Narrative Review: Effects of manipulation and mobilization techniques of cervical spine on pressure pain threshold in neck and shoulder muscles

Neck pain is one of the most common problems seen in medical practice. There are various factors that can cause or provoke neck pain. Myofascial trigger points in shoulder and neck regions are among the most effective factors that may provoke neck and head pain. Recently, it has been revealed that there is a clinical relationship between myofascial trigger points and joints dysfunction. Accordingly, different studies have been conducted in order to evaluate therapeutic effects of different manual approaches including mobilization and manipulation on improving Pressure Pain Threshold (PPT) as an indicator of changes in sensitivity of muscles. The aim of the present study was to conduct a narrative review to evaluate effects of manipulation and mobilization techniques of cervical spine on PPT in neck and shoulder muscles. From among different studies which have assessed the effectiveness of manual techniques directed on cervical spine, 10 most related studies were selected and the therapeutic approaches and results of these studies were studied. Review of these studies indicated that the application of manual techniques on cervical spine, such as manipulation and mobilization, could increase range of motion in cervical spine and even mouth opening according to relationship between cervical spine and tempromandibular joints. On the other hand, according to the relationship between joints and muscles, applying these techniques on cervical spines could improve PPT.Keywords: Manipulation, Mobilization, Pressure Pain Threshold, Cervical Spin

Intra-Examiner and Between-Day Reliability of Algometer for Pressure Pain Threshold and Pain Sensitivity in Upper Trapezius Muscle in Asymptomatic Young Adult Women

Assessment of pain sensitivity, as an important criterion, is used in diagnosis of musculoskeletal impairments, which helps determine prognosis as well as the improvement rate after treatment interventions. Regarding the costs of modalities and treatment equipment used to reduce pain, having a reliable method to determine their efficacy is essential. The aim of the present study was to evaluate intra-examiner and between-day reliability of an accessible digital algometer to assess pressure pain threshold and for pain sensitivity for the first time. A total of 15 healthy young adult women aged 18-30 participated in the study. Three points of upper Trapezius muscle in both sides were tested in 3 repetitions with 30 seconds rest interval. The tests included PPT by controlled speed of increasing pressure and Visual Analogue Scale to evaluate local pain elicited by exertion of 2.5 kg/cm2 of pressure on the marked point. Trials were conducted on two consecutive days. Intra Class Correlation, Coefficient Standard Error of Measurement, and Minimal Detected Change were calculated to analyze the reliability of the measurements. Assessments revealed high to moderate intra-examiner reliability for pressure pain threshold (ICC>0.972) and pain sensitivity (ICC>0.707) and high to moderate between-day reliability for pressure pain threshold (ICC>0.974) and pain sensitivity (ICC>0.676). Although pressure algometer has an acceptable intra-examiner and between-day reliability for estimating the pressure pain threshold and pain sensitivity, a significant decrease was revealed in the mean values of PPT and increase in PS on the second day, as compared to that on the first day, (P<0.05) which could be related to local tissue trauma, learning effect, or central sensitization.Key words: Reliability; Intra-Examiner; Between-Day; Algometer; Pressure Pain Threshold; Pain Sensitivity; Upper Trapeziu

Spinal Stabilization Exercise with and without Whole–Body Vibration: A Randomized Controlled Clinical Trial

Introduction: The present study aimed to compare the impacts of core stability exercises with and without Whole Body Vibration (WBV) training sessions lasting two weeks on trunk muscle endurance in patients with non-specific chronic low back. Methods and Materials: Thirty participants were randomly placed into either a WBV group or a spinal stabilization group at Shahid Beheshti University of Medical Sciences, Tehran, Iran, in 2013. The dependent variables manipulated included the abdominal and spinal muscular endurance, assessed prior to, midway through, and after two weeks and the WBV or spinal stabilization intervention program implemented using stabilizer pressure biofeedback unit and Biering Sorensen test. Results: Changes in transverse abdominal and internal oblique muscle endurance in prone position were statistically significant among the participants in both groups (P<0.05). However, changes in transverse abdominal muscle endurance in supine position and multifidus muscle endurance were not observed to be statistically significant in both groups. In addition, inter-group analysis showed that except for the percentage of changes of multifidus muscle endurance, the vibration group demonstrated significant improvement over the non-vibration group. Conclusion: As no significant difference was observed between the two treatment methods, none of treatment methods was more effective comparatively in terms of improving mid-term trunk muscle endurance.Keywords: Whole body vibration, Trunk muscle endurance, Non-specific chronic low back pain, Core stabilit

