Left Lateral Flexion Research Articles

Feasibility of a Novel Movement Preference Approach to Classify Case Complexity for Adults with Non-Specific Chronic Low Back Pain

The non-specific nature of low back pain (LBP) poses challenges in its diagnosis and clinical management. Classifying case complexity with an exercise method may help overcome these challenges. The present study proposed a movement-based classification system based on Dance Medicine Australia (DMA) Clinical Pilates for patients with non-specific chronic LBP. To test the feasibility of the proposed system, 40 adults with non-specific chronic LBP were assessed on their movement preference (i.e., movement directions that can relieve pain or are pain-free) through the DMA Clinical Pilates method. The movement preferences could be a combination of each of the following movement directions: (1) flexion or extension, (2) left or right lateral flexion and/or (3) left or right rotation. For cases that had central or bilateral pain, the number of movement preferences identified was used to guide the classification. Using the proposed system, all 40 (100%) LBP cases were successfully classified into basic (n = 8, 20%), intermediate (n = 17, 42.5%), advanced (n = 8, 20%) or expert (n = 7, 17.5%) levels of complexity. In conclusion, this study has demonstrated that the proposed movement-based classification system was a feasible method for classifying case complexity in adults with non-specific chronic LBP. Future clinical intervention studies are needed to confirm if this classification system can enhance therapeutic outcomes in patients.

Neck Strength Variations in Dental Students with and without Neck Pain: A Longitudinal Study

Neck pain can induce specific motor responses and alterations in muscle strength. Therefore, this study aimed to investigate and compare the progression of cervical muscle strength within and between students with and without neck pain over the course of their first semester of clinical training. We used an online Nordic Musculoskeletal Questionnaire for group allocation, and neck strength in flexion, extension, and lateral flexion on both sides was measured using the KForce Bubble Pro hand-held dynamometer. Forty-four students were divided into neck pain (n = 21) and asymptomatic (n = 23) groups. Both groups increased neck strength by the end of the semester in flexion, extension, and left and right lateral flexion (p < 0.001). Students experiencing neck pain showed a significantly lesser degree of improvement (p = 0.036) in right lateral flexion. The agonist/antagonist ratios revealed an enhanced role of neck extensors across both groups. Dental students showed overall increased cervical strength in their first semester of clinical training. Those with neck pain exhibited a diminished rate of strength gain in right lateral flexion when compared with students without pain by the semester’s end, suggesting different neuromuscular adjustments to clinical practice in students experiencing pain, which may lead to functional impairments in later training stages.

Comparing the effects of neck stabilization exercises versus dynamic exercises among patients having nonspecific neck pain with forward head posture: a randomized clinical trial

BackgroundNonspecific neck pain (NSNP) is a well-established global burden affecting. It is also a common problem in Pakistan. The burden of neck pain is also increasing day by day due to poor work ergonomics, and increased use of computers and mobiles after the pandemic. An individual’s poor posture is often associated with forward head posture (FHP). Limited evidence is available about the effects of neck stabilization (NSE) and dynamic exercises (NDE) for nonspecific neck pain particularly in patients with FHP. This aimed to compare the effects of NSE versus NDE among patients having NSNP with FHP in reducing pain, disability, forward head posture and improving neck range of motion.MethodsIt is a single-blinded randomized clinical trial with 60 patients aged 18–40 years, with moderate intensity NSNP for > 3 weeks and < 6 months along with FHP with a moderate disability on neck disability index (NDI) randomly assigned to the treatment groups. Group 1 was doing NSE and group 2 was doing NDE. Transcutaneous Electical Nerve Stimulation, cold packs, and stretching exercises were given to both groups. A total of 9 sessions (3 sessions/ week) were given to participants. NDI questionnaire, Visual analogue scale (VAS), goniometry, and plumb line measurement tool were used as baseline and assessment at the end of 3rd week. The data was analyzed on SPSS version 21. Descriptive analysis was performed. Independent t-test was used for between group comparison and paired t-test used for within group comparison. A p-value less than 0.05 was considered statistically significant.ResultsAfter treatment within-group analysis of both NSE and NDE showed significant (p < 0.001) improvement in pain on VAS, all ROMs of the neck including flexion, extension, left and right lateral flexion and left rotation, plumb line and NDI score with very large effect size. However, between-group analysis showed non-significant differences (p > 0.05) for post-treatment mean VAS, neck ROM, NDI and plumb line measurement.ConclusionBetween NSE and NDE, no one is more beneficial than another. Both are equally effective in alleviating pain, increasing ROM, decreasing functional disability, and improving forward head posture in patients with NSNP.Trial RegistrationRegistered trial at ClinicalTrials.gov Identifier: NCT05298631, 28/03/2022, prospectively registered.

