Neuromuscular Exercise Research Articles

Neuromuscular exercise and back counselling for female nursing personnel with recurrent non-specific low back pain: study protocol of a randomised controlled trial (NURSE-RCT)

IntroductionNursing personnel have high risk for incidence of low back pain (LBP) followed by development of chronic pain and disability. Multiple risk factors such as patient handling, night shift work...

Iniciación al entrenamiento de fuerza en edades tempranas: revisión

Strength training in prepubertal and pubertal age is widely recommended by scientific organizations responsible for overseeing the healthy training of these populations. In this context, this paper aims to develop a critical review of the strength training at early age. To this end, papers published in English were reviewed from 1995 to 2014 in ISI-indexed journals, considering those chronologically most recent first.Among the main evidence we can point out that the benefits far outweigh the risks that could lead to this type of training, provided it is carefully supervised by qualified technician and the design of the entire program adapted to features of the subjects, individual needs and goals. Also, the training program shall provide for the particular dose of neuromuscular exercise of each of its components and how to progress substantially the same over time.

The impact of hip strengthening and/or neuromuscular control on frontal plane knee kinematics and kinetics in females: a systematic review

Background: Physical therapists commonly treat individuals with anterior knee pain (AKP) and anterior cruciate ligament (ACL) injuries. Despite the suggestion for including hip strengthening or neuromuscular control exercises in preventative programs to change knee mechanics and reduce AKP and ACL injuries and in the treatment of AKP, no previous systematic review has addressed the impact of these exercises on frontal plane knee mechanics.Objective: The purpose of this systematic review was to determine the level of evidence associated with hip strengthening or neuromuscular control exercises as an intervention to improve frontal plane knee mechanics during dynamic activity in females.Methods: Databases searched included PubMed, CINAHL Plus with full text, and SportDiscus with full text; specific search terms were used. All studies were to include females without any current knee pain or injury. Studies had to investigate the impact of a hip strengthening or a hip neuromuscular control program or a combination of strengthening and neuromuscular control. The primary outcome measure of interest was frontal plane knee mechanics.Results: A total of 414 articles were identified. Eight additional articles were identified using other sources. Fourteen studies were ultimately included in the qualitative analysis. There was support for neuromuscular control exercises as well as neuromuscular control plus strengthening exercises to improve frontal plane knee mechanics during dynamic activity in females. Strengthening alone was not supported.Conclusion: Clinically, one should consider either a neuromuscular control program or a combined neuromuscular control plus strength training program for females to improve frontal plane knee mechanics during dynamic activity. This may be particularly relevant in prevention of ACL injuries and AKP.

Effects of proprioceptive neuromuscular facilitation neck pattern exercise on the ability to control the trunk and maintain balance in chronic stroke patients.

[Purpose] The aim of this study was to investigate the effects of proprioceptive neuromuscular facilitation neck pattern exercise on the ability to control the trunk and balance in chronic stroke patients. [Subjects and Methods] A total of 30 study subjects were selected and randomly divided into an experimental group of 15 subjects, who received the proprioceptive neuromuscular facilitation neck pattern exercise, and a control group of 15 subjects, who received a traditional rehabilitation treatment. [Results] Statistically significant changes in all the items of the Trunk Impairment Scale, the Trunk Impairment Scale total score, and the Berg Balance Scale were observed in both the experimental group and the control group. significant between-group differences were found in all items among the subitems of the Trunk Impairment Scale except the static sitting balance. [Conclusion] Proprioceptive neuromuscular facilitation neck pattern exercise was shown to have a positive effect on increasing the ability to control the trunk and maintain balance in chronic stroke patients.

Comparison between Task - Oriented Training and Proprioceptive Neuromuscular Facilitation Exercises on Lower Extremity Function in Cerebral Palsy-A Randomized Clinical Trial

