a clinically significant beneficial impact on knee osteoarthritis, with effect sizes exceeding minimal clinically important differences for pain and function.

Cerebral palsy (CP) is a leading cause of physical disability in children, characterized by impaired motor function and muscle weakness. Progressive resistance training (PRT) has emerged as a potential strategy for improving lower limb strength, though the existing evidence remains inconsistent.

To assess the impact of PRT on lower limb muscle strength in youth with CP, compared to control or alternative interventions.

This study systematically reviewed randomized controlled trials (RCTs) following PRISMA guidelines. Six RCTs involving 232 participants with CP (ages 8–25 years, GMFCS levels I-III) were included in the quantitative meta-analysis. Standardized mean differences (Hedges’ g) were calculated using a random-effects model. Risk of bias was assessed using the Cochrane RoB 2 tool, and evidence certainty was evaluated using GRADE framework.

PRT significantly improved lower limb muscle strength compared to controls (Hedges’ g = 0.46, 95% CI [0.26-0.66], p < 0.001) with low-to-moderate heterogeneity (I² = 25.6%). Evidence certainty was rated as MODERATE. Subgroup analyses suggested potentially larger effects for gym-based interventions and participants with GMFCS II-III. Sensitivity analyses confirmed result robustness. No serious adverse events were reported.

PRT effectively enhances lower limb strength in youth (8–25 years) with CP, particularly under structured, supervised conditions. Further research is needed to clarify its long-term functional and psychosocial benefits.

Intermittent Hypoxia-Hyperoxia Therapy (IHHT) is a recent, non-invasive method proposed to enhance physiological adaptations and promote recovery in musculoskeletal dysfunctions. However, evidence to guide practice remains limited. This systematic review aims to evaluate the therapeutic effects of IHHT on pain and health outcomes in patients with musculoskeletal dysfunctions.

A systematic search was conducted following PRISMA guidelines across MEDLINE, EMCARE, CINAHL, Embase, Scopus, Google Scholar, and Semantic Scholar. Eligible studies included patients with musculoskeletal disorders receiving IHHT compared to usual care or no intervention, with outcomes assessing pain and general health. Cochrane RoB 2.0 tool and the PEDro scale evaluated methodological quality, while certainty of the evidence was assessed using the GRADE criteria and review quality with AMSTAR tool.

In seven trials, recruiting 321 participants, IHHT demonstrated significant improvements in pain (SMD = −0.5, 95% CI = −1.14 to −0.13, p < 0.0001), and general health (MD = −12.06, 95% CI = −16.73 to −7.39, p < 0.00001), reduction in psychological parameters (p < 0.00001), and improved functional mobility (p < 0.006). Moderate heterogeneity was reported across outcomes. Sensitivity and subgroup analysis clarified effect directions. Limitations included small sample size, short follow-up durations, and moderate to high methodological quality across included trials.

IHHT appears to be well-tolerated and effective intervention for improving pain, general health, severity of dysfunction, and psychological parameters, with no major adverse events reported in the included trials. However, overall certainty remains moderate, highlighting the need for future trials to monitor and report safety outcomes.

Chronic ankle instability (CAI) is a common sequela of lateral ankle sprains and is characterized by proprioceptive deficits, impaired postural control, and functional limitations. Balance training (BT) is widely prescribed in rehabilitation; however, the magnitude and consistency of its effects remain uncertain.

To synthesize and critically evaluate evidence from systematic reviews and meta-analyses that assess the effectiveness of balance training in adults with CAI.

An umbrella review of systematic reviews, with or without meta-analyses, was conducted. PubMed, Web of Science (WoS), Scopus, and ScienceDirect were searched up to November 1, 2025. Methodological quality was assessed using AMSTAR 2, risk of bias was assessed using ROBIS, and certainty of evidence was assessed using GRADE. When possible, a meta-analysis was performed using a random-effects model with Hartung–Knapp adjustment. Effect sizes were expressed as Hedges’ g (95% CI) and heterogeneity was assessed using I² and τ².

