Musculoskeletal Conditions Research Articles

Magnetic resonance imaging of the dromedary camel carpus

BackgroundThe dromedary camel (Camelus dromedarius) carpal joint presents multiple joints and constitutes several bones and soft tissues. Radiography and/or ultrasonography of the carpus are challenging due to structural superimposition. High-field magnetic resonance imaging (MRI) technique precludes superimposed tissues and offers high soft tissue contrast in multiple sequences and planes. Hence, understanding the normal MRI anatomy is crucial during clinical investigations. Magnetic resonance imaging is highly sensitive for investigation of soft tissues and articular cartilage; therefore, it is extensively used for outlining joint anatomy and evaluation of a wide range of musculoskeletal conditions. MRI images of a specific anatomical region acquired by using multiple sequences in various planes are necessary for a complete MRI examination. Given the dearth of information on the MRI features of the dromedary camel carpus, the current study demonstrates the MRI appearance of the clinically significant structures in the camel carpus in various sequences and planes using a high-field 1.5 Tesla superconducting magnet. For this purpose, twelve cadaveric forelimbs, obtained from 6 clinically sound lameness free adult dromedary camels, were examined.ResultsThe cortex and medulla of the radius, carpal bones and metacarpus were evaluated. Articular cartilage of the carpal joints was depicted and showed intermediate intensity. Carpal tendons expressed lower signal intensity in all pulse sequences. The collateral and inter-carpal ligaments showed mixed signal intensity.ConclusionsThe obtained data outlines the validation of MRI for investigation of the camel carpus and could set as a reference for interpretation in clinical patients.

Proprioceptive neuromuscular facilitation stretching exercises for treatment of temporomandibular dysfunction in patients with forward head posture: A double-blinded, randomized, controlled trial.

Proprioceptive neuromuscular facilitation (PNF) stretching exercises have been widely advocated for the management of patients with different musculoskeletal conditions. However, its effect on the treatment of temporomandibular dysfunction (TMD) in patients with forward head posture (FHP) has not been fully investigated. To investigate the effect of PNF stretching exercises on the treatment of TMD in patients with FHP. A prospective, randomized, double-blinded clinical trial. Twenty-four patients with TMD and FHP aged from 18-40 years were randomly assigned to PNF or control group. The PNF group composed of 12 patients received PNF stretching exercises of masticatory muscles in addition to routine physical therapy treatment (FHP correction exercises and ultrasound for the temporomandibular joint); the control group composed of 12 patients received routine physical therapy treatment only. Interventions were conducted twice a week for six weeks. Craniovertebral angle, pain threshold, pain intensity, temporomandibular joint ROM, and temporomandibular joint function were assessed for all participants before and after the intervention. The outcomes were analyzed using Two-way mixed MANOVA. For further multiple comparisons, post-hoc tests with the Bonferroni correction were performed. There was no significant difference between both groups pre-treatment (p> 0.05). Comparison between groups post-treatment revealed statistically significant differences in all outcome measures (p< 0.05) in favor of the PNF group. Adding PNF stretching exercises of masticatory muscles to routine physical therapy programs is an effective method for management of TMD in patients with FHP more than routine physical therapy programs alone.

Physiotherapy educators' perceptions of physiotherapists' competencies and continuing education in the practice of musculoskeletal physiotherapy direct access.

The aim of direct access (DA) physiotherapy practice in Finland is the treatment of musculoskeletal (MSK) conditions by physiotherapists who have completed continuing DA education. It is difficult to pinpoint the competencies of DA physiotherapists as their roles and scope of practice varies. The present study aimed to explore the competencies and education of DA physiotherapists through the perceptions of DA educators. Data were collected through individual semi-structured interviews of eleven Finnish physiotherapy educators who described their perceptions of DA physiotherapists' competencies and their continuing DA education. The interviews were recorded and transcribed verbatim and then examined using a reflexive thematic analysis. Two main themes were formulated on the basis of the data, conveying the educators' perceptions. The first theme, Interaction as grounds for meaningful clinical reasoning, had two subthemes: Meaningful encounter and Rationally and safely locating the core of the client's problem. The second theme, Continuing professional development in an expert role, had four subthemes: Continuous learning, Self-reflection, Deep understanding and Taking responsibility for one's own expertise. The present study revealed how DA educators perceive the competencies of DA physiotherapists. The findings highlight the perceived significance of the physiotherapists' interaction with the client as a ground for meaningful clinical reasoning, and their responsibility for their own continuing professional self-development.