Background and objective: The large majorities of children with Cerebral Palsy (CP) have difficulty in walking; demonstrate poor balance control, that leads to poor gait and reaching movement as the maintenance of stability is critical to all movements. There are various approaches and strategies to improve gait, balance and lower extremity function, Task-Oriented Training and Proprioceptive Neuromuscular Facilitation exercises are one of them. Therefore, this study aims to compare the effect of Task-Oriented Training and Proprioceptive Neuromuscular Facilitation exercises on lower extremity function in children with cerebral palsy. Material and method: Thirty patients who fulfilled the inclusion criteria were randomly allocated into two groups. Group A -Task- Oriented Training, Group B- Proprioceptive- Neuromuscular Facilitation. Exercises with 15 patients in each group. All the patients were evaluated with Pediatric Balance Scale, and Gait parameters- Gait Velocity, Stride length and Cadence at pre and post treatment level. Results: When comparison of pre and post intervention values of Pediatric Balance Scale and Gait parameters was done, significant difference was found (P<0.001) in both groups. When comparison was done at post intervention level for Pediatric Balance Scale and Gait parameters, significant result was found (P<0.001) for Stride Length and cadence and non-significant results for Pediatric Balance Scale and Gait velocity. Conclusion: From finding of this study it was concluded that both Task-Oriented Approach and Proprioceptive Neuromuscular Facilitation Exercises are beneficial in improving lower extremity function in children with cerebral palsy.

Improvement in symptom severity, cognitive assessment, processing speed, reaction time and visual acuity in a professional hockey player with a prior concussion

Event Abstract Back to Event Improvement in symptom severity, cognitive assessment, processing speed, reaction time and visual acuity in a professional hockey player with a prior concussion Matthew M. Antonucci1, 2, 3*, Paul E. Link2, 3, Frederick R. Carrick1, 4 and Derek A. Barton2, 3 1 Carrick Institute, Clinical Neuroscience, United States 2 Plasticity Brain Centers, Neurorehabilitation, United States 3 NeuroSynergy Associates, PA, Neurorehabilitation, United States 4 Harvard Medical School and Harvard-Macy MGH Institute of Health Professions, USA, Medical Education, United States Background: A 23-year-old, male, right hand dominant/left-hand stick holding, hockey player with a history of concussion presents with occasional lightheadedness, fogginess, and a constant feeling of being in a “daze”. His Graded Symptom Checklist (GSC) severity was 48/162. His Standard Assessment of Concussion (SAC) was 26/30, Trails A (TA) 13.6 seconds, Trails B (TB) was 31.2, Trails AB difference (TA-B) was 17.6. His Simple Reaction Time (sRT) was 300 milliseconds, Processing Speed (PS) was 83 symbols matched correctly in 2 minutes, Choice Reaction Time (cRT) latency was 387 milliseconds and his Visual Acuity line difference (VA) was 1.2 on intake. Methods: A five-day, multimodal program of receptor based neurological rehabilitation was administered three times per day, one hour per session. Each session consisted of electrical non-invasive nerve stimulation, neuromuscular reeducation exercises, vision therapy exercises, vestibular rehabilitation exercises, hand-eye coordination exercises, and off-vertical axis rotations. Results: Following conclusion of five days of treatment there were significant improvements in GSC (-95.9%), SAC (+10.4%), TA (-22.1%), TB (34.6%), TB-A (-31.4%), PS (+8.8%), sRT latency (-21.33%), cRT latency (-13.2%), and VA (-83.33%). Conclusion: Short duration, multimodal, intensive programs of receptor based neurological rehabilitation may be a viable method to improve neurological integrity and performance in individuals with Post-Concussive Syndrome. The authors suggest further investigation into short duration, multi-modal, intensive approaches to restoring neurological function in individuals suffering from mild traumatic brain injury (mTBI) Keywords: concussion rehabilitation, standard assessment of concussion, Trail Making Test (TMT), Reaction Time, MTBI Conference: International Symposium on Clinical Neuroscience: Clinical Neuroscience for Optimization of Human Function, Orlando, United States, 7 Oct - 9 Oct, 2016. Presentation Type: Poster Presentation Topic: Abstracts ISCN 2016 Citation: Antonucci MM, Link PE, Carrick FR and Barton DA (2016). Improvement in symptom severity, cognitive assessment, processing speed, reaction time and visual acuity in a professional hockey player with a prior concussion. Front. Neurol. Conference Abstract: International Symposium on Clinical Neuroscience: Clinical Neuroscience for Optimization of Human Function. doi: 10.3389/conf.fneur.2016.59.00058 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 02 Sep 2016; Published Online: 07 Sep 2016. * Correspondence: Dr. Matthew M Antonucci, Carrick Institute, Clinical Neuroscience, Cape Canaveral, United States, drnucci@gmail.com Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Matthew M Antonucci Paul E Link Frederick R Carrick Derek A Barton Google Matthew M Antonucci Paul E Link Frederick R Carrick Derek A Barton Google Scholar Matthew M Antonucci Paul E Link Frederick R Carrick Derek A Barton PubMed Matthew M Antonucci Paul E Link Frederick R Carrick Derek A Barton Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Improvement in symptom severity, cognitive assessment, and choice reaction time in a college professor with post-concussive syndrome.

