Joint Mobility Research Articles

Background: Spinal Muscular Atrophy (SMA) is a progressive neuromuscular disorder often necessitating spinal surgery to manage deformities and improve posture. Post-operative rehabilitation plays a vital role in restoring mobility and functional independence. Manual therapy interventions such as Grade IV Joint Mobilization (GVJM) and Soft Tissue Mobilization (STM) are frequently used in rehabilitation, but their comparative efficacy in pediatric SMA patients remains underexplored. Objective: To evaluate and compare the effectiveness of Grade IV Joint Mobilization and Soft Tissue Mobilization in improving post-operative outcomes—specifically range of motion, pain reduction, and functional mobility—in children with SMA. Methods: A randomized controlled trial was conducted on 30 children aged 5–12 years diagnosed with Type II or III SMA following spinal surgery. Participants were randomly assigned to the GVJM group (n=15) or STM group (n=15). Both groups received 20-minute therapy sessions, three times weekly for six weeks. Range of Motion (ROM), pain intensity (VAS), and functional mobility (TUG and PEDI) were assessed at baseline, six weeks, and 12 weeks. Data were analyzed using paired and independent t-tests with p<0.05 as the significance threshold. Results: Both groups showed significant improvements in all outcome measures (p<0.05). The GVJM group demonstrated superior gains in ROM (Δ15.1°, p=0.003, d=0.92), greater pain reduction (Δ3.3 vs. 2.3 VAS points, p=0.006), and faster functional mobility (Δ7.3s vs. 5.9s, p=0.011). These improvements persisted at 12 weeks, indicating sustained benefits of GVJM over STM. Conclusion: Grade IV Joint Mobilization is more effective than Soft Tissue Mobilization for enhancing joint mobility, reducing pain, and improving functional recovery in children with Spinal Muscular Atrophy after spinal surgery. Integration of both techniques may further optimize rehabilitation outcomes in pediatric neuromuscular care.

Scoping review. Spasticity is a common and often challenging sequela of spinal cord injury (SCI) associated with pain, contractures, and reduced quality of life. While passive movement (PM) is primarily used to maintain joint mobility, clinical observations and participant reports suggest that both manual and automated techniques can contribute to the management of spasticity in SCI. However, the evidence base concerning PM's impact on spasticity outcomes in SCI populations remains unclear. This review aims to identify the scope and synthesize the empirical evidence of PM interventions for managing spasticity in individuals with SCI. Seven databases (Embase, Medline, PsycInfo, Web of Science, Scopus, CENTRAL, and CINAHL) were systematically searched. Eligible studies were peer-reviewed, reported original data, included adult participants (≥18 years) with SCI, presented a therapeutic intervention consisting solely of PM techniques, and reported any spasticity outcome. Data were extracted and analyzed by two independent reviewers. The initial search identified 1628 unique studies, of which 13 were included for analysis. The PM interventions included passive cycling and robotic PM interventions (n = 8), continuous passive motion (n = 4), and manual passive range of motion (PROM) (n = 1). While a minority of studies demonstrated sustained improvements in spasticity outcomes, the majority reported short-term reductions observedin small sample groups, single-session experiments, or using suboptimal research designs. This review assembled the existing evidence on PM interventions for managing spasticity in individuals with SCI. Despite finding consistent short-term improvements, further high-quality research is needed to determine clinical efficacy and inform future rehabilitation practices.

