Increase In Range Of Motion Research Articles

Acute Effects of Local High-Frequency Percussive Massage on Deep Fascial and Muscular Stiffness and Joint Range of Motion in Young Adult Men.

Local high-frequency percussive (HFP) massage has recently found widespread application in physical therapy. Although HFP massage reportedly improves range of motion (ROM), the mechanism underlying its action has not yet been proven. This study aimed to clarify whether a 5-minute percussive massage regimen affects muscular or connective tissues, such as the deep fascia and deep intermuscular fascia and the change in joint ROM. The study sample was calculated using G*Power analysis program, and this study enrolled 15 healthy men who underwent 5-minute HFP massage to the medial gastrocnemius muscle. Shear-wave elastography was used to measure tissue stiffness in the deep fascia, muscle, and deep intermuscular fascia through shear-wave velocity as well as the ROM of the volunteers' ankle joint dorsiflexion before and after the HFP massage. A value of P < .05 was used to declare statistical significance, and post hoc was used to calculate the effect size using G*Power. Shear-wave velocity revealed a significant change in the deep fascia (P = .003; shear-wave velocity: -0.7m/s) and significant increase in ROM of ankle dorsiflexion (P = .002; increase in ROM: 3.0°) after 5minutes of HFP massage. However, the muscle and deep intermuscular fascia did not exhibit any significant changes. HFP massage for 5minutes modified the stiffness of the deep fascia and concurrently improved the ankle joint-dorsiflexion ROM. This method can be used as an intervention to decrease stiffness of the deep fascia and increase the ROM efficiently.

The effects of static and dynamic stretching on deep fascia stiffness: a randomized, controlled cross-over study

AimPrevious stretching studies mostly investigated effects on the skeletal muscle but comprehensive explorations regarding the role of the connective tissue are scarce. Since the deep fascia has been demonstrated to be sensitive to mechanical tension, it was hypothesized that the fascia would also respond to stretching, contributing to enhanced range of motion (ROM).MethodsForty (40) recreationally active participants (male: n = 25, female: n = 15) were included in the randomized controlled cross-over trial and allocated to different groups performing 5 min static (STAT) or dynamic (DYN) plantar flexor stretching or control condition (CC) in a random order. Pre- and immediately post-intervention, muscle and fascia stiffness, as well as muscle and fascia thickness were measured using high-resolution ultrasound and strain elastography. ROM was assessed in the ankle joint via the knee to wall test (KtW) and goniometer.ResultsSTAT reduced both, muscle and fascia stiffness (d = 0.78 and 0.42, p < 0.001, respectively), while DYN did not reduce stiffness compared to the control condition (p = 0.11–0.41). While both conditions showed significant increases in the KtW (d = 0.43–0.46, p = 0.02–0.04), no significant differences to the CC were observed for the isolated ROM testing (p = 0.09 and 0.77). There was a small correlation between fascia stiffness decreases and ROM increases (r = − 0.25, p = 0.006) but no association was found between muscle stiffness decreases and ROM increases (p = 0.13–0.40).ConclusionOur study is the first to reveal stretch-induced changes in fascia stiffness. Changes of fascia`s but not muscle`s mechanical properties may contribute to increased ROM following stretching.

Hindfoot joint kinematics analysis after the resection of talocalcaneal coalition

BackgroundThe subtalar joint movement between the talus and calcaneus is restricted in patients with talocalcaneal coalition (TCC). When the motion of the subtalar joint is restricted, shock absorption in the foot decreases, leading to pain during walking. Resection methods to maintain subtalar motion by removing abnormal unions have been proposed. The purpose of this study was to analyze the joint kinematics of patients who underwent TCC resection and to quantitatively evaluate the results of the surgery based on the measured kinematics. MethodsJoint kinematics of five patients with TCC were obtained using a biplane fluoroscopic imaging system and an intensity-based two-/three-dimensional registration method. The joint kinematics of the tibiotalar and subtalar joints and the tibiocalcaneal motion during the stance phase of walking were obtained. From the kinematics of the hindfoot joints, the inversion/eversion range of motion (ROM) of the patients before and after resection was statistically analyzed using the Wilcoxon signed-rank test to test whether TCC resection improved the ROM. ResultsDuring the loading response period, the eversion ROM of the subtalar joint and tibiocalcaneal motion significantly increased postoperatively. In addition, a significant postoperative increase was observed in the subtalar and tibiocalcaneal inversion ROM during the pre-swing period. SignificanceTCC resection surgery increased the ROM of the subtalar joint, which in turn contributed to the increase in tibiocalcaneal ROM. Increased subtalar and tibiocalcaneal ROM could result in increased shock attenuation and may be a contributing factor to pain relief during walking.