Twenty-seven systematic reviews were included, of which five contributed quantitative data (25 individual studies; n = 1,821 adults). Dynamic postural control showed a significant pooled effect favoring BT over the control group (Hedges’ g = 0.91; 95% CI 0.41–1.41; high heterogeneity). Additional comparisons demonstrated significant advantages for BT over control and visual-occlusion-augmented training, whereas vibration-only protocols outperformed combined BT + vibration training in isolated analyses. An outlier influence was identified in the primary study. Static balance outcomes have been inconsistently reported across reviews and cannot be quantitatively synthesized. No meta-analytic data were available for pain, ankle range of motion (ROM), muscle strength, or health-related quality of life owing to insufficient or heterogeneous reporting. The overall certainty of evidence for dynamic postural control was rated as moderate according to the GRADE.

Balance training provides moderate certainty evidence for improving dynamic postural control in adults with CAI. Evidence of static balance and broader functional outcomes remains limited, with substantial methodological heterogeneity across reviews. These findings should be interpreted cautiously, and high-quality randomized trials with standardized protocols and long-term follow-up are required to strengthen the clinical evidence base.

Chronic nonspecific low back pain (CNLBP) is a leading cause of disability, with diaphragm dysfunction implicated in impaired spinal stability. However, systematic evidence on targeted interventions remains limited.

To quantify the efficacy of diaphragm-focused interventions on pain and function in CNLBP.

The systematic review/meta-analysis followed PRISMA-Cochrane guidelines. Analyzed randomized controlled trials (RCTs) assessing diaphragmatic interventions (manual therapy, respiratory training, neuromuscular re-education). Databases were searched until February 2025. Random-effects models and subgroup analyses were applied.

Meta-analysis of 7 RCTs (n = 283) showed diaphragmatic interventions significantly reduced pain (overall SMD = −1.11, 95%CI: −1.52–−0.71, p < 0.01). Diaphragmatic training (SMD = −1.37) and manual therapy (SMD = −1.25) were most effective, while neuromuscular re-education was not significant (SMD = −0.62). For disability, overall SMD was −0.83（95%CI: −1.14–−0.52, p < 0.01, with manual therapy showing the largest effect size (SMD = −1.30), followed by diaphragmatic training (SMD = −0.69) and neuromuscular re-education (SMD = −0.47). Excluding one 4-week DNS study eliminated heterogeneity and increased pain effect to SMD = −1.24. Evidence certainty was low (GRADE).

Diaphragm-targeted interventions improve short-to-midterm pain and function. Future high-quality RCTs are needed to confirm long-term efficacy and standardize protocols.

In people with hemophilia(PwH) repeated joint bleeding leads to physical limitations.However, there may be some factors,such as fear of movement or kinesiophobia, which may decrease physical activity.All these may reduce psychological well-being, and quality-of-life(QoL) throughout the lifespan in PwH.

For this reason the aim of this study was to examine the presence of fear of movement, physical activity, depression and anxiety levels, and health-related QoL in PwH compared to healthy male controls.

This was an unmatched case-control study with age- and gender-matched group distributions (frequency matching) including 40 cases and 45 controls.Tampa Scale for Kinesiophobia(TSK),International Physical Activity Questionnaire Short-Form(IPAQ-SF),Beck Depression Inventory(BDI),Beck Anxiety Inventory(BAI) and 36-Item Short-Form Health Survey(SF-36) were used to evaluate the participants.

The average age of participants in the Hemophilia Group was 33.15 ± 10.02 years(range 18–50 years) and in the Control Group was 31.29 ± 8.72 years(range 18–50 years), with no statistically significant difference between the groups (p > 0.05).The results were analyzed using Mann-Whitney U test.When both groups were compared, a significant difference was found in TSK scores measured for kinesiophobia(p = 0.000,r = -0.51).PwH had significantly lower-scores in the General Health(p = 0.001,r = -0.37),Physical Functioning(p = 0.000,r = -0.64),Bodily Pain(reflecting higher pain levels)(p = 0.037,r = -0.23) and Role Physical(p = 0.016,r = -0.26) domains of QoL compared to the healthy subjects.

