Muscle energy techniques in the management of chronic obstructive pulmonary disease : a narrative review

Physiotherapy plays a major role in the long-term management of COPD. Guidelines issued by the BTS (2013) and the GOLD guidelines (2017) set a strong recommendation for pulmonary rehabilitation, chest mobility and breathing exercises as a management for these patients. Research is now focusing on METs as an adjunct to other treatments but evidence is still inconclusive. The aim of this review is to evaluate the effectiveness of METs on chest expansion, pulmonary function and exercise tolerance for patients diagnosed with COPD. Papers were included under the population intervention comparator outcome (PICO) framework. Critical appraisal, data abstraction, and synthesis were carried out by the different authors. Out of 23 titles screened, 7 interventions with a low to moderate risk of bias met the inclusion criteria. Studies that implemented METs intervention were observed to have promising results on chest expansion, pulmonary function and exercise tolerance when integrated with self-stretching exercises, chest mobility exercises and/or breathing exercises, aerobic training and pulmonary rehabilitation. METs as an adjuvant treatment in patients with COPD show favourable improvements in pulmonary function, chest expansion and exercise tolerance. However, there is still insufficient evidence.peer-reviewe

The effectiveness of a 12 week exercise programme in hip osteoarthritis : a randomised controlled trial

Purpose: Osteoarthritis (OA) is a common disease caused by the destruction of the joint cartilage. Pain, stiffness and dysfunction during activities of daily living are common reasons leading to a hip arthroplasty. Programmes based on quadriceps strengthening are now evidence-based. Therefore, this study aims to explore and investigate the effects of a 12-week hip exercise programme on pain and functional levels. Methods: This study reports outcomes of a randomised controlled trial. 40 participants were randomly allocated into 2 groups: control group and an intervention group. All participants were asked general demographic data at baseline, followed by assessment using the NPRS, WOMAC Scale, 6 MWT and muscle testing. Participants in the control group received no intervention, whereas the others performed hip exercises. A 12-week exercise programme resulted in highly statistically significant improvements for participants in the intervention group and minimal changes for the control group.peer-reviewe

The prevalence of musculoskeletal injuries in tennis players : a case study

Tennis is a popular sport both globally and locally. It is characterised by repeated strokes and explosive movements, which places the athlete at a high – risk of injuries. This study aimed at gathering data on the prevalence of tennis-related musculoskeletal injuries and injury characteristics from a local Maltese tennis club and analyse the impact of using different injury definitions on the number of collected injuries. Through this case study, an adapted version of the OSTRC questionnaire was distributed via email to members of one Maltese amateur tennis club. Using the ‘all physical complaints’ injury definition data on the prevalence and characteristics of musculoskeletal injuries suffered in the previous 6 months was gathered. Results were then analysed via SPSS and Microsoft Office Excel. A total of 61 injuries from 106 participants were recorded, with a point prevalence of 57.5%. 11 out of these 61 injuries were ‘time-loss’ injuries, and 33 were substantial injuries. The most injured locations were the elbow, knee, and ankle. Gradual onset were the most common, with most of them occurring in the elbow (41%). The ankle was mostly impacted by sudden onset injuries (36.3%). Following injury severity calculations, sudden onset injuries to the thigh and gradual onset injuries to the elbow and knee were the most burdensome. Through this study, an overview of injury prevalence and awareness from a small group of tennis players from one club has been obtained, setting recommendations for a local wide scale study to investigate the total population prevalence, information which will provide more insight for physiotherapists to help with injury prevention programmes, especially focusing on the elbow and knee, seeing that both were most frequently recorded and most burdensome.peer-reviewe

Systemic inflammation in COPD is not influenced by pulmonary rehabilitation

Purpose: Pulmonary rehabilitation is known to lead to improvements in exercise tolerance, health-related quality of life and help reduce symptoms. Exercise, one of the largest components of such an intervention, although of great benefit, can increase the inflammatory response related to chronic obstructive pulmonary disease, depending on intensity and duration. Through this study, the effects of a 12week, high-intensity PR programme on COPD inflammatory-related markers were investigated. Materials and methods: This study is a longitudinal, observational type of study. Sixty COPD patients were enrolled, 49 of which completed the programme. A 2-h high-intensity PR programme was delivered, twice weekly for 12 weeks. The following markers were assessed at baseline, 4, 8 and 12 weeks through rehabilitation – C-reactive protein, erythrocyte sedimentation rate, neutrophil, eosinophil counts, complete blood count, six-minute walk test and St. George’s Respiratory Questionnaire. Serum amyloid A levels were assessed at baseline, week 8 and 12 and exhaled NO at baseline and upon completion of the programme. Results: This 12-week PR programme resulted in no changes in the inflammatory markers but resulted in significant improvements in both the 6MW distance and health quality of life. Conclusions: Beneficial effects on functional and HRQoL measures resulted, which, however, appear unrelated to changes in the systemic inflammatory markers.peer-reviewe