Restoration of Range of Motion in the Cervical Spine through Single-Segment Artificial Disc Replacement Using the Baguera®C Prosthesis.

Background: Anterior cervical discectomy and fusion (ACDF) is a standard procedure for degenerative diseases of the cervical spine, providing nerve decompression and spinal stabilization. However, it limits cervical spine motility, restricts fused segment activity, and may lead to adjacent degeneration. Cervical disc arthroplasty (CDA) is an accepted alternative that preserves the structure and flexibility of the cervical spine. This study aimed to explore the dynamic changes in the range of motion (ROM) of the cervical spine after CDA using a viscoelastic artificial disc, as well as the factors affecting mobility restoration. Methods: A retrospective analysis was conducted on 132 patients who underwent single-level anterior cervical discectomy and CDA from January 2015 to June 2022. Result: Analysis of data from 132 patients revealed a significant improvement in clinical outcomes. The mean ROM of C2-C7 and functional spinal unit (FSU) segments significantly increased from 2 to 36 months post-operatively. Cervical spine flexibility was preserved and enhanced after prosthesis implantation. However, it took six months for the cervical spine motility to stabilize. In addition, sex and age were found to impact motility restoration, with female and younger patients exhibiting larger ROMs post-surgery. Additionally, CDA at the C5-C6 level resulted in the greatest increase in ROM, potentially improving overall kinematic ability. Conclusions: Single-segment artificial disc arthroplasty effectively restores the ROM in degenerative cervical spine conditions.

Effectiveness of PNF Pattern in Regular Physical Therapy Sessions on Functional Mobility in Frozen Shoulder

Frozen shoulder, or adhesive capsulitis, is a musculoskeletal condition that presents with symptoms such as discomfort, nocturnal pain, and limited range of motion. Abduction and external rotation are significantly reduced. Objective: To investigate the effectiveness of combining proprioceptive neuromuscular facilitation (PNF) patterns into routine physical therapy sessions for patients with frozen shoulder. Methods: A six-week quasi-experimental study was conducted on a total of 30 participants, divided into group A (n=15) and group B (n = 15), selected from the outpatient department (OPD). Pain, disability, and range of motion were evaluated as outcome measures. The group A received proprioceptive neuromuscular facilitation (PNF) patterns in addition to their usual physical therapy sessions, and group B only received conventional physical therapy sessions. Disabilities of the Arm, Shoulder and Hand (DASH), VAS (Visual Analog Scale) and goniometer were used to assess pain, disability and range of motion (ROM). Data were analyzed using SPSS version 23.0. Results: Both groups showed a significant reduction in DASH and VAS scores and an increase in ROMs, as group A showed a better result in terms of DASH score and abduction range (p&lt;0.05). Conclusions: Both the experimental and control groups had statistically significant outcomes. The PNF pattern and Codman exercises both have a positive impact on rehabilitation. However, PNF is more advanced because it involves a combination of movements that are also useful in daily activities. Additionally, PNF helps develop memory for correct patterned movements. On the other hand, Codman exercises are only effective for retaining and improving shoulder ranges.

Non-immersive virtual reality based treatment for children with unilateral cerebral palsy: Preliminary results.