Event Abstract Back to Event Improvement in symptom severity, cognitive assessment, and choice reaction time in a college professor with post-concussive syndrome. Matthew M. Antonucci1, 2, 3*, Paul E. Link2, 3, Derek A. Barton2, 3 and Frederick R. Carrick1, 4 1 Carrick Institute, Clinical Neuroscience, United States 2 Plasticity Brain Centers, Neurorehabilitation, United States 3 NeuroSynergy Associates, PA, Neurorehabilitation, United States 4 Harvard Medical School and Harvard-Macy MGH Institute of Health Professions, Medical Education, United States Background: A 42-year-old, college professor, with a history of concussion following a motor vehicle accident, presented with symptoms of headache, neck pain, balance problems, fatigue, low energy and trouble driving. Graded Symptom Checklist (GSC) severity was 33/162. Trails A (TA) and Trails B (TB) had scores of 27.0 seconds and 32.9 seconds respectively. Choice Reaction Time (cRT) latency was 424 milliseconds. Methods: A five-day, multimodal program of receptor based neurological rehabilitation was administered three times per day, one hour per session. Each session consisted of electrical somatosensory stimulation, vestibular rehabilitation exercises, neuromuscular reeducation exercises, hand-eye coordination exercises, vision therapy exercises and off-vertical axis rotations. Results: Following conclusion of five days of treatment there were improvements in GSC (-75%), decreased TA (-37%) and TB (-10%), and cRT latency (-15.8%). Conclusion: Short duration, multimodal, intensive programs of receptor based neurological rehabilitation may be a viable method to improve neurological integrity and performance in individuals with Post-Concussive Syndrome. The authors suggest further investigation into short duration, multi-modal, intensive approaches to restoring neurological function in individuals suffering from mild traumatic brain injury (mTBI) Keywords: concussion rehabilitation, Off-vertical axis rotation, cognitive processing, Trail Making Test (TMT), MTBI, Vestibular Rehabilitation Conference: International Symposium on Clinical Neuroscience: Clinical Neuroscience for Optimization of Human Function, Orlando, United States, 7 Oct - 9 Oct, 2016. Presentation Type: Poster Presentation Topic: Abstracts ISCN 2016 Citation: Antonucci MM, Link PE, Barton DA and Carrick FR (2016). Improvement in symptom severity, cognitive assessment, and choice reaction time in a college professor with post-concussive syndrome.. Front. Neurol. Conference Abstract: International Symposium on Clinical Neuroscience: Clinical Neuroscience for Optimization of Human Function. doi: 10.3389/conf.fneur.2016.59.00095 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 02 Sep 2016; Published Online: 07 Sep 2016. * Correspondence: Dr. Matthew M Antonucci, Carrick Institute, Clinical Neuroscience, Cape Canaveral, United States, drnucci@gmail.com Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Matthew M Antonucci Paul E Link Derek A Barton Frederick R Carrick Google Matthew M Antonucci Paul E Link Derek A Barton Frederick R Carrick Google Scholar Matthew M Antonucci Paul E Link Derek A Barton Frederick R Carrick PubMed Matthew M Antonucci Paul E Link Derek A Barton Frederick R Carrick Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Hamstring Injuries in the Athlete: Diagnosis, Treatment, and Return to Play.

Hamstring injuries are very common in athletes. Acute hamstring strains can occur with high-speed running or with excessive hamstring lengthening. Athletes with proximal hamstring tendinopathy often do not report a specific inciting event; instead, they develop the pathology from chronic overuse. A thorough history and physical examination is important to determine the appropriate diagnosis and rule out other causes of posterior thigh pain. Conservative management of hamstring strains involves a rehabilitation protocol that gradually increases intensity and range of motion, and progresses to sport-specific and neuromuscular control exercises. Eccentric strengthening exercises are used for management of proximal hamstring tendinopathy. Studies investigating corticosteroid and platelet-rich plasma injections have mixed results. Magnetic resonance imaging and ultrasound are effective for identification of hamstring strains and tendinopathy but have not demonstrated correlation with return to play. The article focuses on diagnosis, treatment, and return-to-play considerations for acute hamstring strains and proximal hamstring tendinopathy in the athlete.