Efficacy of Post-Isometric Relaxation vs. Sustained Stretching for Improving Cervical Spine Mobility in Upper Cross Syndrome-A Randomized Controlled Trial

Background: Upper Crossed Syndrome (UCS) is a common musculoskeletal disorder characterized by muscle imbalance in the head and shoulder areas, often exacerbated by poor posture. Muscle Energy Technique (MET), including Post-Isometric Relaxation (PIR) and sustained stretching, is commonly used to alleviate symptoms associated with UCS. Methodology: This randomized controlled trial compared the efficacy of PIR versus sustained stretching in reducing muscle tightness of the upper trapezius and levator scapulae muscles among 30 participants at Al-Sehat Rehabilitation Centre, Karachi, Pakistan. Pain intensity was assessed using the Numeric Pain Rating Scale (NRS), and cervical range of motion (ROM) was measured with an inclinometer. Results: PIR and sustained stretching significantly reduced pain and improved cervical ROM. PIR showed superior pain reduction, while sustained stretching enhanced ROM, particularly in left rotation and lateral flexion. Conclusion: PIR and sustained stretching are effective treatments for managing UCS-related symptoms. PIR excels in pain management, whereas sustained stretching enhances cervical ROM. Clinicians should consider these findings when designing treatment protocols for UCS. Keywords: Disability, Pain Management, Range of Motion, Upper Cross Syndrome.

Outcomes of Mulligan Concept Applications in Obese Individuals with Chronic Mechanical Low Back Pain: A Randomized Controlled Trial.

Various treatment modalities have been employed for mechanical low back pain (MLBP), but evidence of their efficacy varies greatly. Objectıve: This randomized controlled trial aimed to assess the outcomes of Mulligan concept applications, including sustained natural apophyseal glides (SNAGS) and natural apophyseal glides (NAGS), in obese patients with MLBP. The study, conducted between January 2021 and June 2022 at a tertiary hospital, involved randomizing patients into two groups. Both groups underwent six sessions of stretching and strengthening exercises every other day. The Mulligan group received additional intervention with SNAG and NAGS techniques. Measurements were made regarding the Visual Analog Scale (VAS) score, Oswestry Disability Index (ODI) score and range of motion (ROM) for the patients' MLBP level. Post-interventions, both groups exhibited positive changes in flexion ROM, extension ROM, right and left rotation ROM, right and left lateral flexion ROM, VAS score, and ODI score compared to pre-intervention (p < 0.001 for both groups and variables). The Mulligan group showed a higher increase in ROM and a more significant decrease in VAS and ODI scores. Conclusıons: Mulligan mobilization techniques prove significantly beneficial for enhancing ROM in all directions, reducing pain levels, and alleviating disability in obese individuals with MLBP.

Investigation of The Correlation Between Pain, Proprioception and Range of Motion in Patients With Temporomandibular Joint Dysfunction

Purpose: The aim of study was to investigate the relationship between pain, proprioception and range of motion in patients with temporomandibular joint dysfunction (TMD). Material and Methods: The study was completed with 45 participants diagnosed with TMD and 45 healthy controls. Visual analog scale and graded chronic pain scale were used to assess pain intensity, dolorimeter was used for pain pressure threshold (PPT) assessment. Evaluation of cervical proprioception by cervical joint position error test (JPET), cervical joint range of motion assessment by digital goniometer, mouth opening measurements were made with a ruler. Results: In the study, pain intensity was high and PPT was low in the TMD group. In the JPET, the right-left rotation and left lateral flexion values in the TMD group had higher mean values than the control group (p=0.028, p=0.003, p=0.004, respectively). There was a significant difference between the groups in digital goniometer measurement in right-left rotation, right-left lateral flexion movements(p=0.008, p=0.001, p=0.041, p=0.005, respectively). The TMD group had a lower mean than the control group in painless, maximum assisted and unassisted mouth opening measurements(p=0.001, p=0.001, p=0.001, respectively). Conclusion: TMD patients presented a lower PPT, less accurate head repositioning, and some impairment in cervical range of motion.