Unilateral cerebral palsy (UCP) represents about 30-40% of overall cerebral palsy diagnoses. Upper limb impairment has a significant negative impact on activities of daily living (ADL), and recent studies have shown that the use of virtual reality (VR) can increase motivation and promote an improvement in ADL. This preliminary study was aimed at exploring the acceptability and usability of a VR rehabilitation treatment, using the VITAMIN Platform, for children with UCP. A secondary goal of the study was to compare the results of usual standardized clinical scales and questionnaires with kinematic results as well as with the quantitative measures acquired by the VITAMIN platform in each exercise of the rehabilitation sessions. Six children with UCP (aged 7-15) were recruited for a preliminary investigation in using a non-immersive VR system. The treatment was composed of 10 weekly sessions of 45 minutes. Each child played five types of exergames, using the impaired upper limb to hit virtual objects projected on a wide screen. Standardized clinical scales, kinematic analysis, and questionnaires were used to extensively assess upper limb function before and at the end of treatment. Five typically-developing children provided a reference for the instrumented kinematic assessment. At the end of the treatment, Melbourne Assessment 2 (MA2) scores increased for all the participants (mean increase in range of movement (ROM) + 19.1%, accuracy + 4.6%, dexterity + 13.1%, fluency + 10.3%). Shoulder flexion-extension ROM also improved (mean increase + 10.5°), and according to the kinematic analysis, shoulder movements became more similar to reference profiles. These results were confirmed by a general improvement in performing ADL, assessed by the ABILHAND-Kids questionnaire. Finally, a general agreement among the different measures and indexes emerged from the acquired data. The results show that VR treatment with the VITAMIN platform could be engaging and functional for rehabilitation of children with UCP. The good agreement among the qualitative and quantitative measures and indexes confirms the potential of such novel treatment. However, due to the limited sample size and small number of sessions, further and larger investigations are required to evaluate the effectiveness and to generalize the results.

Efficacy of neural mobilization and Maitland accessory mobilization in patients with tennis elbow- randomized controlled trial

ObjectiveThe objective of the study was to evaluate the efficacy of Maitland accessory mobilization and neural mobilization in patients with tennis elbow. MethodTwenty-five patients meeting the selection criteria were randomly assigned to three experimental groups: Group C (conventional treatment), Group B (neural mobilization), and Group A (Maitland mobilization). Quality of life was assessed using the Patient Rated Tennis Elbow Evaluation (PRTEE), while pain, range of motion, and grip strength were evaluated using the Visual Analog Scale (VAS), a universal goniometer, and a handheld dynamometer. The interventions were administered three times per week for four weeks to the respective groups. ResultsNon-parametric tests were employed to analyze the results due to the non-normal distribution of the data (p < 0.05). Both the Wilcoxon signed-rank test and the Kruskal-Wallis test were utilized to assess differences within and between groups. The results of the between-group analysis demonstrated significant differences in pain (p = 0.018) and quality of life (p = 0.045) among the three groups. ConclusionAfter a 4-week intervention, all three groups exhibited notable improvements in discomfort levels, grip strength, and quality of life. Notably, Group B demonstrated the most substantial increase in range of motion (ROM) compared to Groups A and C. Consequently, incorporating neural mobilization into the treatment plan is recommended for patients experiencing Tennis Elbow.

Sports massage has the potential to reduce ischemic muscle pain and increase range of motion after exercise

The aim of this study was to analyze the potential of exercise massage on ischemic muscle pain and ROM after exercise. This experimental research uses a pre and post control group design. Research subjects were selected using purposive sampling technique. Next, the subjects were divided into 2 groups, namely group (K1) which was not given special treatment and group (K2) which was given sports massage. A total of 18 healthy men participated in this study. Our first procedure is preparing research administration and permission to borrow facilities and infrastructure. Next, we screened respondents who were used as research subjects based on inclusion and exclusion criteria and filled out Informed Consent. On the day of the research, all subjects collected data on the characteristics of the research subjects, then warmed up, and then the subjects did exercises in the form of treadmill training with an intensity of 50-60% of their maximum ability. The intensity of the exercise was monitored using a polarizer. Exercise is carried out for 15 minutes. 30 minutes after exercise, all subjects had pre-test data taken to measure ischemic muscle pain and Range of Motion. After collecting pre-test data, subjects carried out interventions based on their respective groups. After being given the intervention, the subject carried out post-test data collection. The intensity of ischemic muscle pain was measured using VAS and ROM was measured at the knee joint using a goniometer. The results of our study reported that the group given exercise massage was able to reduce the intensity of systemic muscle pain and increase ROM significantly (P &lt; 0.05). Providing sports massage after exercise can reduce ischemic muscle pain and increase ROM. Considering that pain intensity and ROM are necessary to support body function, our research findings can be used as an alternative to support physical performance.