A Qualitative Examination of a New Combined Cognitive-Behavioral and Neuromuscular Training Intervention for Juvenile Fibromyalgia.

Adolescents with juvenile fibromyalgia (JFM) are typically sedentary despite recommendations for physical exercise, a key component of pain management. Interventions such as cognitive-behavior therapy (CBT) are beneficial but do not improve exercise participation. The objective of this study was to obtain preliminary information about the feasibility, safety, and acceptability of a new intervention--Fibromyalgia Integrative Training for Teens (FIT Teens), which combines CBT with specialized neuromuscular exercise training modified from evidence-based injury prevention protocols. Participants were 17 adolescent females (aged 12 to 18 y) with JFM. Of these, 11 completed the 8-week (16 sessions) FIT Teens program in a small-group format with 3 to 4 patients per group. Patients provided detailed qualitative feedback via individual semistructured interviews after treatment. Interview content was coded using thematic analysis. Interventionist feedback about treatment implementation was also obtained. The intervention was found to be feasible, well tolerated, and safe for JFM patients. Barriers to enrollment (50% of those approached) included difficulties with transportation or time conflicts. Treatment completers enjoyed the group format and reported increased self-efficacy, strength, and motivation to exercise. Participants also reported decreased pain and increased energy levels. Feedback from participants and interventionists was incorporated into a final treatment manual to be used in a future trial. Results of this study provided initial support for the new FIT Teens program. An integrative strategy of combining pain coping skills via CBT enhanced with tailored exercise specifically designed to improve confidence in movement and improving activity participation holds promise in the management of JFM.

The effects of a strength and neuromuscular exercise programme for the lower extremity on knee load, pain and function in obese children and adolescents: study protocol for a randomised controlled trial.

BackgroundChildhood obesity is one of the most critical and accelerating health challenges throughout the world. It is a major risk factor for developing varus/valgus misalignments of the knee joint. The combination of misalignment at the knee and excess body mass may result in increased joint stresses and damage to articular cartilage. A training programme, which aims at developing a more neutral alignment of the trunk and lower limbs during movement tasks may be able to reduce knee loading during locomotion. Despite the large number of guidelines for muscle strength training and neuromuscular exercises that exist, most are not specifically designed to target the obese children and adolescent demographic. Therefore, the aim of this study is to evaluate a training programme which combines strength and neuromuscular exercises specifically designed to the needs and limitations of obese children and adolescents and analyse the effects of the training programme from a biomechanical and clinical point of view.Methods/DesignA single assessor-blinded, pre-test and post-test randomised controlled trial, with one control and one intervention group will be conducted with 48 boys and girls aged between 10 and 18 years. Intervention group participants will receive a 12-week neuromuscular and quadriceps/hip strength training programme. Three-dimensional (3D) gait analyses during level walking and stair climbing will be performed at baseline and follow-up sessions. The primary outcome parameters for this study will be the overall peak external frontal knee moment and impulse during walking. Secondary outcomes include the subscales of the Knee injury and Osteoarthritis Outcome Score (KOOS), frontal and sagittal kinematics and kinetics for the lower extremities during walking and stair climbing, ratings of change in knee-related well-being, pain and function and adherence to the training programme. In addition, the training programme will be evaulated from a clinical and health status perspective by including the following analyses: cardiopulmonary testing to quantify aerobic fitness effects, anthropometric measures, nutritional status and psychological status to characterise the study sample.DiscussionThe findings will help to determine whether a neuromuscular and strength training exercise programme for the obese children population can reduce joint loading during locomotion, and thereby decrease the possible risk of developing degenerative joint diseases later in adulthood.Trial registrationClinicalTrials NCT02545764, Date of registration: 24 September 2015.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-015-1091-5) contains supplementary material, which is available to authorized users.