Prevalence and Predictors of Carpal Tunnel Syndrome Symptoms Among Teachers in Jazan: A Cross-Sectional Study.

Background Carpal tunnel syndrome (CTS) is a common musculoskeletal condition of the hand and wrist frequently associated with repetitive hand motion and environmental considerations. Teachers are more likely to acquire CTS because of their lengthy writing and computer use. This study aimed to determine the prevalence of CTS symptoms and related variables among schoolteachers in Jazan, Saudi Arabia. Methods This study was conducted as a cross-sectional survey of teachers in Jazan, utilizing an online platform for data collection. The Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) was the primary tool used to determine symptom intensity and functional status. The data were rigorously analyzed using a range of statistical methods, including descriptive statistics, the Mann-Whitney U test, the Kruskal-Wallis test, Spearman's correlation, the chi-square test, Fisher's exact test, and binary logistic regression, ensuring the robustness of the findings. Results The study comprised 336 schoolteachers with a mean age of 43.3 ± 6.5 years, of whom 58.0% were female and 42.0% were male. About 8.0% of instructors reported CTS symptoms. Female gender (median Symptom Severity Scale (SSS): 15.0 vs. 12.0, p < 0.001; median Functional Status Scale (FSS): 8.0 vs. 8.0, p < 0.001), increased time spent writing (r = 0.237, p < 0.001 for SSS; r = 0.217,p < 0.001 for FSS), and presence of comorbidities such as diabetes (median SSS: 16.0, p = 0.002; median FSS: 8.0, p = 0.001) had a negative correlation with symptom severity (r = -0.174, p = 0.002) and functional impairment (r = -0.141, p = 0.011). Surgical therapy (median SSS: 32.0; median FSS: 24.0; p<0.001) and post-treatment symptom recurrence (median SSS: 28.0; median FSS: 22.0; p<0.001) were associated with increased severity and disability. According to binary logistic regression, increased writing time significantly predicted CTS diagnosis (OR = 1.151, 95% CI: 1.024-1.295, p = 0.018). Conclusion CTS symptoms are common among Jazan teachers, and various sociodemographic, vocational, and clinical variables influence their intensity and functional status. Ergonomic treatment, early identification, and suitable management measures are critical for preventing and mitigating the effects of CTS among teachers. Additional research is required to develop focused therapies and enhance the results of this occupational group.

Physiotherapy Outcomes Are Associated With Shorter Waiting Times, More Treatment Sessions and Younger Age: Analysis of a Clinical Database.

Musculoskeletal (MSK) conditions affect over 20.3 million people in the UK, presenting a substantial economic impact on health and social services. Physiotherapy can alleviate MSK conditions, especially if delivered in the acute or sub-acute period. However, patients often present after significant waiting times. Our analysis examined how waiting times and the number of treatments influenced physiotherapy outcomes for MSK conditions. Retrospective analysis of the Data for Impact, Physio First dataset. Logistic regression models assessed the effects of symptom duration, treatment frequency, and other variables on pain, Patient-Specific Functional Scores (PSFSs), and Goal Achievement (GA). Analysis of 15,624 patient records showed that patients treated within two weeks of symptom onset were more likely to have favourable outcomes in pain (odds ratio [OR]=2.01, 95% Confidence Interval [95% CI]=1.65-2.45), PSFS (OR=1.80, 95% CI=1.55-2.08), and GA (OR=1.74, 95% CI=1.51-2.01) compared to those treated after longer durations. Receiving four or more treatment sessions significantly improved outcomes compared with only one session (pain: OR=4.64, PSFS: OR=5.72, GA: OR=1.94, all p's<0.001), with no additional benefits beyond four sessions. Younger age was associated with better outcomes (approximately OR=0.99 per year age difference). Other findings included better outcomes in males and in those with fewer previous episodes of the condition. Shorter waiting times, a greater number of treatments, and younger patient age are associated with better physiotherapy outcomes for MSK conditions.