Seven weeks of pectoralis muscle stretching does not induce non‐local effects in dorsiflexion ankle range of motion

AbstractBoth an acute bout, as well as chronic static stretching (SS), can increase the joint range of motion (ROM). However, ROM increases of a non‐stretched muscle (non‐local) are reported following an acute SS session, and these effects have not been studied for long‐term SS training. Therefore, this study aimed to investigate the effects of a comprehensive 7‐week SS training program of the pectoralis muscles on ankle dorsiflexion ROM. Thirty‐three healthy, physically active participants (20 male and 13 female) were assigned to either the SS (n = 18) or the control (n = 15) group. The SS group performed a 7‐week SS intervention that comprised three sessions a week, including three exercises of the pectoralis muscles for 5‐min each. Before and after the intervention period, the ankle dorsiflexion ROM was tested with a dynamometer. There was no significant time (p = 0.93, F1,31 = 0.008; η2 = 0.000) or time x group effect (p = 0. 56, F1,31 = 0.342; η2 = 0.011) in ankle dorsiflexion ROM, indicating no changes in ROM in the intervention as well as the control group. Although previous studies on the acute effects of stretching reported non‐local increases in ROM, our study showed no such changes after 7 weeks of SS training. Consequently, if the goal is to chronically increase the ROM of a specific joint, it is recommended to directly stretch the muscles of interest.

Total knee arthroplasty and rehabilitation

Arthroplasty is the reconstruction of the joint to relieve pain, increase range of motion and provide stabilization in any joint. The main goals of total knee arthroplasty are to relieve pain, improve function, improve quality of life, create a long-lasting artificial joint, and prevent or reduce surgical complications. Joint infection, sepsis or systemic infections, neuropathic arthropathy, painful stiff knee fusion due to complex regional pain syndrome (CRPS), genu recurvatum due to neuromuscular weakness, painless and well-functioning knee arthrodesis are absolute contraindications to total knee arthroplasty. In addition, the patient should be monitored for circulation, sensation and infections during the acute period (1-5 days). An appropriate DVT prophylaxis should be given. There is evidence that long-term physical deficiencies persist after arthroplasty. Since decreased muscle strength, decreased flexibility, abnormalities in walking, and deficits in postural stability can be detected, it is recommended to continue exercise programs for at least 1 year.

Clinical Outcomes After Arthroscopic Treatment of Extraspinal Diffuse Idiopathic Skeletal Hyperostosis (DISH) Involving the Hip Joint.

The hip joint can be affected by extraspinal diffuse idiopathic skeletal hyperostosis (DISH). This study aimed to compare the clinical characteristics of hips with DISH to those with mixed-type femoroacetabular impingement symptoms (FAIS). In addition, patient-reported outcome (PRO) scores were reported among patients with DISH involving the hip joint who underwent arthroscopic treatment. A retrospective analysis was performed using data from patients who underwent hip arthroscopy between 2017 and 2021. Patients who had a preoperative diagnosis of extraspinal DISH of the hip joint and postoperative Hip Outcome Score-Activities of Daily Living (HOS-ADL), Hip Outcome Score-Sports Subscale (HOS-SSS), International Hip Outcome Tool 12-component form (iHOT-12), modified Harris Hip Score (mHHS) and visual analog scale (VAS) for pain scores were enrolled in the study. The patients' characteristics were compared with those of a control group (1:2) consisting of mixed-type patients with FAIS. The control group was matched in terms of age, sex, body mass index (BMI), and symptom duration. Eleven hips (0.87%) with extraspinal DISH (study group) were matched to 22 FAIS hips (control group). All the patients were male. The mean age of patients was 42.0 ± 8.0 in the study group. The study group was characterized by a larger preoperative alpha angle (79.1 ± 6.8 vs 64.8 ± 9.7, P < .001), lateral center-edge angle (LCEA) (49.7 ± 6.0 vs 40.7 ± 3.2, P < .001), and postoperative LCEA (36.6 ± 3.0 vs 34.2 ± 2.0, P = .013). In addition, a higher proportion of acetabular (81.8% vs 31.8%, P = .007) and femoral head chondral lesions (45.5% vs 9.1%, P = .016). Cartilage damage has the potential to affect the prognosis of arthroscopic treatment. Nevertheless, at the final follow-up, patients with DISH experienced a significant increase in range of motion (ROM), notable enhancements in all PROs, and favorable rates of minimal clinically important difference (MCID) for the PROs. The occurrence of DISH in the hip joint is considerably infrequent, characterized by hip pain and limited ROM. Despite increased alpha angle and LCEA, and more acetabular and femoral head chondral damage noted at the time hip arthroscopy, patients with DISH observed a significant improvement in ROM, notable enhancements in all PROs, and favorable rates of MCID for the PROs.

The non-local effects of 7-week foot sole static stretching and foam rolling training on shoulder extension range of motion.

