Compare the Effect of Traditional and Virtual Reality Training on Subjective-sense of Instability and Balance in Basketball-players with Functional Ankle Instability: Matched Randomized Clinical Trial

Background: Functional ankle instability (FAI) is a common injury. Traditional training improved the reported balance impairment and subjective sense of instability in athletes with FAI. Objective: This study aims to compare the effects of traditional and virtual reality training on a subjective sense of instability and balance in athlete with FAI. Material and Methods: In this single-blinded matched randomized clinical trial design, Fifty-four basketball players were randomly assigned in the virtual reality (n=27) or control (n=27) groups. All athletes performed 12 sessions Wii exercises or traditional training in the virtual reality and the control group, respectively, for three days a week. To assess the subjective-sense of instability and balance, we used Cumberland Ankle Instability Tool (CAIT) and Star Excursion Balance Test (SEBT), respectively. Measures were taken at pre- and post-test and one month after training as a follow-up. The between-group comparisons were done by the analysis of Covariance. Results: At the pre-test, the CAIT score was 22.37, 22.04 in the control and virtual reality groups, respectively and at the post-test, these scores increased to 26.63, 27.26. The involved limb showed significant differences in posteromedial and posterior directions of the SEBT and CAIT score in the post-test and in the posterior direction and CAIT score in the follow-up. The virtual reality group had better performance than the control group but the effect size is small (cohen’s d<0.2).  Conclusion: Based on our results, both training protocols were effective in reducing the subjective-sense of instability and improved balance in athletes with FAI. Moreover, virtual reality training was very attractive for the participants

The effect of forward head posture on cervical joint position sense

A number of studies have investigated the effect of age, trauma, disease and fatigue on cervical joint position sense. However, there is an absence in data regarding the role of posture on proprioception. The aim of the current study was to investigate the effect of Forward Head Posture (FHP) on cervical joint position sense. Twenty Forward Head Posture volunteers (14 women, 6 men), with the mean age of 23.94 (SD=3.26) years, and 17 normal head posture volunteers (8 women, 9 men) with the mean age of 23.50 (SD=2.68) years were asked to perform the Cervicocephalic relocation test (CRT) to the neutral head position (NHP). The aim of this test was to evaluate the participants' ability to relocate the head to neutral position after they actively rotated it to left and right sides. Three trials were performed for each rotation to the left and right. In order to assess cervical joint repositioning accuracy, Absolute, Constant and Variable errors were used. No significant difference in repositioning errors was observed between experimental and control group in absolute and constant errors (P&gt;0.05); however, compared to normal group, Forward Head Posture subjects manifested significantly higher levels of variable errors (P&lt;0.05). Forward Head Posture can significantly affect the positioning consistency of cervical proprioception. Nonetheless, further investigation on the effect of Forward Head Posture on cervical proprioception in altered situations is recommended.

The Effect of Therapeutic Exercise on Long-Standing Adductor-Related Groin Pain in Athletes: Modified Hölmich Protocol

Objective. The Hölmich protocol in therapeutic exercise is the most appropriate method for the treatment of long-standing adductor-related groin pain (LSAGP). Herein, we evaluated a modified Hölmich protocol to resolve the possible limitations intrinsic to the Hölmich protocol in terms of the rate of return to sport and the recovery period for athletes with LSAGP. Design. The study followed a single-blind, before/after study design, where 15 athletes with LSAGP (mean age = 26.13 years; SD = 4.48) performed a 10-week modified Hölmich therapeutic exercise protocol. Results. Outcome scores related to pain, hip adductor and abductor muscle strengths, and the ratio of maximum isometric and eccentric hip adduction to abduction strength increased significantly. Likewise, hip abduction and internal rotation ROM improved significantly compared to that at baseline. Furthermore, functional records (t-test, Edgren Side Step Test, and Triple Hop Test) showed significant improvement after treatment. Finally, 13 athletes (86.6% of the participants) successfully returned to sports activity in a mean time of 12.06 weeks (SD = 3.41). Conclusion. The findings of this study objectively show that the modified Hölmich protocol may be safer and more effective than the Hölmich protocol in athletes with LSAGP in promoting their return to sports activity. This trial is registered with  IRCT2016080829269N1

Knee Muscle Reciprocal Co-Activation in Patellofemoral Pain Syndrome During Isokinetic Exercise: A Voluntary Response Index Analysis