This study demonstrated that PwH had significantly higher levels of kinesiophobia and lower health-related QoL in domains of General Health,Physical Functioning,Role Physical,and Bodily Pain compared to healthy controls.These findings highlight the need for a multidisciplinary approach to treatment in hemophilia patients, addressing not only joint health but also fear of movement and psychological factors.

Low back pain (LBP) is highly prevalent among adolescent rowers and may be influenced by altered trunk-pelvic mechanics and hamstring characteristics. Hamstring-targeted physiotherapy interventions are widely used in clinical practice; however, comparative evidence regarding their effects on muscle mechanical properties and LBP in adolescent rowing populations is limited.

To compare the effects of ballistic hamstring stretching, hamstring extender exercise, and kinesiotaping on hamstring viscoelastic properties, low back pain, and athletic performance in elite adolescent rowers.

This single-blind, parallel-group randomized controlled trial included 60 elite male adolescent rowers (aged 14–18 years) with chronic low back pain, and participants were randomly assigned to three groups for a twelve-week program performed during training sessions four times per week. All outcomes were assessed at baseline and week 12, including hamstring viscoelastic properties measured using a handheld myotonometer, pain intensity assessed with the Numeric Pain Rating Scale, and athletic performance evaluated by the 2000-m rowing ergometer and standing long jump tests. Data were analyzed using age-adjusted analysis of covariance (ANCOVA).

After adjustment for baseline values and age, both exercise-based interventions were associated with more favorable changes in hamstring viscoelastic properties and greater reductions in pain intensity compared with kinesiotaping (p < 0.001). Between-group differences in athletic performance were statistically significant but modest.

Hamstring-focused exercise interventions were associated with greater improvements in muscle mechanical properties and reductions in LBP compared with kinesiotaping in adolescent rowers. These findings support the inclusion of active hamstring exercises in rehabilitation programs for athletes with LBP.

Fibromyalgia (FM) is a disorder characterized by chronic widespread pain and fatigue, making diagnosis challenging. Early diagnosis is essential for improving the quality of life of FM.

This study aimed to evaluate whether FM can be diagnosed using magnetic resonance imaging (MRI) and to determine whether lumbar paraspinal muscle volume (LPMV) reduces susceptibility to FM by providing spinal balance, based on the hypothesis that alterations in paraspinal muscle structure and lumbar sagittal alignment may reflect neuromuscular adaptations secondary to central sensitization.

This retrospective cross-sectional study was conducted between July 2020 and March 2024. Thirty-one patients with FM and 32 healthy controls underwent MRI. The parameters evaluated included the intervertebral disc angle (IDA), lumbar lordosis angle (LLA), sacral tilt (ST), lumbosacral angle (LSA), and LPMV. The IDA was measured between the superior and inferior endplates of adjacent vertebrae in the sagittal plane, whereas the LPMV was quantified using Digital Imaging and Communications in Medicine (DICOM) software.

Age (OR = 1.12, p = 0.010) and IDA-4 score(OR = 1.467, p = 0.004) were independent risk factors for FM. LPMV, IDA-1, and IDA-4 values were significantly higher in FM (p < 0.05).

MRI-assessed spinal angles and LPMVs were associated with FM; however, these findings should not be interpreted as diagnostic or predictive markers. Higher paraspinal muscle volume, increased IDA-4 values, and older age were associated with FM. Given the limited sample size and potential confounders, the results should be interpreted cautiously.

Some knee osteoarthritis (KOA) patients show knee flexion in standing despite full extension in supine.

This study examined whether sagittal spinopelvic alignment is associated with the discrepancy between supine and standing knee extension.