The reliability, variability and minimal detectable change of multiplanar isometric trunk strength testing using a fixed digital dynamometer

ABSTRACT Trunk strength plays a vital role in athletic performance, rehabilitation and general health, however, current assessment methods are expensive, non-portable or unreliable. This study aimed to investigate the within- and between-session reliability, variability, standard error of measurement and minimal detectable change (MDC) of trunk strength in the sagittal (flexion and extension) and frontal planes (left and right lateral flexion) using a fixed digital dynamometer. Eighteen participants (ten men and eight women) attended two sessions separated by 7 days. Participants were fitted with a trunk harness which was secured to an immovable base via a digital dynamometer. Three maximal voluntary isometric contractions were completed across four positions (prone, supine, left-side recumbent and right-side recumbent, respectively) on a glute-hamstring raise machine. All positions demonstrated excellent reliability and low variability within session (ICC: 0.95–0.98; CV: 5–7%) and between sessions (ICC: 0.98–0.99; CV: 4–6%), across all positions. The between-session MDC ranged from 8% (prone) to 13% (right-side recumbent), translating to absolute values between 2.9 and 3.2 kg across all positions. Maximal isometric force testing using a fixed digital dynamometer provides reliable measurements of multiplanar trunk strength, providing a practical method for use in clinical practice.

Evaluating a 14-week neck strengthening protocol for neuromuscular indicators associated with head and neck trauma

Increased neck strength has been linked to a potential decrease in traumatic brain injuries (TBI). The purpose was to determine the efficacy of a neck-strengthening protocol using a novel neck-strengthening device to increase isometric neck strength and rate of force development (RFD). Utilizing self-generated centripetal force, participants trained for 14 weeks. A linear mixed model was used to analyze the relationship between post-assessment measurements and pre-assessments measurements, while accounting for repeated measure random effect at the individual level, and a regular random error term. RFD values were 4.344 times higher in the clockwise direction and 5.978 times higher in the counterclockwise direction when comparing pre and post assessment measurements. Isometric neck strength increased significantly (p ​< ​0.05) in the cervical extension (p ​= ​0.010) and left lateral flexion (p ​= ​0.009) directions. The results can be used in strength training and clinical settings to potentially reduce the incidence of TBI.

Assessing the feasibility of a neck‐strength training intervention in university women's rugby

AbstractCervical muscle strength has been demonstrated to reduce concussion risk in high school athletes, and interventions to improve this in male rugby players have elicited strength improvements. However, the feasibility of introducing neck‐strengthening interventions into women's rugby has not been investigated. This study sought to pilot a neck‐strength intervention in university‐level women's rugby players. A fixed‐frame dynamometer was used to assess the multi‐directional isometric neck‐strength of 14 university women's rugby players (20.3 ± 1.0 years). Between baseline and end‐of‐season testing, a neck‐strengthening program was completed. Interviews were conducted with six players and two coaches to understand program engagement. Interviews were transcribed verbatim and processed via inductive content analysis. Increases in absolute neck‐strength post‐intervention in left and right lateral flexion (left 85.4 ± 29.7 N to 108.2 ± 41.6 N, p = 0.02, right 87.4 ± 33.3 N to 110.5 ± 40.3 N, p = 0.01) and flexion (128.4 ± 28.8 N to 147.9 ± 30.5 N, p = 0.01) were perceived positively by the players although there were suggestions that greater adaptability according to training age and more variety was required. Participants initially demonstrated limited awareness of neck‐strength training but engaged well with the exercises once the potential benefits were understood. This intervention shows promise as an effective, palatable strategy to improve neck‐strength in university women's rugby players. Further research is needed to establish whether such improvements in neck‐strength are associated with meaningful reductions in head impact occurrence.