The Interplay of Microbiota, Long COVID, and Musculoskeletal Pain: A Narrative Review

Context: Long COVID, a condition that persists after the acute phase of COVID-19, poses a significant burden, with 10 - 45% of recovered patients experiencing persistent symptoms. Among these, approximately 46% report musculoskeletal pain. This narrative review explores the potential connections between gut microbiota, Long COVID, and musculoskeletal pain, aiming to introduce new therapeutic avenues and preventive strategies for managing musculoskeletal symptoms in Long COVID patients. Evidence Acquisition: A comprehensive search was conducted using Google Scholar, Lens.org, and ConnectedPaper.com to identify relevant articles published between 2019 and 2024. Keywords related to microbiota, Long COVID, and musculoskeletal pain were used. Articles were selected based on predefined inclusion and exclusion criteria, and their quality was assessed. Data from the selected articles were synthesized to provide an overview of the interplay between microbiota, Long COVID, and musculoskeletal pain. Results: Recent research highlights the significant role of gut microbiota in modulating immune responses and systemic inflammation. Dysbiosis has been linked to the severity and progression of COVID-19 and the persistence of Long COVID symptoms. Individuals with Long COVID often experience new-onset musculoskeletal manifestations, such as joint pain, myalgia, and chronic musculoskeletal pain. Additionally, gut dysbiosis has been associated with conditions like lower back pain and knee osteoarthritis. This suggests that the relationship between gut dysbiosis and musculoskeletal problems in general may also extend to musculoskeletal pain in Long COVID patients, indicating broader implications for musculoskeletal outcomes. Therapeutic strategies targeting the gut microbiota, such as probiotics, prebiotics, and dietary interventions, have shown promise in managing these symptoms and improving overall health outcomes. Conclusions: The evidence underscores the importance of understanding the microbiota-musculoskeletal nexus in Long COVID. Gut dysbiosis contributes to systemic inflammation, exacerbating musculoskeletal symptoms in Long COVID patients. The associations between gut dysbiosis and other musculoskeletal conditions emphasize the need for microbiota-targeted therapeutic strategies. Future research should focus on elucidating the mechanisms linking gut dysbiosis to musculoskeletal pain, exploring the gut-brain axis, and developing personalized approaches to modulate the microbiota. Advancing our understanding of this nexus can pave the way for innovative therapeutic strategies to address the complex health challenges posed by Long COVID and other musculoskeletal conditions.

The Functional Organization of Corticomotor Neurons Within the Motor Cortex Differs Among Basketball and Volleyball Athletes With Patellar Tendinopathy Compared to Asymptomatic Controls.

Patellar tendinopathy (PT) typically affects jumping-sport athletes with functional impairments frequently observed. Alterations to the functional organization of corticomotor neurons within the motor cortex that project to working muscles are evident in some musculoskeletal conditions and linked to functional impairments. We aimed to determine if functional organization of corticomotor neuron projections differs between athletes with PT and asymptomatic controls, and if organization is associated with neuromuscular control. We used a cross-sectional design, and the setting was Monash Biomedical Imaging. Basketball and volleyball athletes with (n = 8) and without PT (n = 8) completed knee extension and ankle dorsiflexion force matching tasks while undergoing fMRI. We determined functional organization via identification of the location of peak corticomotor neuron activation during respective tasks (expressed in X, Y, and Z coordinates) and calculated force matching accuracy for both tasks to quantify neuromuscular control. We observed significant interactions between group and coordinate plane for functional organization of corticomotor projections to knee extensors (p < 0.001) and ankle dorsiflexors (p = 0.016). Compared to controls, PT group peak corticomotor activation during the knee extension task was 9.6 mm medial (p < 0.001) and 5.2 mm posterior (p = 0.036), and during the ankle dorsiflexion task 8.2 mm inferior (p = 0.024). In the PT group, more posterior Y coordinate peak activation location during the knee extension task was associated with greater task accuracy (r = 0.749, p = 0.034). Functional organization of corticomotor neurons differed in jumping athletes with PT compared to controls. Links between functional organization and neuromuscular control in the PT group suggest organizational differences may be relevant to knee extension neuromuscular control preservation.