Background. Musculoskeletal diseases and injuries are among the leading causes of chronic functional impairment, particularly in the context of military conflicts, resulting in an increasing number of patients with myogenic contractures. Despite considerable advances in modern rehabilitation, the effectiveness of functional recovery in this patient cohort remains limited due to insufficient evidence and inconsistencies in existing rehabilitation protocols. The search for effective rehabilitation methods for patients recovering from explosive and combat-related injuries is therefore of particular relevance. Objective: to enhance the effectiveness of physical therapy for patients with myogenic contractures of the lower limb joints through the use of the Omego Plus robotic rehabilitation system with biofeedback. Participants and Methods. A randomized controlled trial was conducted involving 60 patients (mean age: 38.2 ± 9.7 years), divided into two groups. The main group received standard physical therapy (based on the National Institute for Health and Care Excellence guidelines) combined with training using the Omego Plus robotic system, while the control group received standard therapy only. Patient assessment was performed at three time points: upon admission, on day 14 of rehabilitation, and three months after discharge. Objective evaluation methods included goniometry (range of motion), manual muscle testing (muscle strength), the Visual Analog Scale (pain intensity), and functional mobility tests — the 10-Meter Walk Test and the Timed Up and Go Test (gait speed and balance). Results. Both groups demonstrated positive changes, but statistically significant improvements were observed in the main group. Greater restoration of joint mobility was recorded, particularly in ankle dorsiflexion, along with increased strength of the hip abductor and adductor muscles. The most pronounced differences were noted in gait speed and pain reduction, especially at the three-month follow-up. Conclusions. The use of the Omego Plus robotic rehabilitation system as an adjunct to standard physical therapy significantly enhances the effectiveness of functional recovery in patients with lower limb myogenic contractures. These benefits are reflected in improved muscle strength, range of motion, gait speed, and a marked decrease in pain intensity. The findings underscore the need to revise existing rehabilitation protocols and highlight the importance of incorporating long-term robotic-assisted therapy into comprehensive rehabilitation programs.

Perceptions and beliefs of physical therapists regarding the mechanisms of manual therapy.

Underwater treadmill (UWTM) therapy is increasingly applied in canine rehabilitation, yet evidence on its effects after multiple sessions on joint mobility remains limited. The aim of this pilot study was to evaluate the impact of a 10-session UWTM programme on passive range of motion (PROM) in dogs with various disorders. Clinical records from 50 dogs were analysed. Each patient completed two 20 min sessions per week over five consecutive weeks. PROM in the carpal, elbow, shoulder, tarsal, stifle, and hip joints was measured using a goniometer before and after the programme. After ten sessions, a significant improvement was observed in all joints, both in flexion and extension. Flexion angles decreased from 2.89% in the tarsal joint to 12.21% in the carpal joint, while extension angles increased from 0.61% in the elbow to 2.55% in the stifle joint. Consequently, overall PROM improved, with median increases ranging from 1.9% in the tarsus to 5.6% in the hip. These improvements were observed consistently across diagnostic groups. No significant correlations were found between age and the degree of PROM improvement. In summary, the findings indicate that a 10-session UWTM programme is associated with measurable improvements in joint mobility and may be a valuable component of multimodal canine rehabilitation.

Clinimetric analysis of the numeric pain rating scale, Oswestry disability index, and the Roland-Morris disability questionnaire in patients with lumbar spinal stenosis treated with conservative interventions.