The effect of Hand Positions on the Vibration Platform on Shoulder Muscle: Strength and Proprioception

Introduction: To compare the short-term effect of one session of Whole Body Vibration (WBV) in two positions of hand on the vibration platform on isokinetic strength of Rotator cuff and shoulder proprioception. Method and Materials: A total of 60 young healthy students participated in the present study completing three positions of control (no vibration), push up with straight elbow, and push up with semi flexed elbow (two vibration positions) running for two minutes with 30-minute rest between the positions. After control position, vibration positions were tested randomly on the Power Plate device (F: 30Hz and low amp). The isokinetic strength of Rotator Cuff and the absolute angular error in joint repositioning test in 3 target angles of 0°, 45°, and 90° were measured using Kin-Com dynamometer before and after each position. Then, the results of the three positions were compared together. Results: Despite decrease in dynamic strength of medial rotators after three positions, this decrease was observed to be significantly less in push up with straight elbow compared with that in control position (P=0.03). Also, there was a significant difference in Concentric MPT of Lateral Rotators between the three positions with control position revealing the greatest decline in lateral rotators strength (P=0.01) and push up with straight elbow was found to be more effective than semi flexed elbow (P=0.03). Moreover, There was a significant improvement in angle repositioning for the three positions; however, it was considerably more only in zero degree in the push up with semi flexed elbow position as compared with that in the control position (P=0.03). No significant changes were found between push up with straight elbow and semi flexed elbow positions, either. Conclusions: The two different hand positions did not alter the effect of vibration on neuromuscular system in young and healthy individuals. Although a single session of WBV had a positive effect on the neuromuscular system of the young healthy participants, the two positioning did not make a significant difference.Key words: Whole body vibration training, shoulder muscle strength, proprioceptio

The Effect of Strengthening Exercises on Functional Ability in Patients with MS: A Review Study

Introduction: Patients with multiple sclerosis (MS) usually report gait and balance disorders. Exercise therapy, especially strengthening exercise, is a safe and effective treatment approach in these patients. Therefore, the aim of this review study was to determine the effect of strengthening exercises on functional ability in patients with MS. Methods and Materials: A search of databases such as PubMed, science direct, Cochrane library, and Google scholar was reviewed to determine the existing articles on the effect of strengthening exercises on functional ability in patients with MS. Results: According to the evaluation of studies from 2000 to 2020, 8 articles met the inclusion criteria. These articles examined the effect of strengthening exercises on functional ability in patients with MS. The results showed that strengthening exercises improved balance variables, functional ability, strength, and quality of life. Conclusion: Various interventions including stretching, balance, strengthening exercises, and electrical stimulation have been used to treat balance disorders, decreased muscle strength, gait efficiency and quality of life in patients with MS. Among these interventions, strengthening exercises have been shown to play an effective role in improving functional ability, although more studies are needed in this area

Pedobarography of the coper and non-coper ACL-deficient knee subjects during single and double leg stance

Introduction: Biomechanical studies have frequently shown a close relationship between the knee and ankle joint movements. ACL-deficiency may change the foot pressure pattern of the ACL-deficient knee subjects. The current study aimed to investigate the pattern of the foot pressure in coper and non-coper ACL-deficient knee subjects during standing on one and both feet. Methods and Materials: This case-control study was conducted on 12 coper and 12 non-coper ACL-deficient knee subjects and 25 age-sex matched healthy subjects. The subjects were tested barefoot during single and bilateral standing on the platform of a Zebris pedobarograph tool. The outcome measures included the measurements of the pressures of each part of the foot during the tests. Results: The results showed a significantly decreased total pressure only between the non-coper and control groups during double leg stance test. In terms of the forefoot pressure, a significant increased pressure was shown only in the non-coper ACL-deficient knee subjects during both single and double leg stance tests (P<0.05). In both test conditions, the coper ACL-deficient knee subjects showed forefoot and hind foot pressures very close to the control group (P>0.05). Conclusion: This study revealed marked changes following ACL-deficiency mainlyin non-coper ACL-deficient knee subjects. The increased forefoot pressure in non-coper ACL-deficient knee subjects was probably due to the forwarded line of gravity in these patients aligned with their base of support to keep their knees more stable. Further studies are needed to verify the differences between the male and female ACL-deficient knee subjects.Keywords: Coper/non-coper ACL-deficient knee subjects; Stability; Pedobarograph; Foot pressure system; Postural contro