Reliability of Rehabilitative Musculoskeletal Sonography for Measuring the Visible Cross-Sectional Area of Suboccipital Muscles.

Aims The primary aim of this study is to assess the reliability of rehabilitative sonography as a non-invasive imaging technique for measuring the visible cross-sectional area (CSA) of the deep suboccipital muscles. Objectives Objectives involve determining both the intra-rater and inter-rater reliability of sonographic measurements to ensure consistent and reproducible results across different sessions and examiners. The ultimate goal is to validate rehabilitative sonography as a reliable tool for clinical and research applications in the assessment and management of musculoskeletal (MSK) conditions involving the deep suboccipital muscles. Design and setting Seventeen participants, including nine women and eight men without neck or vertebral pain, were evaluated using MSK sonography. The visible CSA of suboccipital muscles was assessed using real-time B-mode sonography in a sitting position with a linear probe (5 cm, 7.5 MHz) aligned perpendicularly to the muscle fibers of the rectus capitis posterior minor (RCPM) in one sonogram and the obliquus capitis inferior (OCI) and rectus capitis posterior major (RCPMJ) in another. Two experienced examiners performed sonography measurements, and the procedure was repeated one hour and again one day later. Results Intra-class correlation coefficient (ICC) values for Examiner 1 were 0.84 and 0.79 for RCPM, 0.84 and 0.71 for RCPMJ, and 0.86 and 0.77 for OCI at the one-hour and one-day repetitions, respectively. ICC values for Examiner 2 were 0.86 and 0.77 for RCPM, 0.77 and 0.86 for RCPMJ, and 0.61 and 0.64 for OCI at the one-hour and one-day repetitions, respectively. Inter-rater ICC values were 0.77 for RCPM, 0.82 for RCPMJ, and 0.68 for OCI. Standard error of measurement (SEM) values for Examiner 1 were 11.63 and 13.92 mm² for RCPM, 10.30 and 7.91 mm² for RCPMJ, and 22.84 and 34.61 mm² for OCI. SEM values for Examiner 2 were 11.82 and 13.40 mm² for RCPM, 11.91 and 7.04 mm² for RCPMJ, and 39.20 and 37.73 mm² for OCI. SEM values between examiners were 13.74 mm² for RCPM, 10.36 mm² for RCPMJ, and 36.03 mm² for OCI. Conclusions These findings suggest that sonography is a reliable method for measuring the CSA of the RCPM, RCPMJ, and OCI muscles, provided that the examiners are well-trained and consistent in their techniques and that the average of three measurements is used.

How Do We Better Serve Excluded Populations When Delivering Digital Health Technology? Inclusion Evaluation of a Digital Musculoskeletal Self-Management Solution.

Digital self-management platforms have been proposed as a solution to better support people manage their musculoskeletal (MSK) condition. However, research studies often explicitly exclude people who can't access internet connected devices. An important consideration is that digital exclusion (for people without access to an internet connected device) from these new digital options will worsen already existing inequality and inequity in healthcare. To evaluate the acceptability and potential causes of digital exclusion of the South West London (SWL) MSK self-management app. (1) Explore why some patients are not using the app and any barriers they have. Explore why some clinicians are not prescribing the app. (2) Make recommendations, based on these findings, to improve digital inclusion. An explanatory sequential mixed method service evaluation that consisted of initial questionnaires to identify suitable collaborators, followed by structured interviews of patients and clinicians. Following a comprehensive data analysis, 10 sub-themes were grouped into four main themes: (1) Beliefs: Importance of understanding the role of digital; face to face consultation is still valued and needed. (2) Barriers: Lack of digital literacy; lack of physical examination/contact with a clinician. (3) Enablers: Immediate access to advice and information; perceived better control over health; ease of use; no appointment needed. (4) Solutions: Support and training; greater awareness. As digital health technology develops, strategies must change, requiring deliberate work and investments to improve inclusion. Our findings highlight how digital technology design and delivery can be adapted to address the causes of digital exclusion.

Mechanical evaluation of human cadaveric lumbar soft tissues suggests possible physiological stress shielding within musculoskeletal soft tissues by the thoracolumbar fascia.