Efficacy of wet cupping in the pain management of cervical spondylosis – A randomized, controlled, open -label, parallel-group clinical trial

Background and objectiveCervical spondylosis is a chronic degenerative process of the cervical spine characterized by pain in neck, degenerative changes in intervertebral disc and osteophyte formation. Cervical spondylosis is translated as Wajaʻ ur Raqaba, a type of joint pain. The present study was aimed to evaluate the effect of wet cupping in the pain management of cervical spondylosis. MethodsThis Open, randomized, controlled, clinical study was conducted on 44 patients. Subjects in the test group (n = 22) received a series of three-staged wet cupping treatment, performed on 0, 7th and 14th day. Subjects in the control group (n = 22) received 12 sittings of Transcutaneous Electrical Nerve Stimulation (TENS): 6 sittings per week for two weeks. The objective findings of treatment were assessed with the help of VAS, Neck Disability Index (NDI) and Cervical range of motion. ResultsIntra group comparison in test group from baseline to 21st day were found highly significant (p < 0.001) in terms of VAS, NDI, Flexion, Extension and Left rotation score. While in Right rotation, Left rotation and Left lateral flexion score were found moderately significant (p < 0.01). Statistically significant difference was observed between two groups at 21st day in VAS scale, NDI, and Cervical range of motion score (p < 0.001). Interpretation and conclusionḤijāma Bish Sharṭ was found better in the management of pain due to cervical spondylosis than TENS. It can be concluded that Ḥijāma Bish Sharṭ may a better option for the pain management of cervical spondylosis. Clinical trial registrationThe trial was registered on clinical trial registry website (www.ctri.nic.in) bearing a CTRI Number, CTRI/2020/03/024,249.

Effects of acupuncture at myofascial trigger points combined with sling exercise therapy on clinical recovery and cervical spine biomechanics in patients with cervical spondylotic radiculopathy

Objective This research aimed to ascertain the effects of acupuncture at myofascial trigger points (MTrPs) in combination with sling exercise therapy (SET) on the clinical recovery and cervical spine biomechanics in patients with cervical spondylotic radiculopathy (CRS). Methods Eighty patients with CSR were divided into Group A and Group B. Group A was treated with acupuncture at MTrPs, and Group B was treated with acupuncture at MTrPs combined with SET. The cervical spine function, pain level, cervical spine biomechanics and the occurrence of complications were compared between the two groups before and after treatment. Results After treatment, the Japanese Orthopaedic Association scores, Clinical Assessment Scale for Cervical Spondylosis scores, cervical forward flexion angle, posterior extension angle, left lateral flexion angle, right lateral flexion angle, left lateral rotation angle, and right lateral rotation angle of the Group B were raised, and the Neck Disability index, Visual Analogue Scale scores, and Neck Pain Questionnaire scores were reduced versus those of the Group A. The difference in complication rates between the two groups was not of statistical significance. Conclusion Acupuncture at MTrPs combined with SET promotes functional recovery of the cervical spine, reduces pain, and improves cervical spine biomechanics in patients with CRS.

Effectiveness of eye-cervical re-education versus motor imagery therapy on chronic neck pain: A randomized controlled trial

The aim of this study was to investigate the effect of adding eye cervical re-education exercises (ECRE) versus motor imagery therapy (MIT) to conventional physical therapy (CPT) on pain, functional disability, and cervical range of motion (ROM) in subjects with chronic neck pain (CNP). The study employed a randomized controlled trial design with 60 patients with CNP. Participants were selected from the outpatient clinics of the Faculty of Physical Therapy at Cairo University and were randomly assigned to three groups: conventional physical therapy only (CPT) (Group I, N = 20), eye-cervical re-education exercises plus CPT (Group II, N = 20), and motor imagery therapy plus CPT (Group III, N = 20). All participants received 3 sessions per week for 4 weeks. Visual Analogue Scale (VAS), Neck Range of Motion (ROM) and Neck Disability Index (NDI) were measured at baseline and after 4 weeks of intervention. In terms of pain intensity, neck disability index, neck flexion and extension, right and left lateral flexion, and right and left rotation ROM outcome measures, the results revealed statistically significant differences between groups (p &lt; 0.05). Group II showed statistically significant improvement compared to both Group I and Group III in all measured outcomes (p &lt; 0.05). Additionally, Group III showed statistically significant improvement compared to Group I in all measured outcomes (p &lt; 0.05). Adding eye-cervical re-education exercises or motor imagery therapy to conventional physical therapy resulted in notable improvements. Eye-cervical re-education exercises, in particular, showed greater benefits in reducing pain, enhancing cervical ROM, and decreasing disability compared to conventional physical therapy alone in patients with chronic neck pain.