Metacarpal shaft fractures require techniques that balance stability with rapid rehabilitation. Conventional crossed K‑wires are minimally invasive yet provide limited interfragmentary compression and may compromise reduction, whereas mini‑plates offer rigid fixation at the expense of larger incisions, longer operative time, and higher cost. Building on these trade‑offs, we evaluated a transverse K‑wire technique across adjacent metacarpals augmented with the Nice knot. In our cohort, this approach delivered perioperative efficiencies-no secondary surgery, shorter operative time, smaller incisions, and lower hospitalization costs-without increasing complications. Early joint mobility at 4 weeks was statistically greater with the Nice knot approach, but the effect size was small and likely of limited clinical relevance. We performed a retrospective cohort analysis of patients treated for second to fifth metacarpal shaft fractures at our institution between December 2021 and January 2025. Two groups were compared: (1) Transverse K‑wire fixation across adjacent metacarpals combined with Nice knot suture augmentation (Nice knot group) and (2) conventional open reduction and internal fixation with mini‑plates (plate group).Outcome measures included average hospitalization cost, operative time, incision length, postoperative metacarpophalangeal joint range of motion (ROM) at 2,4 and 6 weeks, grip strength recovery, time to union, Disabilities of the Arm, Shoulder and Hand (DASH) score, and complication rate. Baseline variables (age, sex, dominant‑hand involvement, preoperative waiting period) were assessed for group comparability. Baseline characteristics-including patient age, sex, dominance of the injured hand, and time from injury to surgery-did not differ significantly between the Nice knot and plate groups (all P > 0.05). Relative to the plate group, the Nice knot group had a 29.3% lower mean hospitalization cost (432.7 ± 43.7 EUR vs. 611.5 ± 94.5 EUR; P < 0.01) and a 38.8% shorter mean operative time (23.2min vs. 37.9min; P < 0.01), accompanied by a smaller median incision length (2.5cm vs. 4.7cm; P < 0.01). At 4 weeks postoperatively, the median metacarpophalangeal joint range of motion was greater in the Nice knot cohort (82°vs 80°; P = 0.039). By 6 weeks, there were no significant between‑group differences in joint mobility, grip strength recovery, or time to fracture union (all P > 0.05). At the primary 6‑month endpoint, DASH scores did not differ significantly between groups (P > 0.05). Complication rates were similarly low (3.03% vs. 3.33%; P = 1.000), indicating that trans‑metacarpal K‑wire fixation with Nice knots does not increase the risk of adverse events relative to plate fixation.At 6 months, DASH difference was 1.0 (95% CI - 0.8 to 2.8), meeting non‑inferiority versus Δ = 10. Transverse K‑wire fixation across adjacent metacarpals combined with Nice knot suture augmentation achieved comparable 6‑month functional outcomes to plate fixation, while reducing cost, operative duration, and incision length without increasing complication risk. A small, statistically significant advantage in MCP AROM at 4 weeks (≈ 2°) was observed, but its clinical relevance is likely limited. These findings support this technique as a safe, minimally invasive, and economically favorable option for selected displaced oblique or spiral metacarpal shaft fractures.

Objective: To evaluate the effect of Chinese herbal fumigation steam therapy (CHFST) combined with functional exercise on post-stroke hemiplegic shoulder pain (HSP). Methodology: This is a retrospective case-control analysis, with case data selected from 136 HSP patients who received treatment at Suzhou Hospital of Integrated Traditional Chinese and Western Medicine from January 2024 to January 2025. Among them, 68 patients who received Chinese herbal fumigation steam therapy (CHFST) combined with functional exercise were matched in a 1:1 ratio with a cohort receiving functional exercise alone, both in addition to routine care. The changes in shoulder pain, shoulder joint range of motion and upper limb motor function, as well as the World Health Organization Quality of Life-BREF (WHOQOL-BREF) scores of the two groups, were evaluated after four weeks of intervention. Results: The degree of shoulder joint pain in the CHFST group was significantly lower than that in the control group after two and four weeks (P&lt;0.05). The range of motion for shoulder flexion, extension, abduction and external rotation in the CHFST group was higher and the FMA-UE score of upper limb motor function was better than that in the control group after four weeks (P&lt;0.05). Similarly, after four weeks, the WHOQOL-BREF score in the CHFST group was significantly higher compared to the control group (P&lt;0.05). Conclusions: The combination of CHFST and functional exercise therapy for HSP can more effectively alleviate pain, improve upper limb motor function, shoulder joint mobility and quality of life of patients than the routine treatment regimen.

BackgroundTraumatic amputations have increased worldwide over the past two decades and are expected to increase by 72% by 2050. Surgical replantation provides superior functional recovery and patient satisfaction but is limited to specialized centers and restricted by short ischemia times, due to life-over-limb prioritization in patient care. To overcome these limitations, we developed an ex vivo limb perfusion system (EVEP) to extend limb viability and, for the first time, investigate its impact on peripheral nerve regeneration, a key prerequisite for functional recovery following replantation.MethodsHind limbs of 6 healthy pigs were amputated, and after 2 h of warm ischemia, limbs were either perfused normothermally for 6 h with PerfadexPlus® ± medication using in-house developed EVEP or stored statically (4 °C vs. room temperature). Perfusion parameters, blood gas analysis, serum markers, cytokine levels, thermal imaging, colloid oncotic pressure, weight gain, joint mobility, peripheral nerve histomorphometric and stereological analyses were performed.ResultsData confirm a valid and reliable EVEP with an optimized perfusion protocol. Comparison of perfusion groups revealed lower serum injury markers in the medication group, which included methylprednisolone treatment. Additionally, the medication group exhibited reduced weight gain and preserved unrestricted joint mobility, but concurrently led to a significant decrease in pro-regenerative cytokine levels associated with Wallerian degeneration (WD).ConclusionsIn general, EVEP mitigates ischemia-related damage and facilitates ex vivo induction of WD, a critical prerequisite for nerve regeneration, functional recovery, and prevention of neuroma formation with subsequent phantom pain, by establishing the pro-regenerative environment for WD, which is further amplified by omitting the anti-inflammatory methylprednisolone.Supplementary InformationThe online version contains supplementary material available at 10.1186/s40779-025-00656-6.