In this retrospective cross-sectional study, 124 KOA patients undergoing preoperative evaluation were reviewed. Standing sagittal hip–knee–ankle angle (sHKA) was measured on full-length standing lateral radiographs, and supine sHKA was measured with a handheld two-arm goniometer. The difference between standing and supine sHKA (ΔsHKA) was examined. Patients were classified as having a ΔsHKA of ≥10° or <10°.Age, sagittal vertical axis (SVA), lumbar lordosis (LL), pelvic tilt, pelvic incidence (PI), and PI–LL were analyzed using multivariable logistic regression and receiver operating characteristic (ROC) analysis.

21 patients (16.9%) had ΔsHKA ≥10°. These individuals were older and had larger SVA, pelvic tilt, and PI-LL. PI-LL was associated with ΔsHKA of ≥10° (odds ratio: 1.08; 95% CI: 1.01–1.11; p = 0.03). ROC curve showed a PI-LL cutoff of 42.5° (AUC: 0.796; sensitivity: 47.6%; specificity: 96.1%).

Larger PI-LL was associated with standing knee flexion, even in patients with full extension in the supine position. Therefore, sagittal spine alignment should be evaluated in KOA patients.

There is limited evidence regarding the proportion of somatosensory deficits and their contribution to mobility, particularly in relation to independence and safety among ambulatory individuals with stroke from a developing country.

To report the proportion of somatosensory deficits, and investigate the relationship between sensorimotor deficits and mobility outcomes among individuals with stroke who walked with or without a walking device.

Eighty participants, with an average age of approximately 60 years both male and female, were cross-sectionally assessed for their sensorimotor functions, and mobility using the 10-meter walk test, timed up and go test (TUG), five times sit-to-stand test (FTSST), and 6-min walk test. The Spearman's rank correlation coefficient (r_s) was used to analyze the correlation between sensorimotor and mobility outcomes.

Nearly 60% of the participants experienced somatosensory deficits (5 absent and 42 impaired sensation). A large proportion of these individuals walked with a walking device (42.6%). Mobility outcomes indicated that these participants walked non-functionally with high risk of fall and low functional endurance. The motor scores were strongly correlated with the TUG data (r_s = −0.719, p < 0.01), whereas the somatosensory scores were related predominantly to the FTSST data (r_s = −0.520, p < 0.01).

Somatosensory impairments are common among ambulatory individuals with stroke. These impairments were primarily associated with mobility performed without hands. Therefore, rehabilitation strategies should target somatosensory alongside motor functions to enhance independence and safety, especially when therapeutic goals involve mobility without upper limb contribution.

Sacroiliac joint dysfunction (SIJD) is a common cause of low back pain, yet no single clinical test is definitive. Diagnostic sacroiliac joint (SIJ) block is widely used, but the diagnostic value of sustained versus immediate pain relief remains unclear.

To compare the diagnostic accuracy of SIJ block immediately and 1 week after injection in patients with suspected SIJD and to determine the incidence of concurrent conditions influencing the final diagnosis.

We retrospectively reviewed 168 outpatients with low back pain and SIJ score ≥ 4 who received ultrasound-guided SIJ block using 2.5 mL of 1% lidocaine between 2019 and 2024. Pain relief was evaluated using the Pain Relief Scale immediately and 1 week post-injection. In patients without sustained block effects, additional imaging and selective blocks were performed. Diagnostic accuracy (sensitivity, specificity, and predictive value) was calculated at each time point.

An immediate block effect was observed in 92.3% of patients; however, only 75.0% reported sustained relief at 1 week. Overall, 75.6% were diagnosed with SIJD alone, whereas 18.7% had SIJD concurrent with another condition. Immediate effect showed high sensitivity (0.99) but low specificity (0.30), whereas 1-week effect maintained high sensitivity (0.97) and significantly higher specificity (0.93).

The diagnostic utility of the SIJ block significantly improves when the effect is sustained 1 week after injection, as it excludes other etiologies. Immediate relief alone may be misleading, particularly in secondary SIJD. Notably, 1-week follow-up after SIJ block improved diagnostic accuracy and guided appropriate management.