Static stretching and foam rolling can increase the range of motion (ROM) of a joint acutely as well as chronically. Although studies have reported ROM increases of a non-stretched heterologous muscle (non-local) following an acute static stretching or foam rolling session, these effects have not been studied for long-term training interventions. Therefore, the purpose of this study was to investigate the effects of a comprehensive 7-week static stretching and foam rolling training program of the foot sole on shoulder extension ROM. A total of 33 healthy, physically active participants (20 male) were assigned to either the intervention (n = 19) or control (n = 14) group. The intervention group performed a 7-week combined static stretching and foam rolling intervention comprising three sessions a week, including three exercises of the foot sole for 5 min each. Before and after the intervention period, the shoulder extension ROM was tested with three-dimensional (3D) motion caption. The level of significance for all statistical analyses was set to ρ ≤ 0.05. There was no significant time (p = 0.70, F1, 31 = 0.157; η2 = 0.005) or time×group effect (p = 0.38, F1, 31 = 0.785; η2 = 0.025) in shoulder extension ROM, indicating no ROM changes in the intervention or the control group. Although previous studies on the acute effects of stretching and foam rolling reported non-local increases in ROM in heterologous muscles, this study could show that such effects do not occur after chronic SS and foam rolling training for 7 weeks. Consequently, if the goal is to chronically increase the ROM of a specific joint, it is recommended to directly treat the muscles of interest.

Acute effects of resistance training at different range of motions on plantar flexion mechanical properties and force

ABSTRACT The effects obtained from resistance training depend on the exercise range of motion (ROM) performed. We aimed to examine the acute effects of different exercise ROM resistance training on the plantar flexor muscles. Eighteen healthy untrained male adults participated in three conditions: calf raises in 1) partial condition [final (short muscle length) partial ROM], 2) full condition (full ROM), and 3) control condition. The ankle dorsiflexion (DF) ROM, passive torque at DF ROM, passive stiffness of muscle-tendon unit, and maximal voluntary isometric contraction (MVC-ISO) torque were measured before and immediately after the interventions. There were significant increases in DF ROM, passive torque at DF ROM, and a decrease in MVC-ISO, but no significant interaction in passive stiffness. Post hoc test, DF ROM demonstrated moderate magnitude increases in the full condition compared to the partial (p = 0.023, d = 0.74) and control (p = 0.003, d = 0.71) conditions. Passive torque at DF ROM also showed moderate magnitude increases in the full condition compared to the control condition (p = 0.016, d = 0.69). MVC-ISO had a moderate magnitude decrease in the full condition compared to the control condition (p = 0.018, d=−0.53). Resistance training in the full ROM acutely increases joint ROM to a greater extent than final partial ROM, most likely due to stretch tolerance.

A comparison of dynamic warm-up and "warm-up" using self-massage tools on subsequent sit-and-reach displacement.

A dynamic warm-up (DWU) comprising exercise involving rhythmic muscle actions results in an acute increase in range of motion; however, recent findings suggest that a passive one using self-massage techniques might elicit a similar effect. This study's purpose was to compare the acute effect of leg cycling DWU on sit-and-reach score to the effect of a preparatory regimen of foam rolling (FR) or percussive massage (PM). Single-blind, randomized, repeated-measures crossover study. Thirty-two asymptomatic, physically-active participants (male; n = 17) aged 20.9 ± 1.5 years performed sit-and-reach tests before, immediately following and 10-, 20- and 30-minutes following eight minutes of each of the "warm-ups." Analyses of variance at each time point across conditions and for the percent change elicited by each intervention were conducted to determine significant differences (p < 0.05). Repeated-measures ANOVA revealed a significant difference between mean percent difference of sit-and-reach score for FR (8.8 ± 0.5%) compared to DWU and PM (p = 0.046 and 0.048, respectively) while DWU (6.3 ± 0.8%) and PM (6.8 ± 0.5%) did not differ (p = 0.717). There were no differences between scores across interventions at any of the four time points. A bout of FR or PM resulted in an acute increase in a sit-and-reach score during a test performed immediately post and at 10-, 20- and 30-minutes post that was similar in magnitude to that which was present following leg cycling. These passive "warm-ups" are appropriate alternate strategies that can be employed to improve performance on a sit-and-reach test.

The Decline of Lumbar Artificial Disc Replacement.