Pain trajectory and exercise-induced pain flares during 8 weeks of neuromuscular exercise in individuals with knee and hip pain

Patients considering or engaged in exercise as treatment may expect or experience transient increases in joint pain, causing fear of exercise and influencing compliance. This study investigated the pain trajectory during an 8-week neuromuscular exercise (NEMEX) program together with acute exercise-induced pain flares in persons with knee or hip pain. Individuals above 35 years self-reporting persistent knee or hip pain for the past 3 months were offered 8 weeks of supervised NEMEX, performed in groups twice weekly. The program consisted of 11 exercises focusing on joint stability and neuromuscular control. Participants self-reported joint pain on a 0-10 numerical rating scale (NRS) at baseline and 8-weeks follow-up. NRS pain ratings were also collected before and immediately after every attended exercise session. Joint pain was reduced from baseline (NRS 3.6; 95% CI 3.2-4.1) to 8-weeks follow-up (2.6; 95% CI 2.1-3.1), (P<0.01). Pain decreased 0.04 NRS (95% CI 0.02-0.05, P<0.01) on average per exercise session and pre- to post-exercise pain decreased 0.04 NRS (95% CI 0.03-0.05, P<0.01) on average per session, approaching no acute exercise-induced pain in the last weeks. This study found a clear decrease in size of acute exercise-induced pain flares with increasing number of exercise sessions. In parallel, pain ratings decreased over the 8 weeks exercise period. Our findings provide helpful information for clinicians, which can be used to educate and balance patient expectation when starting supervised neuromuscular exercise.

Preoperative Phase in the Rehabilitation of the Patient Undergoing Anterior Cruciate Ligament Reconstruction

Rehabilitation associated with anterior cruciate ligament injury continues to evolve, with the current emphasis on immediate weight bearing and range of motion, coupled with progressive muscular strengthening, proprioception, dynamic stability, and neuromuscular control exercises. The preoperative phase of the rehabilitation program is critical to ensure proper preparation of the patient for surgery, facilitating a successful postoperative outcome. The primary goal is to return the patient’s knee as close as possible to homeostasis by reducing swelling and pain, restoring range of motion, and re-establishing quadriceps control following injury and before surgery The purpose of this article is to provide the reader with a thorough scientifically based preoperative rehabilitation program that can be successfully implemented in any patient before undergoing anterior cruciate ligament reconstruction.

TO STUDY THE EFFECT OF PROPRIOCEPTIVE NEUROMUSCULAR FACILITATION ON BACK MUSCLE STRENGTH, PAIN AND QUALITY OF LIFE IN SUBJECTS WITH CHRONIC LOW BACK PAIN – AN EXPERIMENTAL STUDY

Background:&nbsp;Back pain is a prevalent and expensive problem in society. 60-80% of people will suffer at least one episode of low back pain sometime in their lives and 30-40% of these will experience low back pain each year. Therefore the need of the following study is to see the effect of proprioceptive neuromuscular facilitation on back muscle strength, pain and QOL in subjects with Chronic Low Back Pain.Methods: Ethical approval was taken before study. Forty patients with chronic low back pain (28 male, 12 female) were included in the study and divided into two groups each containing 20 subjects. All the participants were signed written consent after being informed in detail about the study. Group A has been given the proprioceptive neuromuscular facilitation exercises including Rhythmic Stabilization (RST) and Combination of Isotonics (COI) and Conventional back exercises. Group B was given conventional back exercises only. Outcome measures were taken at the end of one month i.e. after the treatment protocol. VAS, SF-36Questionnaire and Core stability gradation were taken in both groups.Results:&nbsp;There is significant improvement in VAS score in both groups but Group A was having more significant improvement than Group B. Also there is significant improvement in core stability grading and SF 36 score in Group A.Conclusion:&nbsp;It is concluded that proprioceptive neuromuscular facilitation exercises on back is effective in reducing pain and improving core muscle strength in subjects with Chronic Low Back Pain.

Preventing Australian football injuries with a targeted neuromuscular control exercise programme: comparative injury rates from a training intervention delivered in a clustered randomised controlled trial

BackgroundExercise-based training programmes are commonly used to prevent sports injuries but programme effectiveness within community men's team sport is largely unknown.ObjectiveTo present the intention-to-treat analysis of injury outcomes from a...