Ultrasound-guided perineural injection of 5% dextrose in water (D5W) is considered a safe treatment option associated with clinical improvement in patients with mild-to-moderate carpal tunnel syndrome (CTS).

This study aimed to evaluate the efficacy of ultrasound-guided D5 W injection in patients with varying severities of CTS, including mild, moderate and severe cases.

36 patients with electrophysiologically confirmed CTS (mild, n = 11; moderate, n = 13; severe, n = 12) received a single ultrasound-guided perineural injection of 5 mL D5W. Patients with severe CTS were included only if surgical treatment was declined or not feasible. Pain, neuropathic pain, symptoms and functional outcomes were assessed using the Visual Analogue Scale (VAS), Douleur Neuropathique en 4 Questions (DN4), and Boston Carpal Tunnel Questionnaire (BCTQ: Symptom Severity Scale [SSS], Functional Status Scale [FSS]) at baseline and weeks 1, 4, 12, and 24.

All three groups demonstrated significant within-group improvements in VAS, DN4, SSS, and FSS scores from baseline, with improvements evident by week 1 and maintained throughout the 24-week follow-up period (p < 0.001). Between-group comparisons showed better outcomes in mild and moderate CTS, whereas the severe group achieved significant improvements but with higher outcome scores (p < 0.05). No major adverse events, including hematoma, nerve injury or tendon rupture were observed during follow-up; however, mild and transient injection-site pain was reported in most patients.

This study suggests that ultrasound-guided perineural D5W injection is associated with clinically meaningful improvements in pain, symptoms and function in patients with CTS across different severity levels, with less favorable outcomes in severe cases. This treatment may be considered a nonsurgical option for selected patients in whom surgical management is declined or not feasible.

Although many studies explore surface electromyography (sEMG) in static postures, research on muscle activation during dynamic tasks in chronic non-specific neck pain (CNNP) is limited.

To compare trapezius and sternocleidomastoid (SCM) activation and functional capacity during five upper limb tasks between individuals with CNNP and asymptomatic controls.

This was a cross-sectional comparative observational study. Twenty-seven individuals with CNNP and 25 asymptomatic controls completed five tasks: repetitive reaching (RRT), sustained overhead work (OW), waist-to-overhead lift (OL), fingertip dexterity (FD), and hand–forearm dexterity (HFD). sEMG recorded upper (UT), middle (MT), and lower trapezius (LT), and SCM activity. Functional capacity was assessed using selected WorkWell Systems Functional Capacity Evaluation (WWS-FCE) tasks.

CNNP individuals showed greater UT activation across all tasks (p < 0.01, d = 0.78–1.67) and significant MT differences in most conditions (p < 0.01, d = 0.84–1.44). LT showed smaller but significant differences (p < 0.05, d = 0.47–0.84). SCM activity increased during OL (p < 0.01, d = 0.73–1.08) and in one RRT subtask (p = 0.011, d = 0.73). CNNP performed worse than controls in RRT (p < 0.001, d = –1.32 to −1.61), OW (p < 0.001, d = –2.17), OL (p = 0.006–<0.001, d = –0.80 to −1.26), and HFD (p < 0.001, d = –1.06 to −1.36), with no significant FD differences (p > 0.05). Significant Group × Task interactions were observed for UT, MT, and SCM (p < 0.05).

Muscle activation profiles in chronic non-specific neck pain change with tasks, highlighting the importance of evaluating functional activities beyond static-posture assessments.

Chronic neck pain (CNP) is associated with disturbances in cervical motor control and altered postural strategies. However, little is known about how cervical motor demands influence the recruitment of deep abdominal stabilizers. This study examined the activation of the transversus abdominis–internal oblique (TrA–IO) during isolated and combined cervical–trunk motor tasks in individuals with CNP.