This study investigates the potential for stress shielding within musculoskeletal soft tissues through analysis of stress distributions between lumbar fascial and muscle tissues via mechanical testing. Using a custom apparatus, 51 posterior thoracolumbar fascia (TLF) samples and 18 erector spinae (ES) cadaveric samples underwent tensile testing involving three loading-unloading cycles, followed by loading to 6% strain, to mechanically characterize samples. Parallel tensile testing using 20 pairs of two TLF samples, and seven pairs of TLF and ES samples was then conducted for stress distribution analysis between tissues. P<0.05 was deemed significant. The TLF and ES exhibited an average elastic modulus of 150.9MPa and 0.6MPa, respectively. At 6% strain, parallel testing of the TLF pairs yielded an average tensile stress of 8.4MPa and 1.7MPa (p<0.001) exhibited by the stiffer and less stiff TLF samples, respectively. Similarly, TLF-ES parallel testing resulted in average tensile stresses of 7.1MPa and 0.07MPa of the TLF and ES (p<0.002). Results suggest elevated loading towards stiffer TLF samples relative to less stiff TLF and ES samples. In soft tissues affected by LBP, skewed stress distributions may result in the TLF withstanding the majority of stress, yielding cyclical stress shielding that may contribute to and/or promote LBP. This novel study demonstrates a potential load allocation bias towards the TLF, laying the foundation for stress shielding within lumbar musculoskeletal soft tissues affected by degenerative musculoskeletal conditions.

Effect of Core Exercises on Clinical and Functional Outcomes After Total Knee Arthroplasty in Individuals With Knee Osteoarthritis: A Systematic Review.

Core muscles constitute the centre of the kinetic chain, and core exercises have been effective in improving outcomes in many postsurgical lower extremity musculoskeletal conditions. However, the literature on the implementation of core exercises after TKA has not been summarised. The objective was to review the evidence on the effect of core exercises on clinical and functional outcomes after TKA in individuals with knee osteoarthritis (OA). PubMed, Scopus, CINAHL, Web of Science, the Cochrane Library, and ProQuest databases were explored with appropriate keywords for studies published on the effect of core exercises on TKA from inception to 1 April 2024. Two authors independently screened the titles and abstracts and full-texts, and a third author solved the discrepancies. Risk of bias assessment was done with the Joanna Briggs Critical Appraisal tool. The final articles were systematically summarised. A total of 1485 records were retrieved. Sixty-four articles were included for screening full-texts, and four articles were ultimately included. Core exercises were administered for three to 6weeks. The administration of core exercises along with the standard knee rehabilitation programme significantly improved balance, mobility, knee function, transverse abdominis muscle thickness, transversus abdominis contraction, and quality of life after TKA (p<0.05). Core exercises can be administered as an adjunct to standard rehabilitation programs to improve clinical and functional outcomes after TKA. However, there is a dearth of literature in this domain, and more studies are warranted. PROSPERO Registration Number: CRD42024542992.

Exploring the Experience of Pain and Pain Management for Pregnant and Postpartum Veterans with Chronic Musculoskeletal Pain

BackgroundTo examine how veterans experience and treat pain during the perinatal period, we conducted a qualitative study to explore the experiences of pain, pain management, and facilitators and barriers to treatment among perinatal veterans. MethodsWe identified veterans who received care at any of the 15 Veterans Health Administration (VHA) facilities across the United States and were enrolled in an ongoing cohort study. All participants gave birth to a newborn between March 2016 and June 2021 and met the inclusion criteria for having a prepregnancy pain-related musculoskeletal condition. We completed interviews with 30 veterans between November 2021 and January 2022. We used a framework approach to our qualitative analysis. ResultsVeterans in our sample were, on average, 31 years of age, married (80%), and white (47%). The most common type of pain diagnoses were back pain (93%) and joint disorders (73%). We identified the following major themes: 1) veteran experiences of pain during pregnancy, 2) challenges to pain care during the perinatal period, and 3) veteran recommendations for VHA perinatal pain care. Experiences of pain during pregnancy varied and several barriers to pain care were identified. Veterans suggested several ways the VHA could improve pain care during the perinatal period, including more training for VHA providers on perinatal pain care and greater complementary and integrative health coverage. ConclusionsUnderstanding the unique needs of pregnant veterans with chronic pain is important to provide high-quality care during the perinatal period. Veterans who participated in this study highlighted several areas where the VHA could improve pain management during pregnancy and postpartum.