Lower back pain associated with degenerative disc disease is a common occurrence, with many surgical treatments targeting the degenerated disc to relieve symptoms. Current surgical options for degenerative disc disease primarily consist of a discectomy followed by either spinal fusion or artificial disc replacement, with the former being increasingly more common in the lumbar region despite the risk of adjacent segment disease. Though artificial disc replacement aims to provide an increase in range of motion and decreases risk of adjacent segment disease, surgeons are increasingly opting for spinal fusion in the lumbar region. This review investigates underlying factors that may be contributing to this trend by assessing lumbar artificial disc replacement selection criteria, clinical outcomes, surgical technique, complications, revision burden, and overall cost. While these factors had some role in the physician's decision, ultimately the narrow selection criteria and lack of cost reimbursement by insurance has primarily led to the decline in lumbar artificial disc replacement.

A 4-DOF Exosuit Using a Hybrid EEG-Based Control Approach for Upper-Limb Rehabilitation.

Rehabilitation devices, such as traditional rigid exoskeletons or exosuits, have been widely used to rehabilitate upper limb function post-stroke. In this paper, we have developed an exosuit with four degrees of freedom to enable users to involve more joints in the rehabilitation process. Additionally, a hybrid electroencephalogram-based (EEG-based) control approach has been developed to promote active user engagement and provide more control commands.The hybrid EEG-based control approach includes steady-state visual evoked potential (SSVEP) paradigm and motor imagery (MI) paradigm. Firstly, the rehabilitation movement was selected by SSVEP paradigm, and the multivariate variational mode decomposition (MVMD) and canonical correlation analysis (CCA) method was used for SSVEP EEG recognition; then, the motion intention was obtained by MI paradigm, and the convolutional neural network (CNN) and long short-term memory network (LSTM) were used to build a CNN-LSTM model for MI EEG recognition; finally, the recognition results were translated into control commands of Bowden cables to achieve multi-degree-of-freedom rehabilitation.Experimental results show that the average classification accuracy of the CNN-LSTM model reaches to 90.07% ± 2.23%, and the overall accuracy of the hybrid EEG-based control approach reaches to 85.26% ± 1.95%. The twelve subjects involved in the usability assessment demonstrated an average system usability scale (SUS) score of 81.25 ± 5.82. Additionally, four participants who underwent a 35-day rehabilitation training demonstrated an average 10.33% increase in range of motion (ROM) across 4 joints, along with a 11.35% increase in the average electromyography (EMG) amplitude of the primary muscle involved.The exosuit demonstrates good accuracy in control, exhibits favorable usability, and shows certain efficacy in multi-joint rehabilitation. Our study has taken into account the neuroplastic principles, aiming to achieve active user engagement while introducing additional degrees of freedom, offering novel ideas and methods for potential brain-computer interface (BCI)-based rehabilitation strategies and hardware development.Clinical impact: Our study presents an exosuit with four degrees of freedom for stroke rehabilitation, enabling multi-joint movement and improved motor recovery. The hybrid EEG-based control approach enhances active user engagement, offering a promising strategy for more effective and user-driven rehabilitation, potentially improving clinical outcomes.Clinical and Translational Impact Statement: By developing an exosuit and a hybrid EEG-based control approach, this study enhances stroke rehabilitation through better user engagement and multi-joint capabilities. These innovations consider neuroplasticity principles, integrating rehabilitation theory with rehabilitation device.

Is muscle stiffness a determinant for range of motion in the leg muscles?

Previous training studies with comprehensive stretching durations have reported that an increase in range of motion (ROM) can be related to decreases in muscle stiffness. Therefore, the purpose of this study was to analyze the association between the passive muscle stiffness of three muscle groups (triceps surae, quadriceps, hamstrings) to the respective joint ROM. Thirty-six healthy male soccer players volunteered in this study. After a standardized warm-up, the muscle stiffness was tested via shear wave elastography in six muscles (gastrocnemius medialis and lateralis, rectus femoris, semitendinosus, semimembranosus, and biceps femoris long head). The hip extension, hip flexion, and ankle dorsiflexion ROM were also assessed with a modified Thomas test, a sit and reach test, and a standing wall push test, respectively. We found significant moderate to large correlations between hip flexion ROM and muscle stiffness for the semimembranosus (rP = -0.43; P = 0.01), biceps femoris long head (rP = -0.45; P = 0.01), and overall hamstring stiffness (rP = -0.50; P < 0.01). No significant correlations were found for triceps surae (rP = -0.12; P = 0.51 to 0.67) and rectus femoris muscle stiffness (rP = 0.25; P = 0.14) with ankle dorsiflexion and hip extension ROM, respectively. We conclude that muscle stiffness is an important contributor to hip flexion ROM, but less important for hip extension or ankle joint ROM. Additional contributors to ROM might be tendon stiffness or stretch/pain tolerance.

