Significant Increase In Range Of Motion Research Articles

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

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

Effects of combined taping of quadriceps and hamstring muscles on pain and disability in patients with knee osteoarthritis: Randomized assessor-blinded controlled study

BackgroundThe ability of patients suffering from knee osteoarthritis to carry on routine daily activities is a significantly valuable target. ObjectivesThis study aimed to assess the effect of quadriceps and hamstring taping using kinesio tape on knee pain, function and range of motion (ROM) in patients suffering from knee osteoarthritis. MethodsTwenty-four patients, ages ranging between 50 and 70 years, diagnosed with chronic knee osteoarthritis were randomly allocated into two equal groups. Group (A) received kinesio tape on quadriceps and hamstring muscles in addition to conventional exercises while, group (B) received solely conventional exercises. Pain, knee flexion ROM and function were assessed using the visual analogue scale (VAS), the universal goniometer and Western Ontario and McMaster Universities Osteoarthritis Scale (WOMAC) respectively. Both groups were assessed before and after four weeks of treatment. ResultsMixed Design Multivariate Analysis of Variance (MANOVA) revealed non-significant differences between groups in pain, ROM and WOMAC (P > 0.05) post-treatment. Additionally, pairwise tests revealed significant reduction of VAS and WOMAC with significant increase in ROM (P < 0.05) for group (A) post-treatment. While group (B) showed significant reduction of VAS and WOMAC (P < 0.05) with non-significant change in ROM (P = 0.109) post-treatment. ConclusionQuadriceps and hamstring taping in addition to conventional exercises has no more effect than conventional exercises alone for decreasing pain and disability and increasing ROM in patients suffering from chronic knee osteoarthritis.

Are Acute Effects of Foam-Rolling Attributed to Dynamic Warm Up Effects? A Comparative Study.

Over the last decade, acute increases in range of motion (ROM) in response to foam rolling (FR) have been frequently reported. Compared to stretching, FR-induced ROM increases were not typically accompanied by a performance (e.g., force, power, endurance) deficit. Consequently, the inclusion of FR in warm-up routines was frequently recommended, especially since literature pointed out non-local ROM increases after FR. However, to attribute ROM increases to FR it must be ensured that such adaptations do not occur as a result of simple warm-up effects, as significant increases in ROM can also be assumed as a result of active warm-up routines. To answer this research question, 20 participants were recruited using a cross-over design. They performed 4x45 seconds hamstrings rolling under two conditions; FR, and sham rolling (SR) using a roller board to imitate the foam rolling movement without the pressure of the foam rolling. They were also tested in a control condition. Effects on ROM were tested under passive, active dynamic as well as ballistic conditions. Moreover, to examine non-local effects the knee to wall test (KtW) was used. Results showed that both interventions provided significant, moderate to large magnitude increases in passive hamstrings ROM and KtW respectively, compared to the control condition (p = 0.007-0.041, d = 0.62-0.77 and p = 0.002-0.006, d = 0.79-0.88, respectively). However, the ROM increases were not significantly different between the FR and the SR condition (p = 0.801, d = 0.156 and p = 0.933, d = 0.09, respectively). No significant changes could be obtained under the active dynamic (p = 0.65) while there was a significant decrease in the ballistic testing condition with a time effect (p < 0.001). Thus, it can be assumed that potential acute increases in ROM cannot be exclusively attributed to FR. It is therefore speculated that warm up effects could be responsible independent of FR or imitating the rolling movement, which indicates there is no additive effect of FR or SR to the dynamic or ballistic range of motion.

The effect of various options for decompression of degenerated lumbar spine motion segments on the range of motion: a biomechanical in vitro study

BackgroundLumbar spinal stenosis is a common disease in the aging population. Decompression surgery represents the treatment standard, however, a risk of segmental destabilization depending on the approach and extent of decompression is discussed. So far, biomechanical studies on techniques were mainly conducted on non-degenerated specimens. This biomechanical in vitro study aimed to investigate the increase in segmental range of motion (ROM) depending on the extent of decompression in degenerated segments.MethodsTen fresh frozen lumbar specimens were embedded in polymethyl methacrylate (PMMA) and loaded in a spine tester with pure moments of ± 7.5 Nm. The specimens were tested in their intact state for lateral bending (LB), flexion/extension (FE) and axial rotation (AR). Subsequently, four different decompression techniques were performed: unilateral interlaminar decompression (DC1), unilateral with "over the top" decompression (DC2), bilateral interlaminar decompression (DC3) and laminectomy (DC4). The ROM of the index segment was reported as percent (%) of the native state.ResultsSpecimens were measured in their intact state prior to decompression. The mean ROM was defined as 100% (FE:6.3 ± 2.3°; LB:5.4 ± 2.8°; AR:3.0 ± 1.6°). Interventions showed a continuous ROM increase: FE (DC1: + 4% ± 4.3; DC2: + 4% ± 4.5; DC3: + 8% ± 8.3;DC4: + 20% ± 15.9), LB(DC1: + 4% ± 6.0; DC2: + 5% ± 7.3; DC3: + 8% ± 8.3; DC4: + 11% ± 9.9), AR (DC1: + 7% ± 6.0; DC2: + 9% ± 7.9; DC3: + 15% ± 11.5; DC4: + 19% ± 10.5). Significant increases in ROM for all motion directions (p < 0.05) were only obtained after complete laminectomy (DC4).ConclusionUnilateral and/or bilateral decompressive surgery resulted in a statistically insignificant ROM increase, whereas complete laminectomy showed statistically significant ROM increase. If this ROM increase also has an impact on the clinical outcome and how to identify segments at risk for secondary lumbar instability should be evaluated in further studies.