To compare TrA–IO activation during the abdominal drawing-in maneuver (ADIM) and ADIM combined with the craniocervical flexion test (CCFT) between individuals with CNP and healthy controls, and to evaluate the reliability of RMS-normalized surface EMG measurements.

A total of 38 participants (19 individuals with chronic neck pain and 19 age- and sex-matched healthy controls) performed ADIM and ADIM + CCFT tasks while surface EMG recorded bilateral TrA–IO activity. EMG signals were processed using RMS and normalized to maximal voluntary isometric contraction (%MVIC). A 2 × 2 mixed-model ANOVA evaluated group and task effects. Reliability was assessed using ICC, SEM, and MDC.

Both groups showed increased TrA–IO activation during ADIM + CCFT compared to ADIM (p < 0.01). However, the CNP group demonstrated significantly lower activation during the combined task (left: p = 0.026; right: p < 0.001). No associations were found between EMG activation and pain, disability, or symptom duration. Reliability analyses showed excellent test–retest stability (ICC = 0.91–0.99).

Individuals with CNP exhibit impaired ability to increase deep abdominal activation during cervical motor control tasks, indicating disrupted cervico-lumbopelvic synergy. Rehabilitation programs should integrate deep cervical flexor training with core stabilization strategies to address multi-segmental motor control deficits.

Adolescent idiopathic scoliosis (AIS) is frequently accompanied by spinal pain, but the underlying mechanisms remain unclear. Psychological factors such as kinesiophobia may play a key role in shaping pain perception and limiting physical activity in this population.

To compare kinesiophobia levels between adolescent idiopathic scoliosis and age-matched healthy controls, and to examine the associations among kinesiophobia, pain, and quality of life.

This cross-sectional controlled study included 128 participants (72 with AIS and 56 healthy controls), all of whom had experienced spinal pain at some point in their lives. Pain intensity was evaluated using the Visual Analogue Scale (VAS), kinesiophobia with the Tampa Scale for Kinesiophobia (TSK-17), and quality of life with the refined Scoliosis Research Society-22 (SRS-22r). Cobb measurements were used to assess deformity severity. Statistical analyses were performed to determine intergroup differences and correlations between variables.

Kinesiophobia scores were similar between groups but showed a significant positive correlation with pain intensity both in the AIS group (r = 0.34, p = 0.003) and in controls (r = 0.27, p = 0.044). In AIS patients, those reporting pain had significantly lower SRS-22r pain and function scores (p < 0.05). No correlation was observed between Cobb angle and either pain or TSK scores.

Adolescents with idiopathic scoliosis experience kinesiophobia primarily as a response to pain rather than as a function of deformity severity. Early pain management, reassurance, and motivational strategies to reduce movement-related fear may enhance adherence to exercise therapy and improve rehabilitation outcomes.

To investigate if the Medical Outcomes Study (MOS) sleep scale was reliable, valid, and responsiveness to treatment in Turkish patients with knee osteoarthritis (OA).

This is a methodological validation study. One hundred patients with knee OA and 75 healthy controls were included. The MOS sleep scale was administered to two groups to assess sleep status. The reliability of the questionnaire was assessed using reproducibility and internal consistency (Cronbach's alpha and item-total correlation). To assess reproducibility, the questionnaire was administered twice at 3-day intervals before treatment. It was also administered to patients at the end of treatment to investigate responsiveness to treatment. To assess concurrent validity, correlations with the NHP (Nottingham Health Profile) and the WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) were examined.

The MOS sleep scale all scores were significantly lower in patients with knee OA than in controls (p < 0.05). After the treatment, a significant improvement was observed in all MOS sleep scale scores of the patients (p < 0.05). The Turkish version of the MOS sleep scale was reliable with strong internal consistency (Cronbach alpha: 0.74–0.85 and Item-total correlation:0.50–0.89) and good reproducibility (intra-reader correlation:0.47–0.83, inter-reader correlation:0.43–0.84) in patients with knee OA. When assessing concurrent validity of the scale, it was determined that its correlations with WOMAC and NHP scores were moderate and good levels (r = −0.21–0.50, p = 0.03–0.0001).