Comparative outcome of ultrasound guided vs. fluoroscopy guided hydrodilatation in adhesive capsulitis: a prospective study.

The incidence of adhesive capsulitis varies from 2-5% in the general population to 20% in people with diabetes. One of the most effective treatment methods is hydrodilatation, which can be done under US-guidance or Fluoroscopic guidance. However, the clinical effectiveness of US-guided injections in comparison to fluoroscopy-guided injections is still debatable. The possibility of severe side effects, the expense, and the time required to carry out this minimally invasive procedure highlight how crucial it is for patients to have a precise intra-articular injection. This study aims to compare the effectiveness of Ultrasound-guided vs. Fluoroscopic guided hydrodilatation for patients with adhesive capsulitis. Sixty-four patients were randomly selected for hydrodilatation using any one of the techniques. The patients were evaluated for clinical improvements using the visual analog scale (VAS), oxford shoulder score (OSS), and range of motion (ROM). The US-guided group experienced more pain reduction than the fluoroscopy group within the first four weeks (P < 0.001). The increase in ROM was much more significant in the US-guided group for the first 8 weeks. Improvement in Abduction and External rotation was much more significant (P < 0.001) in the first 4 weeks after hydrodilatation in the US-guided group. The improvement in ROM was maintained on long-term follow-up (mean 24 months), with 45 out of 64 (70.3%) reporting a normal or near normal ROM. On assessing the Oxford shoulder score improvements, the US-guided group's score significantly increased after the first week (P = 0.003), but the fluoroscopy-guided group's score increased after the second week. On comparison between the two groups, the amount of score improvement was more significant in the US-guided group than in the fluoroscopy-guided group in the first 4 weeks (P < 0.001). US-guided technique for intra-articular injection for patients with adhesive capsulitis provided a quicker pain reduction and a larger improvement in range of motion and overall shoulder functions.

Does a Single Session of Cupping Therapy Increase Range of Motion in Individuals With Limited Hamstring Flexibility? A Critically Appraised Topic

Context: Improving hamstring tightness is a common therapeutic goal to maintain performance and reduce injury risk. How effective is a single session of therapeutic cupping on improving hamstring flexibility? Methods: PubMed was searched in the Summer of 2023 using the search terms: cupping and range of motion (ROM). Included studies were intervention studies that evaluated cupping and flexibility within the lower extremity during a single treatment session. Hip flexion ROM was measured with the passive or active straight leg test. Means, SDs, 95% CI, and effect sizes were calculated. Results: Three articles were screened. Warren et al. reported a statistically significant increase in ROM from pre- to posttest of 4.42° using a digital inclinometer during the passive straight leg test. However, this is below a reported minimal detectable difference for the passive straight leg test (10°). Schafer et al. and Williams et al. reported no significant cupping effect over time between groups. Conclusions: There is consistent evidence that a single session of cupping therapy does not increase lower-extremity ROM in patients with limited hamstring flexibility.

Effect of Single Session Three Therapistadministered Posterolateral Mobilisation with Movement Glide on Shoulder Range of Motion: A Case Report

Frozen shoulder, or adhesive capsulitis, is a condition characterised by pain and stiffness in the shoulder joint. It gradually worsens over time, making it difficult to move the shoulder. The exact cause is not always clear, but it can be associated with injury, surgery, or certain medical conditions. Treatment typically involves physiotherapy and pain management. The authors present a case of a 41-year-old male who complained of acute pain in the right shoulder joint over a period of 15 days. Examination revealed a restriction in shoulder Range Of Motion (ROM). The case was treated with a single session of three therapist-administered posterolateral Mobilisation With Movement (MWM) glides. No medication was prescribed to the patient and he was asked to follow-up in the Outpatient Department (OPD) for three days. The single session of posterolateral MWM glide, along with conventional physiotherapy, led to an increase in shoulder ROM and a reduction in pain. This approach can be considered a viable treatment option for frozen shoulder.