The efficacy of non-surgical treatment on pain and sensitization in patients with knee osteoarthritis: a pre-defined ancillary analysis from a randomized controlled trial

To report the efficacy of a 3-month treatment program consisting of neuromuscular exercise, education, diet, insoles and pain medication (MEDIC-treatment) compared to usual care (two leaflets with information and treatment advice) in reducing pain-related measures and sensitization in patients with knee osteoarthritis (OA) not eligible for total knee replacement (TKR). A pre-defined ancillary analysis of the results at 3 months of a randomized controlled trial (RCT) of 100 patients randomized to MEDIC-treatment or usual care. ClinicalTrials.gov (NCT01535001). Outcomes were sensitization assessed at the knee, the lower leg and forearm using a handheld algometer, peak pain intensity in the previous 24 h, pain intensity after 30 min of walking, pain location and pattern, spreading of pain (a region-divided body chart) and the usage of pain medication. The MEDIC group had larger improvements from baseline to 3 months in peak pain intensity (P = 0.02) and pain after 30 min of walking (P < 0.001) and in the number of body sites with pain (P = 0.04). There was no difference in the change in sensitization from baseline to 3 months between groups (P = 0.87), but sensitization decreased in both groups (P < 0.001). A non-surgical treatment program is more efficacious in reducing pain-related measures than usual care, while both are equally efficacious in reducing sensitization, indicating that mechanisms other than pain sensitization contribute to the perceived pain. The patients did not have severe symptomatic knee OA and hence pain sensitization may not yet have developed into a clinically relevant parameter or subgroups with less sensitization may exist.

An evidence-based review of hip-focused neuromuscular exercise interventions to address dynamic lower extremity valgus.

Deficits in proximal hip strength or neuromuscular control may lead to dynamic lower extremity valgus. Measures of dynamic lower extremity valgus have been previously shown to relate to increased risk of several knee pathologies, specifically anterior cruciate ligament ruptures and patellofemoral pain. Therefore, hip-focused interventions have gained considerable attention and been successful in addressing these knee pathologies. The purpose of the review was to identify and discuss hip-focused exercise interventions that aim to address dynamic lower extremity valgus. Previous electromyography, kinematics, and kinetics research support the use of targeted hip exercises with non-weight-bearing, controlled weight-bearing, functional exercise, and, to a lesser extent, dynamic exercises in reducing dynamic lower extremity valgus. Further studies should be developed to identify and understand the mechanistic relationship between optimized biomechanics during sports and hip-focused neuromuscular exercise interventions.

Neuromuscular Exercise post Partial Medial Meniscectomy: Randomized Controlled Trial.

This study aimed to evaluate the effects of a 12-wk, home-based, physiotherapist-guided neuromuscular exercise program on the knee adduction moment (an indicator of mediolateral knee load distribution) in people with a medial arthroscopic partial meniscectomy (APM) within the past 3-12 months. An assessor-blinded, randomized controlled trial including people age 30-50 yr with no to mild pain after medial APM was conducted. Participants were randomly allocated to either a 12-wk neuromuscular exercise program that targeted neutral lower limb alignment or a control group with no exercise. The exercise program included eight individual sessions with one of seven physiotherapists in private clinics, together with home exercises. Primary outcomes were the peak external knee adduction moment during normal-paced walking and during one-leg sit-to-stand. Secondary outcomes included additional measures of knee joint load distribution, patient-reported outcomes, maximal knee and hip muscle strength, and physical function measures. Of 62 randomized participants, 60 (97%) completed the trial. There were no significant between-group differences in the change in peak knee adduction moment during normal-paced walking (mean difference (95% confidence interval), 0.22 (-0.11 to 0.55) N·m/body weight × height %, P =0.19) or during one-leg sit-to-stand (-0.01 (-0.33 to 0.31) N·m/body weight × height %, P = 0.95). There were also no significant between-group differences for any of the secondary outcomes. In patients 3-12 months after a medial APM, a neuromuscular exercise program did not alter the peak knee adduction moment, a key predictor of osteoarthritis structural disease progression. (Australia and New Zealand Clinical Trials Registry, #ACTRN12612000542897.).

Effect of exercise therapy compared with arthroscopic surgery on knee muscle strength and functional performance in middle-aged patients with degenerative meniscus tears: a 3-mo follow-up of a randomized controlled trial.