Residual motion of different posterior instrumentation and interbody fusion constructs

PurposeTo elucidate residual motion of cortical screw (CS) and pedicle screw (PS) constructs with unilateral posterior lumbar interbody fusion (ul-PLIF), bilateral PLIF (bl-PLIF), facet-sparing transforaminal lumbar interbody fusion (fs-TLIF), and facet-resecting TLIF (fr-TLIF).MethodsA total of 35 human cadaver lumbar segments were instrumented with PS (n = 18) and CS (n = 17). Range of motion (ROM) and relative ROM changes were recorded in flexion/extension (FE), lateral bending (LB), axial rotation (AR), lateral shear (LS), anterior shear (AS), and axial compression (AC) in five instrumentational states: without interbody fusion (wo-IF), ul-PLIF, bl-PLIF, fs-TLIF, and fr-TLIF.ResultsWhereas FE, LB, AR, and AC noticeably differed between the instrumentational states, AS and LS were less prominently affected. Compared to wo-IF, ul-PLIF caused a significant increase in ROM with PS (FE + 42%, LB + 24%, AR + 34%, and AC + 77%), however, such changes were non-significant with CS. ROM was similar between wo-IF and all other interbody fusion techniques. Insertion of a second PLIF (bl-PLIF) significantly decreased ROM with CS (FE -17%, LB -26%, AR -20%, AC -51%) and PS (FE − 23%, LB − 14%, AR − 20%, AC − 45%,). Facet removal in TLIF significantly increased ROM with CS (FE + 6%, LB + 9%, AR + 17%, AC of + 23%) and PS (FE + 7%, AR + 12%, AC + 13%).Conclusionbl-PLIF and TLIF show similarly low residual motion in both PS and CS constructs, but ul-PLIF results in increased motion. The fs-TLIF technique is able to further decrease motion compared to fr-TLIF in both the CS and PS constructs.

CLINICAL AND RADIOLOGICAL OUTCOMES OF ALL ARTHROSCOPIC MUSCLE ADVANCEMENT FOR MASSIVE RETRACTED POSTEROSUPERIOR CUFF TEARS

Massive posterosuperior cuff tears (mRCT) retracted to the glenoid are surgically challenging and often associated with high retear rates. Primary repair is a less-favourable option and other salvage procedures such as SCR and tendon transfers are used. This study presents clinical and radiological outcomes of muscle advancement technique for repair of mRCT.Sixty-one patients (mean age 57±6, 77% males and 23% females) (66 shoulders) underwent all-arthroscopic rotator cuff repair that included supraspinatus and infraspinatus subperiosteal dissection off scapular bony fossae, lateral advancement of tendon laminae, and tension-free double-layer Lasso Loop repair to footprint.Pre-and post-operative range of motion (ROM), cuff strength, VAS, Constant, ASES, and UCLA scores were assessed. Radiologic assessment included modified Patte and Goutallier classifications. All patients had MRI at 6 months to evaluate healing and integrity of repair was assessed using Sugaya classification with Sugaya 4 and 5 considered retears.Advanced fatty degeneration (Goutallier 3-4) was present in 44% and 20% of supraspinatus and infraspinatus. Tendon retraction was to the level of or medial to glenoid in 22%, and just lateral in 66%. 50.8% mRCT extended to teres minor. Subscapularis was partially torn (Lafosse 1-3) in 46% and completely torn (Lafosse 4-5) in 20%.At mean follow-up (52.4 weeks), a significant increase in ROM, Relative Cuff Strength (from 57% to 90% compared to contralateral side), VAS (from 4 ±2.5 to 1±1.7), Constant (50±17.8 to 74 ±13.0), ASES (52 ±17.5 to 87 ±14.9), and UCLA (16± 4.9 to 30 ±4.9) scores were noted. There were six retears (10%), one failure due to P. acnes infection. 93% returned to pre-injury work and 89% of cases returned to pre-injury sport. Satisfaction rate was 96%.Muscle advancement technique for mRCT is a viable option with low retear rates, restoration of ROM, strength, and excellent functional outcomes.