Our study showed that the MOS sleep questionnaire is a valid, reliable, and treatment-responsive scale in Turkish patients with knee OA.

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. The effects of ultrasound-guided nerve hydrodissection in the treatment of CTS are controversial.

To evaluate the short-term effectiveness of 5% dextrose (D5 W) injection with ultrasound-guided nerve hydrodissection method together with wrist orthosis treatment in mild and moderate CTS patients and the contribution of this treatment to wrist orthosis treatment.

In this prospective randomized controlled trial, forty-four participants with mild to moderate CTS were randomly assigned the wrist orthosis treatment group (control) and wrist orthosis with D5 W injection treatment group (study) using stratified block randomization. All patients were evaluated via the Visual Analog Scale (VAS), Boston Carpal Tunnel Questionnaire (BCTQ), grip strength (GST), and median nerve cross-sectional area (CSA).

Within-group analysis demonstrated statistically significant improvements in VAS, BCTQS, and BCTQF scores in the control group, and in all evaluated parameters in the study group (p < 0.05). Between-group comparisons of change scores revealed no statistically significant differences for VAS (MD −0.8, 95% CI −1.74 to 0.14), BCTQS (MD −2.95, 95% CI −6.38 to 0.48), CSA (MD −0.46, 95% CI −1.20 to 0.28), or GST (MD 1.33, 95% CI −0.43 to 3.09). However, a statistically significant between-group difference was observed for the BCTQF score, favoring the study group (MD −1.65, 95% CI −3.65 to −0.35; p < 0.05).

USG-guided hydrodissection injection with D5 W in CTS improves wrist orthosis treatment. This injection helps patients perform functions that affect daily activities, such as grasping more effectively. For patients who use wrist orthoses but do not achieve sufficient improvement in their functions, hydrodissection injection with D5 W can be recommended.

Classifying low back pain (LBP) based solely on symptom duration may be insufficient to explain underlying paraspinal muscle degeneration and dysfunction in recurrent and chronic LBP cases.

Fifty-nine females (45 with non-specific low back pain, 14 pain-free controls) were categorized into subgroups using cluster analysis based on personal, pain-related, psychological, and functional characteristics. Lumbar paraspinal muscle structure was assessed using T1-weighted Dixon MRI to measure muscle cross-sectional area (CSA), fat CSA, and muscle fat index (MFI). Muscle function was evaluated using T2-weighted MRI to determine resting T2 values (T2-rest) and T2 shift following muscle activation (T2-shift) at three specific lumbar levels: upper L3 (UL L3), upper L4 (UL L4), and lower L4 (LL L4).

Four new LBP subgroups were identified and compared to HC (healthy control (n = 14), 23.6%): Neutral (NT; n = 5, 8.5%), Personal and Pain Affected (PA; n = 9, 15.3%), Maladaptive cognition affected (MCA; n = 25, 42.4%), and Personal, Pain, Psychological, and Functional Affected (PPFA; n = 6, 10.2%). NT resembled HC indicating healthy lumbar muscle, PA subgroup showed with a higher fat CSA and MFI in paraspinals muscle. PA and MCA exhibited localized muscle hyperactivity. PPFA subgroups remained metabolically inactive.

This novel LBP subgrouping framework revealed distinct patterns of paraspinal muscle fatty infiltration and dysfunction. Fatty infiltration and hyperactivity were linked to BMI, chronicity, and cognitive traits; hypoactivity was found in those with broad psychosocial and functional impairments.

Upper limb motor impairment after stroke is a leading cause of long-term disability. This single-center pilot randomized controlled trial (RCT) evaluated the safety, feasibility, and preliminary efficacy of intermittent theta-burst stimulation (iTBS) combined with task-oriented training (TOT) for upper limb rehabilitation. iTBS, a non-invasive brain stimulation technique, may enhance recovery when paired with task-oriented training (TOT), particularly in the subacute phase of heightened neuroplasticity.