The aim of this study was to compare the effect of a 12-wk exercise therapy program and arthroscopic partial meniscectomy on knee strength and functional performance in middle-aged patients with degenerative meniscus tears. A total of 82 patients (mean age, 49 yrs; 35% women) with a symptomatic, unilateral, magnetic resonance imaging-verified degenerative meniscus tear and no or mild radiographic osteoarthritis were randomly assigned to a supervised neuromuscular and strength exercise program or arthroscopic partial meniscectomy. Outcomes assessed 3 mos after intervention initiation were isokinetic knee muscle strength, lower extremity performance, and self-reported global rating of change. Mean difference in isokinetic knee extension peak torque between the two groups was 16% (95% confidence interval, 7.1-24.0) (P < 0.0001), favoring the exercise group. Patients in the exercise group improved isokinetic knee extension peak by a mean of 25 Nm (range, 18-33 Nm) from baseline to follow-up. Furthermore, patients assigned to exercise therapy showed statistically significant improvements (P ≤ 0.002) in all other measured variables, with moderate to large effect sizes (0.5-1.3). Patients reported a similar and positive effect of both interventions. A 12-wk supervised exercise therapy program yielded clinically relevant and statistically significant improvement in isokinetic quadriceps strength immediately after completion of the program, as compared with treatment with arthroscopic partial meniscectomy.

Efeitos dos exercícios funcionais e neuromusculares no tempo de internação e controle pressórico de pacientes hospitalizados

Introdução: Exercícios funcionais e neuromusculares são importantes ferramentas em centros de reabilitação, porém são pouco explorados em protocolos hospitalares. Objetivo: Verificar se exercícios funcionais e neuromusculares são mais eficazes na redução do tempo de internamento e controle da pressão arterial (PA) dos indivíduos hospitalizados do que a fisioterapia hospitalar de rotina. Métodos: Foram incluídos pacientes hospitalizados por enfermidades não cardiológicas e sem hipertensão arterial sistêmica, sendo estes randomizados para grupo controle (GC), que realizou exercícios respiratórios, exercícios ativo-livres para membros superiores/inferiores e caminhada no corredor, ou grupo de reabilitação funcional (GRF), submetido a exercícios neuromusculares para membros superiores/inferiores, cicloergômetro e treino de subir/descer degraus. Ambos os grupos receberam intervenção 2x/dia. A PA foi aferida na admissão, durante o internamento e na alta hospitalar. O tratamento estatístico foi realizado adotando-se intervalo de confiança de 95% e nível de significância de 5%. Resultados: Avaliados 42 voluntários, dos quais 26 atenderam aos critérios de elegibilidade. Porém, seis foram excluídos, quatro por permanência hospitalar inferior a três dias e dois por não completarem o protocolo de tratamento. A média de idade no GC foi de 72±11 versus 73±8 no GRF. Não houve diferenças estatísticas da PA na admissão. Evidenciou-se redução da PA apenas no GRF durante o internamento (p&lt;0,01), assim como na alta hospitalar (p&lt;0,01). O GC apresentou maior tempo (dias) de internação 7,2±1,8 versus 5,5±1,3 do GRF (p&lt;0,05). Conclusão: Exercícios funcionais e neuromusculares parecem mais eficazes na redução do tempo de internamento e controle da PA dos indivíduos hospitalizados do que a fisioterapia hospitalar de rotina.

The efficacy of 12 weeks non-surgical treatment for patients not eligible for total knee replacement: a randomized controlled trial with 1-year follow-up

To compare the efficacy of a 12-week non-surgical treatment program with usual care in patients with knee osteoarthritis (OA) not eligible for total knee replacement (TKR). This two-arm parallel group assessor-blinded randomized controlled trial (RCT) included 100 adults from secondary care with knee OA, confirmed by radiography (Kellgren-Lawrence grade ≥1), but not eligible for a TKR. The 12-week non-surgical treatment program consisted of individualized progressed neuromuscular exercise, patient education, insoles, dietary advice and prescription of pain medication if indicated, while usual care comprised two leaflets with information and advice on knee OA and recommended treatments. The primary outcome was the change from baseline to 12 months in the Knee injury and Osteoarthritis Outcome Score (KOOS)4 defined as the average score for the KOOS subscales of pain, symptoms, activities of daily living (ADL), and quality of life (QOL). 91% of the patients completed the 12 months follow-up on the primary outcome. Compared with usual care, patients undergoing the treatment program improved more in KOOS4 (adjusted mean difference (95% CI) of 9.6 (4.4-14.8)) with no serious treatment-related adverse events (AE). The number needed to treat (NNT), defined as the number of patients needed to treat for one person to improve 15% was 7.2. Secondary outcomes supported the primary findings. In patients with mostly moderate to severe knee OA not eligible for TKR, a 12-week individualized, non-surgical treatment program is more efficacious at 12 months compared with usual care and has few treatment-related AE. ClinicalTrials.gov (NCT01535001).