Comparison of the Immediate Effects of Various Durations of Trigger Point Compression Technique on Latent Trigger Points of the Upper Trapezius Muscle

Introduction: The aim of the present study was to investigate the immediate effect of time (30 and 90 seconds) trigger point compression techniques in the latent trigger points of upper trapezius muscle. Methods and Materials: A total of 39 women, aged between 20-30 who were diagnosed with latent MTrPs in the upper trapezius muscle, participated in the present study. Participants were randomly assigned to 3 groups, 13 each, using block randomization method: trigger point compression (30 sec), trigger point compression (90 sec), and control group. In all groups, the measurements were carried out before and after the intervention. Results: The duration of 30 and 90 sec trigger point compression techniques were observed to decrease the pain and increase the pain pressure threshold (P<0.001). Significant differences were found between the duration of 30 sec trigger point compression technique and control group in terms of pain magnitudes (P<0.001) and pain pressure threshold (P<0.01). Also, there were significant differences between the duration of 90 sec trigger point compression technique and control group regarding pain magnitudes and pain pressure threshold (P<0.001). Moreover, significant differences were observed between these 2 treatment groups in terms of pain magnitudes (P<0.05) and pain pressure threshold (P<0.001). The duration of 90 sec trigger point compression technique was observed to have more effects compared with that for duration of 30 sec. Conclusions: The results of the present study indicated that each of the 2 treatments decreased pain and increased pain pressure threshold. The results introduce the duration of 90 sec trigger point compression technique as a more effective treatment compared with that of the duration of 30 sec for latent MTrPs.Key words: Compression Technique; Myofascial Trigger Points; Upper Trapeziu

The Functional Abilities and Maximal Vertical Jumping Height in Coper and Non-coper Anterior Cruciate Ligament-Deficient Knee

Objectives: The aim of the present study was to compare the performance of the vertical jump task and the level of disability between the coper and non-coper athletes with an anterior cruciate ligament-minus knee. Methods: Thirty-four professional male athletes with isolated complete anterior cruciate ligament-tear (age 20-29 years and 6-12 months time past injury) were recruited in this study. The subjects were allocated into the coper (n=17) and non-coper (n=17) groups according to their history of having giving way and feeling an instability in their injured knee. The maximum vertical jump height was recorded by a 6-camera Vicon motion analysis system. The functional outcomes of the subjects were assessed with use of the Persian versions of the International Knee Documentation Committee, Knee Injury and Osteoarthritis Outcome Score and Tegner Questionnaires. Results: The results revealed that the coper ACK-deficient knee subjects had a significantly higher International Knee Documentation Committee score as well as two subscales of the KOOS questionnaire including the sports (P=0.001) and the quality of life (P=0.016) than non-copers. However, the subscales of pain (P=0.0137), symptoms (P=0.353) and the activities of daily living (P=0.133) of the KOOS questionnaire did not show any significant differences between the coper and non-coper ACL-deficient knee subjects. In addition, the maximum jumping height was significantly higher in the copers too (P=0.008). Discussion: While the pain, symptoms and daily activities were not different between the two groups, a higher level of the functional abilities, sports activities, quality of life and the maximum jumping height were shown in the coper ACL-deficient knee subjects when compared to the non-copers. A deliberate evaluation of the functional abilities in ACL-deficient knee subjects might play a key role in distinguishing the coper and non-coper ACL-deficient knee subjects