Twenty-nine patients with subacute stroke were randomized into three groups: (1) iTBS + TOT (n = 10), (2) sham iTBS + TOT (n = 9), and (3) traditional physiotherapy (n = 10). All underwent a 4-week intervention. Primary outcomes were safety and feasibility. Secondary outcomes included motor impairment (Fugl-Meyer Assessment for Upper Extremity, FMA-UE), functional independence (Modified Barthel Index, MBI), and neurological deficit (National Institutes of Health Stroke Scale, NIHSS), assessed at baseline, week 2, and week 4.

Twenty-nine participants completed the trial without any adverse events, and one participant from Group 2 discontinued early due to discharge. At week 4, the iTBS + TOT group showed greater improvements in FMA-UE (22.9 points vs. 3.6 and 10.2; p = 0.013; p = 0.013), NIHSS (3.0 vs 6.6; p = 0.009), and MBI (90.7 vs 51.4; p < 0.001) compared with controls, indicating potential functional benefits.

This exploratory pilot RCT suggests that combining iTBS with TOT is safe and feasible, with preliminary evidence supporting its potential to improve upper limb recovery in subacute stroke. However, these findings should be interpreted with caution and validated in larger, adequately powered trials.

Core muscular endurance is believed to support both postural control and proprioceptive accuracy.

This study aimed to investigate the relationship between core endurance, dynamic balance, and proprioceptive function of the hip and shoulder joints in healthy young adults.

Sixty healthy young adults (mean age: 20.9 ± 2.4 years) participated. Core endurance was evaluated using McGill tests: Trunk Anterior Flexor Test (TAFT), Trunk Posterior Extensor Test (TPET), Right and Left Lateral Plank Tests (RLPT, LLPT). Dynamic balance was assessed with the Pedalo^® platform, while shoulder and hip proprioception (flexion and abduction) was measured using the Biodex System 3 Pro.

Significant positive correlations were observed among the McGill core endurance tests, with the strongest association between RLPT and LLPT. However, no significant bivariate correlations were found between the core endurance tests and dynamic balance or shoulder and hip proprioception (flexion and abduction). In the regression analysis, only the mean lateral plank time (LPTmean) emerged as a significant predictor of dynamic balance, whereas the Trunk Posterior Extensor Test (TPET) showed a small but significant association with shoulder flexion joint position sense error. No core endurance test significantly predicted shoulder abduction or hip proprioception.

These findings suggest that lateral core endurance may be particularly associated with dynamic balance under tasks that involve medio-lateral stability demands, and that posterior trunk endurance (TPET) may be related to shoulder flexion proprioception in healthy young adults. These associations are correlational and should be interpreted with caution.

Synovial chondromatosis (SC) is a rare proliferative disorder characterized by the metaplastic formation of cartilaginous and osteochondral nodules in the synovial membrane of joints, tendon sheaths, or bursae. It most commonly affects the knee, followed in frequency by the elbow, ankle, hip, and shoulder. Although SC usually presents as a monoarticular condition, bilateral, extra-articular, or multifocal involvement is uncommon.

We report a 78-year-old patient with a history of cerebrovascular event and coronary artery disease who presented with bilateral intra-articular synovial chondromatosis extending extra-articularly to the right popliteal fossa and quadriceps tendon.

After completing 21 sessions of preoperative rehabilitation, the patient underwent right knee surgery consisting of debridement, synovectomy, and cystectomy.

Pain intensity was assessed using the Visual Analog Scale (VAS), and joint range of motion was recorded.

Although bilateral involvement is rare, SC should be considered in the differential diagnosis of patients presenting with bilateral knee pain and stiffness. We suggest that preoperative rehabilitation may contribute positively to the overall treatment process, and in cases where surgery is declined, rehabilitation alone may lead to improvements in pain and joint mobility.