Effect of a slump posture on pain, proprioception, and electrical activity of the muscles in office workers with chronic non-specific neck pain. A retrospective study

BackgroundThe impact of computer typing in a slump posture on pain, proprioception and muscle recruitment has not been extensively investigated. Therefore, the purpose of this study was to evaluate the extent of pain, proprioception and muscle activity resulting from computer typing in a slump posture in women who already suffer from chronic neck pain. MethodsThis cross-sectional study was conducted between May 20 to July 10, 2021. A total of 15 female 42-(±4.96)-year-old office workers with chronic non-specific neck pain participated in this study. Before and after 60 min of computer typing in a slump posture, proprioception and pain were measured using an inclinometer and visual analog scale (VAS), respectively. The activity of the cervical erector spine (CES) and upper trapezius (UT) muscle was also measured before and after the slump-posture computer typing, in upright, forward, and slump postures. Results: Paired-samples t-tests showed that pain was increased and proprioception in all directions (flexion, extension, right and left lateral flexion, and right, and left rotation) was less accurate (P < 0.05) after 60 min computer typing. The CES and UT muscle activity were elevated more in the forward head and slump posture than in the upright posture (P < 0.05). ConclusionSixty minutes computer typing in a slump posture increased neck pain, resulted in a decreased proprioception in the neck and was accompanied by an increased activity of the neck musculature.

The relationship between trunk control, spinal posture, and spinal mobility in patients with multiple sclerosis: a cross-sectional study.

Trunk control, which plays a key role in balance and mobility, decreases in patients with multiple sclerosis (PwMS) and many parameters such as sensory, motor, and musculoskeletal systems affect trunk control. The aim of this study was to compare trunk control, spinal mobility, and spinal posture in PwMS with healthy controls and investigate the relationship between trunk control with spinal posture and spinal mobility in PwMS. The study was completed with 38 PwMS and 38 healthy controls with matched age and sex. Trunk control was evaluated with the Trunk Impairment Scale (TIS). Spinal posture and mobility were evaluated in sagittal and frontal planes using an IDIAG M360 Spinal Mouse. Spinal posture was evaluated in upright, maximum flexion, extension, left and right lateral flexion positions, and spinal mobility was evaluated from upright to flexion, extension, right and left flexion positions in sagittal and frontal planes. TIS scores, thoracic mobility angles (from upright to flexion and left lateral flexion), lumbar mobility angles (from upright to extension and right lateral flexion) and lumbar posture angle (maximum right lateral flexion) were lower, and thoracic posture angles (upright and maximum extension) were higher in PwMS than healthy controls (p < 0.05). No significant difference was found between other spinal postures and mobility values. In addition, there was only a negative relationship between thoracic spinal mobility from upright to extension and trunk control in PwMS (r = -0.349; p = 0.032). These findings indicate the importance of early detection of trunk disturbances in PwMS. Thus, even in the early stages of multiple sclerosis, detailed trunk assessment will guide the implementation of comprehensive exercise programs.

Neck strength alone does not mitigate adverse associations of soccer heading with cognitive performance in adult amateur players.

Soccer heading is adversely associated with neurocognitive performance, but whether greater neck strength or anthropometrics mitigates these outcomes is controversial. Here, we examine the effect of neck strength or anthropometrics on associations of soccer heading with neurocognitive outcomes in a large cohort of adult amateur players. 380 adult amateur league soccer players underwent standardized measurement of neck strength (forward flexion, extension, left lateral flexion, right lateral flexion) and head/neck anthropometric measures (head circumference, neck length, neck circumference and neck volume). Participants were assessed for heading (HeadCount) and cognitive performance (Cogstate) on up to 7 visits over a period of two years. Principal components analysis (PCA) was performed on 8 neck strength and anthropometric measures. We used generalized estimating equations to test the moderation effect of each of the three PCs on 8 previously identified adverse associations of 2-week and 12-month heading estimates with cognitive performance (psychomotor speed, immediate verbal recall, verbal episodic memory, attention, working memory) and of unintentional head impacts on moderate to severe central nervous system symptoms. 3 principal components (PC's) account for 80% of the variance in the PCA. In men, PC1 represents head/neck anthropometric measures, PC2 represents neck strength measures, and PC3 represents the flexor/extensor (F/E) ratio. In women, PC1 represents neck strength, PC2 represents anthropometrics, and PC3 represents the F/E ratio. Of the 48 moderation effects tested, only one showed statistical significance after Bonferroni correction, which was not robust to extensive sensitivity analyses. Neither neck strength nor anthropometrics mitigate adverse associations of soccer heading with cognitive performance in adult amateur players.