Contemporary treatments for mid-substance achilles tendinopathy: a review

Mid-substance Achilles tendinopathy is primarily a degenerative condition that frequently affects quality of life, especially for patients wanting to continue a high level of activity. It can differ from insertional Achilles tendinopathy both in terms of its epidemiology as well as its management strategies. Currently, numerous treatment options exist in the literature for this fairly common musculoskeletal condition. However, many of these treatments remain experimental with no substantial evidence for efficacy. A number of these options, including regenerative and biologic medicines, have nonetheless demonstrated improvements in patient-reported outcomes and promising potential. As such, there remains no standard approach for management beyond stretching/exercise therapy. This article reviewed the current literature surrounding treatment options and provided summaries and recommendations of eight treatment modalities for this condition. It is intended to serve as a general review as well as an objective evaluation of recent evidence that may provide some guidance for healthcare providers when discussing treatment options with patients.

Noncombat injury and illness prevalence and working score percentage quantify the impact on duty availability in US Army Special Operations military working dogs.

This cross-sectional study determined the 2-year period prevalence and quantified the impact on working status of noncombat injury and illness by a working score percentage (WSP) based on the number of duty days lost (DDL). 126 dogs from 9 US Army Special Operations kennels. Dog injury and illness events between May 1, 2021, and April 30, 2023, were recorded to determine period prevalence and calculate a WSP metric to quantify loss of duty status. 93 health events occurred in 62 of 126 (49.2%) dogs over a 24-month period resulting in 4,130 DDL. The period prevalence was 25 of 126 (19.8%) for dental injuries, 20 of 126 (15.9%) for musculoskeletal injuries, and 13 of 126 (10.3%) for gastrointestinal illnesses. Musculoskeletal conditions resulted in the highest total DDL at 1,472 (35.6%) in 20 dogs, followed by neurologic conditions at 950 (23%) in 4 dogs and heat injuries at 521 (12.6%) in 7 dogs. The total population 24-month mean WSP was 88.1% (95% CI, 86.6 to 89.5). The mean WSP for 43 dogs with acute events was 96.0% (95% CI, 95.0 to 97.0), and the mean WSP for 14 dogs with chronic events was 55.2% (95% CI, 47.8 to 62.5). Quantifying the impact of noncombat illness and injury on the working status of military working dogs is the first step to identify risk factors, develop preventive strategies, resource veterinary care requirements, and improve these canine athletes' health and welfare. The metrics developed in this study can be used to evaluate the population health of working, herding, and sport dogs.

A Study on the Effectiveness of Musculoskeletal Corticosteroid Injections for Reducing Patient Symptom Scores in Primary Care Practice.

To present data on the effectiveness of corticosteroid injections (CSI) in reducing symptom scores for musculoskeletal conditions in patients treated in an NHS primary care CSI service. The data will also examine whether adding local anaesthetic to the corticosteroid preparation affects the overall patient outcomes in symptom scores. A Patient-reported outcomes (PRO) questionnaire was used to collect data. Patients were asked to complete the questionnaire post-CSI. Patients were asked to rate their symptoms on a score of 0-6 before and after their injection. Data were calculated using standard deviation and paired t-test to assess the effectiveness of CSI in reducing symptom scores. Overall, 172 patients (79.6%) reported an improvement in symptomatology post CSI. Improvements were seen across all injection sites. Of those taking medication for their symptoms, 73 patients (55.7%) reported that they were able to reduce their medication. Data did not suggest that adding local anaesthetic to the injectate resulted in better patient outcomes. Post-injection symptom scores were statistically similar across all clinicians. 83.7% of patients experienced a reduction in symptom scores post injection. Adding lidocaine to the injectate preparation did not result in any statistically significant improvement in patient outcome. Over half of the participants were able to reduce their medication post injection, which demonstrates this is a highly effective primary care service for treatment/management of some MSK conditions.

Adjunctive Approach to Therapeutic Laser and Exercise Therapies in Alleviating Pain and Disability in Patients with Low Back Pain: A Systematic Review.