Karate is divided into two disciplines, Kata (forms) and Kumite (sparring), both of which are strongly influenced by the function of the tibiotarsal joint. However, the performance model differences between the two have not yet been thoroughly explored. The aim of this study is to evaluate the differences in ankle range of motion between Kata and Kumite, investigating the correlations between joint mobility, elastic strength, and Rate of Force Development (RFD). The sample consisted of 36 athletes, of male sex, evenly split between the two disciplines, who underwent a specific training protocol for three months. Three tests were administered: Weight Bearing Lunge, Counter Movement Jump, and Squat Jump. Data were analysed using Pearson’s correlation. In the Kata group, a moderate negative correlation emerged between ankle ROM and elastic strength (R = −0.521), and between ankle ROM and RFD (R = −0.570). In the Kumite group, the correlations were weakly negative: R = −0.261 for elastic strength and R = −0.257 for RFD. Greater ankle mobility, typical of Kata, appears to be associated with lower explosive capabilities, whereas more limited mobility in Kumite correlates with higher reactive strength and a faster rate of force development.

Knee arthrofibrosis (AF) is a debilitating complication after total knee arthroplasty. AF is characterized by formation of fibrotic adhesions, loss of joint mobility, and pain. With osteoarthritis prevalence and associated total knee arthroplasties projected to rise sharply, AF is becoming increasingly prevalent, yet its pathogenesis remains poorly understood and no effective treatments exist. Like other fibrotic diseases, knee AF is a multifactorial disease that exhibits TGFβ1-driven myofibroblast transformation and excessive collagen deposition. However, knee AF also displays unique features, including rapid disease development and the establishment of a highly fibrotic mass rather than fibrotic tissue infiltration. Our integrative research approach uses human patient fibroblasts, multiomics profiling, and in vivo animal models to dissect disease mechanisms and identify therapeutic targets. Our work suggests altered adipogenic cell differentiation in the knee and epigenetic pathways controlling myofibroblastogenesis to be involved in AF development. Anti-inflammatory interventions with ketotifen and celecoxib reduce knee AF in vivo, indicating a contributory role of inflammation as well. Together, our novel findings elucidate causal and mechanistic drivers of AF and define this disease as an adipose-depleted fibrotic disorder driven by aberrant differentiation and epigenetic regulation, suggesting new therapeutic avenues for intervention.

Background: The paralyzed ankles of stroke patients show reduced range of motion, muscle tightness, and joint stiffness, further impeding their ability to maintain balance and walk properly. This study aimed to investigate the effects of a combined joint mobilization and active stretching intervention on ankle stiffness, balance, and gait in patients with stroke. Methods: In this study, 24 stroke patients were assigned to two groups of 12 each: the control group (general physical therapy) and the experimental group (joint mobilization technique and active stretching exercise). All interventions were conducted for 30 min a day, 3 times a week, for a total of 4 weeks. Tension and stiffness of the gastrocnemius and tibialis anterior muscles were measured using Myoton®PRO. Balance was evaluated using BioRescue, the Berg Balance Scale (BBS), and the Timed-Up and Go tests (TUG). All measurements were evaluated before the start of the intervention and after four weeks. Results: The muscle tone and stiffness of the medial and lateral gastrocnemius and tibialis anterior muscles of the experimental group were significantly improved compared with those of the control group. The experimental group had significantly increased moving areas in all directions and BBS scores compared with the control group. The experimental group showed a significant decrease in the time spent on the TUG test compared with the control group. Conclusions: We found that joint mobilization combined with active stretching intervention was more effective than general physical therapy in improving ankle joint movement, balance, and gait ability.