The effects of core training on endurance in different trunk movements

Core muscle endurance involves the trunk muscles’ capability to maintain a particular position for as much time as possible. It is essential to know how specific training aimed at this area affects endurance of different trunk movements performance and to what extent. The objective was to assess the effects of trunk training on different core muscle endurance measurements in flexion, extension, and right and left lateral flexion. A literature search was performed using different databases. The studies included: (a) cohorts of healthy people or subjects with chronic low back pain; (b) a core training intervention; (c) pre-post intervention parameters of interest; (d) a minimum of 4 out of 10 on the PEDro scale, and (e) randomised controlled trials. A random-effects model for meta-analyses was used. Fifteen studies were selected for the systematic review and 11 for the meta-analysis, comprising 1,213 participants. Compared to the control condition, core training induced a moderate effect on trunk flexion endurance (ES = 0.67), right-lateral trunk flexion endurance (ES = 0.77), left-lateral trunk flexion endurance (ES = 0.94), and a small effect on trunk extension endurance (ES = 0.49). To back up the results presented in this study, more research into the effects of trunk training on core muscle endurance is needed to confirm these results significantly. Core training improves core muscle endurance in four trunk movements. Core training is more effective in participants with pre-intervention poor results.

"An Innovative Intervention Approach for Chronic Pain Management in Pediatric Static Vertebral Disorders through Physical Therapy"

"Introduction: In this study, we aimed to assess the effectiveness of a novel physical therapy intervention in managing chronic pain associated with pediatric static vertebral disorders. Methods and materials: The investigation encompassed both clinical variables, such as pain perception measured by a visual analog scale (VAS), and morpho-functional variables related to developmental level and spinal status: weight (W, kg), height (H, cm), body mass index (BMI), scapular/shoulder asymmetry (SA, cm), thoracolumbar fold asymmetry (TFA, cm), sacral dimples asymmetry (SDA, cm), intergluteal cleft deviation (ICD, cm), scoliosis measurement (SM, cm), right lumbar lateral flexion (RLLF, cm), left lumbar lateral flexion (LLLF, cm), and Cobb angle. The study involved a cohort of 48 subjects, aged between 8 and 12 years, who were divided into experimental and control groups. The experimental group underwent a six-month physical therapy-based rehabilitation program, while the control group did not receive any intervention during this period. Both groups underwent clinical and morpho-functional evaluations before and after the intervention. The analysis, conducted through a two-way repeated measures ANOVA, intended to explore the interaction between group and time of assessment on each dependent variable. Results: The results revealed significant differences in several variables (VAS scores, SA, TFA, SDA, ICD, SM, RLLF, LLLF, and Cobb angle) between the experimental and control groups (p ≤ 0.02), suggesting a discernible impact of the intervention on physiological and functional parameters related to spinal deformities and chronic pain management. Discussion: The intervention applied to the experimental group produced significant changes in key variables relevant for clinical assessment and morpho-functional analysis, indicating its notable impact on physiological and functional parameters. Conclusions: This study underscores the significant effect of tailored physical therapy interventions in mitigating chronic pain and improving morpho-functional aspects in pediatric spinal deformities."

The effects of Core Stability Exercises and Mulligan's mobilization with movement techniques on sacroiliac joint dysfunction.