The kinematics of fixed-seat rowing : a structured synthesis

Olympic-style sliding-seat rowing is a sport that has been extensively researched, with studies investigating aspects related to the physiology, biomechanics, kinematics, and the performance of rowers. In contrast, studies on the more classic form of fixed-seat rowing are sparse. The aim of this study is to address this lacuna by analysing for the first time the specific kinematics of fixed-seat rowing as practised by able-bodied athletes, thus (i) documenting how this technique is performed in a manner that is replicable by others and (ii) showing how this technique compares and contrasts with the more standard sliding-seat technique. Fixed-seat rowing was replicated in a biomechanics laboratory where experienced fixed-seat rowers, marked with reflective markers following the modified Helen–Hayes model, were asked to row in a manner that mimics rowing on a fixed-seat boat. The findings from this study, complimented with data gathered through the observation of athletes rowing on water, were compared to sliding-seat ergometer rowing and other control experiments. The results show that, in fixed-seat rowing, there is more forward and backward thoracic movement than in sliding-seat rowing (75–77° vs. 44–52°, p < 0.0005). Tilting of the upper body stems was noted to result from rotations around the pelvis, as in sliding-seat rowing, rather than from spinal movements. The results also confirmed knee flexion in fixed-seat rowing with a range of motion of 30–35°. This is less pronounced than in standard-seat rowing, but not insignificant. These findings provide a biomechanical explanation as to why fixed-seat rowers do not have an increased risk of back injuries when compared with their sliding-seat counterparts. They also provide athletes, coaches, and related personnel with precise and detailed information of how fixed-seat rowing is performed so that they may formulate better and more specific evidence-based training programs to meliorate technique and performance.peer-reviewe

On the kinematics of the forward-facing Venetian-style rowing technique

This work presents a qualitative and quantitative pilot study which explores the kinematics of Venetian style forward-facing standing rowing as practised by able-bodied competitive athletes. The technique, made famous by the gondoliers, was replicated in a biomechanics laboratory by a cohort of four experienced rowers who compete in this style at National Level events in Malta. Athletes were marked with reflective markers following the modified Helen Hayes model and asked to row in a manner which mimics their on-water practise and recorded using a Vicon optoelectronic motion capture system. Data collected were compared to its equivalent using a standard sliding-seat ergometer as well as data collated from observations of athletes rowing on water, thus permitting the documentation of the manner of how this technique is performed. It was shown that this rowing style is characterised by rather asymmetric and complex kinematics, particularly upper-body movements which provides the athlete with a total-body workout involving all major muscle groups working either isometrically, to provide stability, or actively.peer-reviewe

On the Kinematics of the Forward-Facing Venetian-Style Rowing Technique

This work presents a qualitative and quantitative pilot study which explores the kinematics of Venetian style forward-facing standing rowing as practised by able-bodied competitive athletes. The technique, made famous by the gondoliers, was replicated in a biomechanics laboratory by a cohort of four experienced rowers who compete in this style at National Level events in Malta. Athletes were marked with reflective markers following the modified Helen Hayes model and asked to row in a manner which mimics their on-water practise and recorded using a Vicon optoelectronic motion capture system. Data collected were compared to its equivalent using a standard sliding-seat ergometer as well as data collated from observations of athletes rowing on water, thus permitting the documentation of the manner of how this technique is performed. It was shown that this rowing style is characterised by rather asymmetric and complex kinematics, particularly upper-body movements which provides the athlete with a total-body workout involving all major muscle groups working either isometrically, to provide stability, or actively

Negative Poisson's ratios in tendons: An unexpected mechanical response.

UNLABELLED Tendons are visco-elastic structures that connect bones to muscles and perform the basic function of force transfer to and from the skeleton. They are essential for positioning as well as energy storing when involved in more abrupt movements such as jumping. Unfortunately, they are also prone to damage, and when injuries occur, they may have dilapidating consequences. For instance, there is consensus that injuries of tendons such as Achilles tendinopathies, which are common in athletes, are difficult to treat. Here we show, through in vivo and ex vivo tests, that healthy tendons are highly anisotropic and behave in a very unconventional manner when stretched, and exhibit a negative Poisson's ratio (auxeticity) in some planes when stretched up to 2% along their length, i.e. within their normal range of motion. Furthermore, since the Poisson's ratio is highly dependent on the material's microstructure, which may be lost if tendons are damaged or diseased, this property may provide a suitable diagnostic tool to assess tendon health. STATEMENT OF SIGNIFICANCE We report that human tendons including the Achilles tendons exhibits the very unusual mechanical property of a negative Poisson's ratio (auxetic) meaning that they get fatter rather than thinner when stretched. This report is backed by in vivo and ex vivo experiments we performed which clearly confirm auxeticity in this living material for strains which correspond to those experienced during most normal everyday activities. We also show that this property is not limited to the human Achilles tendon, as it was also found in tendons taken from sheep and pigs. This new information about tendons can form the scientific basis for a test for tendon health as well as enable the design of better tendon prosthesis which could replace damaged tendons

Negative Poisson's ratios in tendons: An unexpected mechanical response.

UNLABELLED Tendons are visco-elastic structures that connect bones to muscles and perform the basic function of force transfer to and from the skeleton. They are essential for positioning as well as energy storing when involved in more abrupt movements such as jumping. Unfortunately, they are also prone to damage, and when injuries occur, they may have dilapidating consequences. For instance, there is consensus that injuries of tendons such as Achilles tendinopathies, which are common in athletes, are difficult to treat. Here we show, through in vivo and ex vivo tests, that healthy tendons are highly anisotropic and behave in a very unconventional manner when stretched, and exhibit a negative Poisson's ratio (auxeticity) in some planes when stretched up to 2% along their length, i.e. within their normal range of motion. Furthermore, since the Poisson's ratio is highly dependent on the material's microstructure, which may be lost if tendons are damaged or diseased, this property may provide a suitable diagnostic tool to assess tendon health. STATEMENT OF SIGNIFICANCE We report that human tendons including the Achilles tendons exhibits the very unusual mechanical property of a negative Poisson's ratio (auxetic) meaning that they get fatter rather than thinner when stretched. This report is backed by in vivo and ex vivo experiments we performed which clearly confirm auxeticity in this living material for strains which correspond to those experienced during most normal everyday activities. We also show that this property is not limited to the human Achilles tendon, as it was also found in tendons taken from sheep and pigs. This new information about tendons can form the scientific basis for a test for tendon health as well as enable the design of better tendon prosthesis which could replace damaged tendons