Low back pain (LBP), a globally prevalent musculoskeletal condition, affects mobility, mental well-being, and overall quality of life. It is generally caused by disc degeneration, muscular strain, ligamentous sprain, or a disease located at the lumbar spine. Owing to this disability, the social and occupational interactions of an individual might get affected. Modern medicine frequently combines exercise therapy with light amplification by stimulated emission of radiation (LASER) therapy, especially high intensity LASER therapy (HILT) or low level LASER therapy (LLLT), to increase the efficacy of the treatment modalities for LBP. This review aimed to determine the effect of the combined approach of LASER and exercise therapies in managing pain and reducing disability in patients with LBP. PubMed, Google Scholar, Cochrane Library, MEDLINE, and PEDro were searched for full-text research articles published from 2000 to 2023. Overall, 3,913 records were screened from these databases and six high methodological quality studies (PEDro ≥ 5) were included in this review after eligibility assessment. Review manager 5.4.1 was utilized to evaluate the overall quality of the review articles. In conclusion, HILT and LLLT serve as effective adjuncts to exercise therapy in treating LBP, contributing to pain reduction and disability alleviation.

Assessing and Comparing Musculoskeletal Knowledge and Red Flag Identification Skills: A Cross-Sectional Study of Physical Therapists and Primary Care Physicians

Background: Musculoskeletal disorders are one of the most common health issues often managed at the level of primary health care. Enabling physical therapists to be first-contact practitioner for patients with musculoskeletal disorders could improve patient access, expedite management, enhance outcomes and reduce costs. However, this role requires a high level of musculoskeletal knowledge and the ability to detect red flags. Objectives: To assess and compare the musculoskeletal knowledge and abilities to identify red flags between physical therapists and primary care physicians (PCPs). Methods: A cross-sectional study was undertaken using an electronic survey assessed participants’ musculoskeletal knowledge and ability to identify red flags. Study participants included physical therapist and PCPs practicing at Ministry of Health hospitals and/or primary care centers in Riyadh, Saudi Arabia. Results: A total of 60 physical therapists and 76 PCPs participated. Good knowledge levels (total score ≥ 75%) were found for 7% of physical therapists compared to 18% of PCPs, and moderate knowledge levels (total score 60-75%) were found in 70% of physical therapists compared to 62% of PCP participants (P=.003). Conclusion: Physical therapists and PCPs demonstrated an overall moderate level of musculoskeletal knowledge and the ability to identify red flags. The results suggest that with further education on red flags identification, physical therapists in Saudi Arabia could potentially act as first-contact practitioners for patients with musculoskeletal conditions.

Enhancing comprehensive primary care by integrating chiropractic led musculoskeletal care into interprofessional teams through supporting education, competency attainment, and optimizing integration.

Musculoskeletal (MSK) conditions are the leading cause of disability, resulting in up to 40% of visits to family physicians. Current primary care workforce shortages in Canada require other providers to maximize scopes of practice. Few MSK providers have been trained in team-based primary care settings. Study objectives included: (1) educating participating primary care teams through synchronous education, (2) educating Canadian primary care providers through asynchronous education, and (3) integrating chiropractors into primary care teams, whilst evaluating team MSK care knowledge/attitudes and integration experience. Results indicated improvements in collaborative competency, improved understanding and attitudes to chiropractic, and the importance of providing MSK care within funded primary care. Teams employed unique approaches to integrating chiropractors and indicated high demand for their services by patients and providers. Provision of MSK care without economic barrier is desirable and highly valued by teams. Chiropractors are well suited to participate in funded primary care teams in Canada.

A Randomized Study of Myostaal® Liniment as an Add-On Therapy for Muscle Strengthening in Cases of Knee Osteoarthritis.