Sacroiliac joint dysfunction (SIJD), while being the primary contributor to low back pain, is still disregarded and treated as low back pain. Mulligan's Mobilization with Movement (MWM) Techniques and Core Stability Exercises (CSE) are often used to treat low back pain. There is not much evidence that it is effective in SIJD. To evaluate the effectiveness of CSE coupled with MWM (CSE + MWM) in the treatment of SIJD. 39 patients with SIJD were recruited and randomly divided into distinct groups as follows: control group (n = 13), CSE group (n = 13) and CSE + MWM group (n = 13). The Numerical Pain Rating Scale (NPRS), the Roland Morris Disability Questionnaire (RMDQ), the Range of Motion (ROM), the Pressure Pain Threshold (PPT) and the pelvic tilt angle asymmetry ratio in the sagittal plane (PTAR) were used to gauge the intervention's success both before (M0) and after (M1) it. All experimental data were statistically analyzed. The SIJ-related pain metric significantly decreased in both the CSE + MWM group and the CSE group between M0 and M1, as determined by the NPRS and RMDQ. Between M0 and M1, The CSE group's left axial rotation ROM and lumbar flexion ROM were significantly decreased. The CSE + MWM group's extension ROM and left lateral flexion ROM both significantly increased between M0 and M1. In the difference variable (M1-M0), the CSE + MWM group substantially outperformed control group in the left lateral flexion ROM and outperformed the CSE group in the left axial rotation ROM. In individuals with SIJD, CSE + MWM is beneficial in lowering pain, disability, and function. Treatment with CSE and MWM approaches for SIJ appears to boost this efficacy.

Relationship of Endotracheal Tube Cuff Pressures with Changes in Body Positions of Critically Ill Patients on Mechanical Ventilation: An Observational Study.

Endotracheal tube cuff pressure (ETCP) is an important factor to determine the development of complications associated with invasive mechanical ventilation. To avoid preventable complications arising out of immobilization, frequent changes in body positioning are necessary. Such variations in body position can affect ETCP in critically ill patients who are on mechanical ventilation. So, our study aimed to assess the effect of changes in body position on ETCP in patients who are on mechanical ventilation. This prospective observational study included 31 critically ill intubated patients. Each study subject was first placed in a neutral starting position with a 30º head elevation. Then, they were subjected to a sequential change in body position based on the 16 most used positions as part of the critical care unit's (CCUs) daily routine. Endotracheal tube cuff pressure was measured after each position change. Data were analyzed using standard statistical tests. Statistically significant difference in ETCP was observed during anteflexion of neck, hyperextension of neck, left lateral flexion of neck, right lateral flexion of neck, left lateral rotation of neck, right lateral rotation of neck, 10o recumbent position, supine position, Trendelenburg position, and right lateral 30° and 45° positions. Maximum increase in ETCP was seen during anteflexion of neck (31 ± 4.5; 22-42 cm H2O). Our study demonstrates significant deviations in ETCP from the recommended range following changes in the body position of mechanically ventilated patients, highlighting the need for the measurement of ETCP after each position change and maintenance of the same within the target range. Roy O, Dasgupta S, Chandra A, Biswas P, Choudhury A, Ghosh S, et al. Relationship of Endotracheal Tube Cuff Pressures with Changes in Body Positions of Critically Ill Patients on Mechanical Ventilation: An Observational Study. Indian J Crit Care Med 2024;28(1):36-40.

The Impact of HVLA Manipulations and Therapeutic Massage in Increasing the Mobility of the Lateral Flexion of the Neck

The purpose of this study was to establish if high-velocity, low-amplitude manipulation (HVLA) combined with therapeutic massage can improve cervical spine mobility, particularly neck lateral flexion, on the left and right sides, given that lateral neck flexion is 90 degrees. The sample of 75 participants was comprised of 35 men (46.6%) and 40 women (53.3%), all of whom were between the ages of 20 and 60 and were divided into four groups based on their average ages: 20 to 30 years, 31 to 40 years, 41 to 50 years, and 51 to 60 years. These groups were further subdivided into two groups by gender, male and female. Patients' lateral flexion was measured with a goniometer, which displays the angle of lateral flexion before and after treatment. C1-C7 vertebral level and shoulder joint level HVLA procedures were conducted. The therapeutic massage concentrated on the trapezius, sternocleidomastoid, platysma, splenius, and semispinalis muscles using relaxing techniques. Each patient's left and right elbow lateral flexion was measured with a goniometer following HVLA manipulations and therapeutic massage to see whether or not there was a significant increase. After combining the findings and measurements, we were able to determine that these combined methods increase the cervical spine joint mobility of the 75 participants by a mean of 12.36 degrees.