Aims: Systemic lupus erythematosus (SLE) is a chronic autoimmune connective tissue disease that can affect multiple organs and systems. Arthralgia and myalgia are common symptoms in patients with SLE, and their etiology may be inflammatory or may result from joint hypermobility or fibromyalgia. This study aimed to investigate whether musculoskeletal complaints in SLE patients are attributable solely to inflammatory activity or whether they may also be associated with hypermobility or fibromyalgia. Methods: Patients who fulfilled the 2012 SLE classification criteria were included. Patients who had undergone surgical procedures affecting joint mobility within the last 6 months, or those with concomitant diseases such as rheumatoid arthritis or inflammatory myositis that may present with inflammatory arthritis, were excluded from the study. Disease activity at the time of examination was assessed using the SLE Disease Activity Index-2000 (SLEDAI-2K). Hypermobility was evaluated using the Beighton Hypermobility Score, and fibromyalgia was assessed according to the 2016 Fibromyalgia Diagnostic Criteria. Patients were divided into three groups: those with hypermobility, those with fibromyalgia, and those with neither condition. Demographic characteristics, comorbidities, medications, disease activity, and pain scores were analyzed. Results: Six patients with both fibromyalgia and hypermobility were excluded. A total of 120 patients were analyzed, of whom 104 (86.7%) were female. The median (min-max) disease duration was 12 (1-38) years. Hypermobility was detected in 25 patients (20.8%) and fibromyalgia in 28 patients (23.3%). Overall, 44.1% of the cohort had either hypermobility or fibromyalgia. No significant differences were found between groups in terms of comorbidities. Patients with fibromyalgia had higher median patient VAS and pain scores compared with the other two groups, while their SLEDAI-2K activity scores were lower. Arthritis, according to SLEDAI-2K, was more frequent in the group without hypermobility or fibromyalgia. A significant difference in pulse-steroid use was found between the hypermobility and fibromyalgia groups (p=0.01) and between the fibromyalgia and neither group (p=0.02). Conclusion: Severe musculoskeletal pain due to hypermobility may mimic arthralgia or arthritis and may be misinterpreted by clinicians as disease progression. This could lead to unnecessary immunosuppressive therapy (risk of overtreatment), which could lead to increased risk of infection and liver and kidney dysfunction. Therefore, hypermobility and fibromyalgia, which may coexist in the course of SLE, should be thoroughly evaluated. In our study, a significant frequency (almost half of the patients) of pain was due to non-inflammatory causes.

Wearable medical devices for human joint monitoring are critical for applications such as rehabilitation, injury prevention, and performance optimization. However, capturing consistent joint motion data remains a significant challenge, requiring the development of reliable sensing technologies. This work proposes a graphene-laminated fiber Bragg grating (FBG) flex sensor encapsulated in silicone for human joint monitoring with high consistency. The sensor is formed by encapsulating an FBG and a graphene sheet between two silicone sheets, leveraging the graphene’s excellent mechanical properties to enhance the interface between the silicone coating and glass fiber. Additionally, integration into hand gloves to facilitate real-time monitoring of human finger joint movements was carried out. Experimental results demonstrate that the sensor with graphene offers superior consistency across varying displacement and bending ranges. It achieved sensitivities of -0.017 nm/mm and 0.0129 nm/° for displacement and finger bending, respectively, while maintaining lower standard deviation (SD) across test cycles, indicating better performance in consistency. Conversely, the sensor without graphene exhibited higher sensitivities of -0.0199 nm/mm and 0.0258 nm/o but lacked the consistency provided by the graphene-enhanced design. The proposed sensor has huge potential in wearable medical device applications for human joint mobility measurement, particularly in musculoskeletal rehabilitation.