Introduction: The origin of the Patellofemoral Pain Syndrome (PFPS) is not still completely clear and may have a biomechanical or biochemical cause. Motor control dysfunction may have a role in this condition. Voluntary Response Index (VRI) is able to show changes in the central nervous system motor output that occur with intervention, recovery, or progression of the disorder. Therefore, the outcomes may contribute to offer another tool for PFPS motor control evaluation. The aim of the present study, therefore, was to assess the changes in the quadriceps and hamstring reciprocal coactivation patterns that may be observed in individuals with PFPS using the VRI. Methods and Materials: A total of 24 female participants, 12 with sound knees and 12 with PFPS participated in the present study. The study was accomplished in the Biomechanics Laboratory at Rehabilitation School of Tehran University of Medical Sciences in 2015. The participants sat on a Biodex dynamometer. They were asked to perform 10 continuous knee extension and flexion motions with maximal strength at 45˚/s and 300˚/s, distinctly. Simultaneously, electromyographic activities of the vastus medialis (VM), vastus lateralis (VL), rectus femoris (RF), and biceps femoris (BF) were recorded and VRI was calculated. A two-way analysis of variance was run to assess the effect of group and velocity on the VRI (similarity index and magnitude). Results: There was no velocity or group main effect observed for the VRI (P&gt;0.05). In addition, no significant velocity × group interaction was found for the VRI (P&gt;0.05). Conclusion: PFPS may not be linked to altered quadriceps and hamstring reciprocal co-activation patterns during isokinetic exercise. In addition, angular velocity may not be an important parameter in voluntary motor control assessment during isokinetic exercise.Keywords: Reciprocal co-activation; Voluntary response index; Patellofemoral pain syndrome; Isokineti

The Investigation of Median Frequency Changes in Paraspinal Muscles Following Fatigue

Objectives: There are two sub systems of paraspinal muscles, the global-mobilizing system and the local&nbsp;stabilizing system. The multifidus muscles are assigned to the local system and stabilize the joints. In&nbsp;contrast, the longissimus muscles are assigned to the global system and force exertion. This study aimed&nbsp;to investigate the median frequency changes in mobilizing and stabilizing muscles following fatigue. Method: A cross sectional study was designed. sEMG measurements were recorded from twenty&nbsp;participants following a fatigue protocol in B200 dynamometer. Participants performed dynamic trunk&nbsp;flexion-extension against a moderate resistance while standing in a static dynamometer until they could&nbsp;no longer performs the task because of fatigue. Results: Statistical analyses showed significant differences between median frequencies pre and post&nbsp;fatigue (P<0.05). Median frequency of the right and left multifudus muscles reduced from &quot;99.12 and&nbsp;93.2&quot; to &quot;86.55 and 85.85&quot; respectively. Also Median frequency of the right and left longissimus reduced&nbsp;from &quot;76.54 and 76.82&quot; to &quot;66.43 and 68.55&quot; respectively. Conclusion: Median frequency shift toward low values following fatigue in global and local paraspinal&nbsp;muscles was seen. However, median frequency values for the local stabilizer muscle were higher than&nbsp;median frequency values for the global muscles

Effects of wearing a lumbosacral support on velocity and torque of lumbar spine during three-dimensional trunk motion

Introduction: The use of back support is one of the common methods aimed to prevent low back pain. The purpose of the present study was to investigate the effect of wearing a lumbosacral support on lumbar spine velocity and torque in six directions during combined trunk motion. Materials and Methods : In this interventional study, 30 young healthy men were selected simply from convenient samples. They were asked to stand in Isostation B200 system and perform three-dimensional trunk motion against a resistance of 50% of maximal voluntary contraction torque while wearing or not wearing a lumbosacral support. Under each condition of test, five successive motions of trunk were performed in downward direction (as flexion, right lateral flexion, and right rotation) and upward direction (as extension, left lateral flexion, and left rotation), and the variables of average velocity and average torque were recorded during motion. Results : With the use of a lumbosacral support, average velocity was significantly increased in flexion (P=0.015) and extension (P=0.005), but no significant changes were found in other directions (P>0/05). Back support decreased average torque of right rotation significantly (P=0.006), but did not significantly changed this variable in other directions (P>0/05). Conclusion : Wearing a lumbosacral support can increase velocity in sagittal plane. Decreased rotation torque of trunk, as a result of using a back support, may reduce the twisting forces on lumbar spine joints

The Effect of Therapeutic Exercise on Long-Standing Adductor-Related Groin Pain in Athletes: Modified Hölmich Protocol

Objective. The Hölmich protocol in therapeutic exercise is the most appropriate method for the treatment of long-standing adductor-related groin pain (LSAGP). Herein, we evaluated a modified Hölmich protocol to resolve the possible limitations intrinsic to the Hölmich protocol in terms of the rate of return to sport and the recovery period for athletes with LSAGP. Design. The study followed a single-blind, before/after study design, where 15 athletes with LSAGP (mean age = 26.13 years; SD = 4.48) performed a 10-week modified Hölmich therapeutic exercise protocol. Results. Outcome scores related to pain, hip adductor and abductor muscle strengths, and the ratio of maximum isometric and eccentric hip adduction to abduction strength increased significantly. Likewise, hip abduction and internal rotation ROM improved significantly compared to that at baseline. Furthermore, functional records (t-test, Edgren Side Step Test, and Triple Hop Test) showed significant improvement after treatment. Finally, 13 athletes (86.6% of the participants) successfully returned to sports activity in a mean time of 12.06 weeks (SD = 3.41). Conclusion. The findings of this study objectively show that the modified Hölmich protocol may be safer and more effective than the Hölmich protocol in athletes with LSAGP in promoting their return to sports activity. This trial is registered with  IRCT2016080829269N1