Knee osteoarthritis (OA) is a prevalent degenerative musculoskeletal condition, affecting approximately 277 million people worldwide, with significant impacts on mobility, especially in women and obese patients, and an increasing incidence among Indians aged 30 to 50 years. The primary objective was to evaluate the knee muscle-strengthening effect of Myostaal® liniment (Solumiks Herbaceuticals Limited, Mumbai, India) as an add-on to physiotherapy for 90 days compared to physiotherapy alone in participants with knee OA. Secondary objectives included assessing changes in the total Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)score, WOMAC Subscale scores, Six-Minute Walk Test(6MWT) distance, Single Leg Stance Test (SLST) duration, Visual Analogue Scale (VAS) score, and the number of adverse events from baseline to Day 90 between the two groups. Seventy participants were randomly allocated to Group A (Myostaal® liniment plus physiotherapy) or Group B (physiotherapy alone) for 90 days, with Myostaal® liniment applied twice daily in Group A. Data were recorded in Case Report Forms (CRFs) and analyzed using parametric tests for within-group comparisons (one-way ANOVA or Friedman test) and non-parametric tests (Mann-Whitney test) for between-group comparisons, with significance set at p<0.05. The knee muscle strength (index knee) in Group A (test medication group) was significantly greater compared to Group B (standard treatment group) at Visit 3 (p<0.05; Day 60±3) and Visit 4 (p<0.001; Day 90±3). For the non-index (other) knee, a statistically significant increase in knee muscle strength was observed (p<0.001 at Day 90±3) solely in Group A. A notable reduction in total WOMAC score was seen in Group A from Visit 2 (p<0.01; Day 30±3) onward, compared to Visit 1 (Day 0). The scores at Visit 3 (p<0.001; Day 60±3) and Visit 4 (p<0.001; Day 90±3) were significantly lower than those at Visit 2 (Day 30±3). The local application of Myostaal® liniment through massage as an adjunct to a physiotherapy regimen, improved knee muscle strength in participants with knee OA, leading to an enhancement in joint functionality. Additionally, Myostaal® linimentprovided superior pain relief as an add-on therapy.

Barriers and Facilitators to the Implementation of Digital Health Services for People With Musculoskeletal Conditions in the Primary Health Care Setting: Systematic Review.

In recent years, the effectiveness and cost-effectiveness of digital health services for people with musculoskeletal conditions have increasingly been studied and show potential. Despite the potential of digital health services, their use in primary care is lagging. A thorough implementation is needed, including the development of implementation strategies that potentially improve the use of digital health services in primary care. The first step in designing implementation strategies that fit the local context is to gain insight into determinants that influence implementation for patients and health care professionals. Until now, no systematic overview has existed of barriers and facilitators influencing the implementation of digital health services for people with musculoskeletal conditions in the primary health care setting. This systematic literature review aims to identify barriers and facilitators to the implementation of digital health services for people with musculoskeletal conditions in the primary health care setting. PubMed, Embase, and CINAHL were searched for eligible qualitative and mixed methods studies up to March 2024. Methodological quality of the qualitative component of the included studies was assessed with the Mixed Methods Appraisal Tool. A framework synthesis of barriers and facilitators to implementation was conducted using the Consolidated Framework for Implementation Research (CFIR). All identified CFIR constructs were given a reliability rating (high, medium, or low) to assess the consistency of reporting across each construct. Overall, 35 studies were included in the qualitative synthesis. Methodological quality was high in 34 studies and medium in 1 study. Barriers (-) of and facilitators (+) to implementation were identified in all 5 CFIR domains: "digital health characteristics" (ie, commercial neutral [+], privacy and safety [-], specificity [+], and good usability [+]), "outer setting" (ie, acceptance by stakeholders [+], lack of health care guidelines [-], and external financial incentives [-]), "inner setting" (ie, change of treatment routines [+ and -], information incongruence (-), and support from colleagues [+]), "characteristics of the healthcare professionals" (ie, health care professionals' acceptance [+ and -] and job satisfaction [+ and -]), and the "implementation process" (involvement [+] and justification and delegation [-]). All identified constructs and subconstructs of the CFIR had a high reliability rating. Some identified determinants that influence implementation may be facilitators in certain cases, whereas in others, they may be barriers. Barriers and facilitators were identified across all 5 CFIR domains, suggesting that the implementation process can be complex and requires implementation strategies across all CFIR domains. Stakeholders, including digital health intervention developers, health care professionals, health care organizations, health policy makers, health care funders, and researchers, can consider the identified barriers and facilitators to design tailored implementation strategies after prioritization has been carried out in their local context.