Severe obesity is frequently accompanied by restricted joint mobility and chronic pain, both of which compromise quality of life and functional independence. Despite well-documented benefits of exercise in managing severe obesity, adherence remains low due to perceived physical limitations and discomfort. This study identified primary physical limitations faced by individuals with severe obesity and proposed evidence-based, accessible exercise modalities tailored to their needs. A systematic literature search was conducted using Scopus, PubMed, Web of Science, and Google Scholar. Search terms included combinations of 'obese,' 'severe obesity,' 'exercise,' 'training,' 'stability,' 'mobility,' and 'pain.' Ten studies examining effects of exercise interventions on mobility, stability, and pain in severely obese individuals were selected based on predefined inclusion criteria. Findings consistently indicated that low-impact exercise modalities such as yoga-based stretching, core training, and stabilization exercises using balance pads, chairs, and gym balls significantly improve mobility, enhance postural stability, and reduce musculoskeletal pain over intervention periods as short as 4 weeks. Interventions incorporating core muscle stretching and instability-based training were particularly effective in improving functional outcomes and balance control. This review highlights prevalent musculoskeletal and neuromuscular impairments associated with severe obesity and underscores the functional role of core musculature in mitigating these limitations. Based on synthesized evidence, we propose a set of low-complexity, high-accessibility exercise strategies feasible in both clinical and home-based settings. These recommendations provide a practical framework for improving physical function and reducing pain among individuals with severe obesity, supporting more sustainable engagement in physical activity.

BackgroundThe Detumescence Analgesic Plaster (DAP) has been widely used in clinical practice for knee osteoarthritis (KOA) treatment, yet its active ingredients and molecular mechanisms remain incompletely understood.PurposeThis study aimed to systematically characterize DAP’s chemical composition and decipher its chondroprotective pathways in KOA.MethodsA papain-induced KOA rat model was employed to evaluate DAP’s therapeutic effects through behavioral assessments (mechanical withdrawal threshold, gait analysis) and histological evaluations (H&E, safranin O-fast green staining). UPLC-Q-TOF/MS combined with Franz diffusion cells identified DAP’s chemical profile. RNA-seq was performed to compare gene expression between KOA and DAP-treated groups, followed by protein–protein interaction (PPI) and gene co-expression network analysis to prioritize key targets. Validation was conducted using Western blot, qPCR, and immunohistochemistry. IL-1β-stimulated chondrocytes were used to screen active ingredients and validate their effects on mitochondrial function.ResultsDAP treatment significantly alleviated pain, restored joint mobility, and preserved cartilage integrity in KOA rats. Chemical profiling identified 92 compounds, including 28 active ingredients with high transdermal permeability. RNA-seq revealed 206 DAP-reversed genes primarily associated with mitochondrial dysfunction, oxidative stress, and inflammatory signaling. Network analysis pinpointed 23 core targets, with mitochondrial complex I subunits (NDUFA5, NDUFA6, NDUFS6), AMPK, and MYL3 emerging as critical nodes in oxidative phosphorylation. DAP restored the expression of these targets in KOA cartilage. In vitro experiments demonstrated that 1,5-dicaffeoylquinic acid, verproside, and catalposide attenuated ROS production, enhanced ATP synthesis, and stabilized mitochondrial membrane potential via the NDUFA6/AMPK/MYL3 axis, thereby inhibiting chondrocyte apoptosis.ConclusionThis study provides the first evidence that DAP exerts chondroprotective effects by ameliorating mitochondrial dysfunction and oxidative stress in KOA through the mitochondrial complex I/AMPK/MYL3 signaling pathway. These findings offer a mechanistic basis for DAP’s clinical efficacy and highlight potential therapeutic targets for KOA management.Graphical Supplementary InformationThe online version contains supplementary material available at 10.1186/s13020-025-01215-w.

A fracture is a condition in which there is a partial or complete loss of bone or cartilage continuity caused by direct or indirect trauma. In the case of a fracture of the proximal one-third of the left radius, the injury generally occurs due to a strong impact or direct trauma to the left arm, often resulting from a traffic accident or a fall. Patients with this condition typically experience several problems, including pain at the fracture site, decreased muscle strength, limited range of motion (ROM), and functional activity disturbances such as difficulty in gripping, lifting, or writing. Physiotherapy management plays a crucial role in restoring upper limb function. The methods used include Infrared (IR) therapy and Exercise Therapy (ET). Infrared therapy helps improve blood circulation, reduce muscle spasms, and alleviate pain through the application of heat. Meanwhile, Exercise Therapy consists of Free Active Exercise, Passive Exercise, and Resisted Active Exercise, which aim to increase muscle strength, improve joint mobility, and gradually restore the patient’s functional abilities. The results of the physiotherapy intervention showed a significant reduction in pain, increased muscle strength, improved ROM, and enhanced functional activity of the left upper extremity, allowing the patient to return to daily activities more optimally and independently.

Osteoarthritis of the knee is a degenerative condition of the knee joint characterized by the thinning of cartilage, leading to friction between the femur and tibia. This condition results in pain, limited joint mobility, and reduced strength of the quadriceps and hamstring muscles. Physiotherapy plays a crucial role in reducing these symptoms through modality-based approaches and structured exercise therapy. This study is a case study involving a single patient with right knee osteoarthritis. Data were collected through direct observation and evaluation of therapeutic outcomes. Interventions were conducted over four sessions using Transcutaneous Electrical Nerve Stimulation (TENS) to reduce pain, Ultrasound to enhance blood circulation and reduce inflammation, and exercise therapy focusing on improving muscle strength and joint range of motion. After four therapy sessions, there was a reduction in pain intensity, improved strength of the quadriceps and hamstrings, and increased joint range of motion. These results demonstrate that the combination of TENS, ultrasound, and exercise therapy is effective in improving function and quality of life for patients with right knee osteoarthritis. This study emphasizes the importance of a multimodal physiotherapy approach in managing chronic musculoskeletal disorders.

A systematic review of the chronic effects of self-myofascial release on athletic performance.

To compare effectiveness of multiple metatarsal osteotomy versus first metatarsophalangeal arthrodesis in treating severe metatarsal adductus hallux valgus deformity. A retrospective analysis was conducted on the clinical data of 25 patients with severe metatarsal adductus hallux valgus deformity admitted between June 2010 and May 2014 who met the selective criteria. Among them, 15 patients underwent multiple metatarsal osteotomy (osteotomy group), while 10 patients underwent first metatarsophalangeal arthrodesis (fusion group). There was no significant difference between groups ( P>0.05) in gender, age, disease duration, affected side, preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS) score for pain, intermetatarsal angle (IMA), hallux valgus angle (HVA), or metatarsal adduction angle (MAA). The osteotomy group underwent fixation with screws and/or staples fixation, while the fusion group utilized anatomic fusion plates and trans-articular compression screws. The study compared the following outcome indicators between groups: operation time, pre- and post-operative differences (change values) in AOFAS scores, VAS scores, and radiographic parameters (HVA, MAA), osteotomy healing outcomes, and recurrence of hallux valgus deformity. Both surgical procedures were completed successfully. The operation time was significantly shorter in the fusion group than in the osteotomy group ( P<0.05). All patients were followed up 96-144 months (mean, 116 months). The follow-up time was (129.1±7.2) months in the osteotomy group and (104.4±8.0) months in the fusion group, with no significant difference between groups ( P>0.05). X-ray films revealed the radiographic union in two groups, and the fusion time was significantly shorter in the fusion group than in the osteotomy group ( P<0.05). At last follow-up, both groups demonstrated significant improvements in AOFAS and VAS scores compared to preoperative levels ( P<0.05). However, the differences in the change values of AOFAS and VAS scores between groups were not significant ( P>0.05). During follow-up, 3 cases (20%) of deformity recurrence occurred in the osteotomy group, while no recurrence was observed in the fusion group. There was no significant difference in the incidences of deformity recurrence between groups ( P>0.05). For severe metatarsus adductus hallux valgus deformities, both multiple metatarsal osteotomy and first metatarsophalangeal arthrodesis can correct the deformity. The former preserves metatarsophalangeal joint mobility but demands high technical proficiency from the surgeon, involves relatively longer operation times, extended bone healing periods, and higher complication incidences. The latter procedure is relatively simpler, facilitates faster postoperative recovery, allows early weight-bearing, and yields more reliable outcomes, though it sacrifices first metatarsophalangeal joint mobility.