Subtle segmental angle changes of single-level lumbar fusions and adjacent-level biomechanics: cadaveric study of optically measured disc strain.

Changes to segmental lordosis at a single level may affect adjacent-level biomechanics and overall spinal alignment with an iatrogenic domino effect commonly seen in adult spinal deformity. This study investigated the effects of different segmental angles of single-level lumbar fixation on stability and principal strain across the surface of the adjacent-level disc. Seven human cadaveric L3-S1 specimens were instrumented at L4-5 and tested in 3 conditions: 1) neutral native angle ("neutral"), 2) increasing angle by 5° of lordosis ("lordosis"), and 3) decreasing angle by 5° of kyphosis ("kyphosis"). Pure moment loads (7.5 Nm) were applied in flexion, extension, lateral bending, and axial rotation, followed by 400 N of axial compression alone and together with pure moments. Range of motion (ROM), principal maximum strain (E1), and principal minimum strain (E2) across different surface subregions of the upper adjacent-level disc (L3-4) were optically assessed. Larger magnitudes of either E1 or E2 indicate larger tissue deformations and represent indirect measures of increased stress. At the superior adjacent level, a significant increase in ROM was observed in kyphosis and lordosis versus neutral in flexion (p ≤ 0.001) and extension (p ≤ 0.02). ROM was increased in lordosis versus neutral (p = 0.03) and kyphosis (p = 0.004) during compression. ROM increased in kyphosis versus neutral and lordosis (both p = 0.03) in compression plus extension. Lordosis resulted in increased E1 across the midposterior subregion of the disc (Q3) versus neutral during right lateral bending (p = 0.04); lordosis and kyphosis resulted in decreased E1 in Q3 versus neutral with compression (p ≤ 0.03). Lordosis decreased E1 in Q3 versus neutral during compression plus flexion (p = 0.01), whereas kyphosis increased E1 in all quartiles and increased E2 in the midanterior subregion versus lordosis in compression plus flexion (p ≤ 0.047). Kyphosis decreased E1 in Q3 (p = 0.02) and E2 in the anterior-most subregion of the disc (Q1) (p = 0.006) versus neutral, whereas lordosis decreased E1 in Q3 (p = 0.008) versus neutral in compression plus extension. Lumbar spine monosegmental fixation with 5° offset from the neutral individual segmental angle altered the motion and principal strain magnitudes at the upper adjacent disc, with induced kyphosis resulting in larger principal strains compared with lordosis. Segmental alignment of single-level fusion influences adjacent-segment biomechanics, and suboptimal alignment may play a role in the clinical development of adjacent-segment disease.

Clinical Results of Arthroscopic Partial Trapeziectomy With Suture-Button Suspensionplasty for Thumb Carpometacarpal Arthritis.

This study represents the clinical results, especially range of motion (ROM) improvement, of arthroscopic partial trapeziectomy with suture-button suspensionplasty for symptomatic grade II and III thumb carpometacarpal arthritis with a minimum 1-year follow-up. Thirty-two patients (mean: 67.5 years) with grade II and III thumb carpometacarpal arthritis treated with arthroscopic partial trapeziectomy with suture-button suspensionplasty were retrospectively followed up for at least 1 year. The physical assessments included ROM, pain visual analogue scale (VAS), strength, and the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. The physical variables were retrospectively compared before surgery and at the final follow-up. Preoperative radial abduction and palmar abduction (45.4 ± 16.4° and 54.3 ± 13.9°, respectively) were significantly increased at the final follow-up (59.7 ± 16.9° and 65.5 ± 14.2°, respectively). Preoperative VAS score, pinch strength, and DASH score (70.5 ± 14.0, 57.2 ± 24.8% and 36.8 ± 14.8, respectively) were also significantly improved at the final follow-up (7.9 ± 9.1, 91.0 ± 39.6%, and 11.7 ± 10.5, respectively). Complications involved 1 case of irritation of the superficial branch of the radial nerve and 1 case of dystonia. Two suture-buttons were removed due to patient discomfort. A significant increase in ROM and pain relief was obtained after suture-button suspensionplasty with arthroscopic partial trapeziectomy.

18. Do differences in segmental angle of single level posterior lumbar fixation affect adjacent level biomechanics: cadaveric study of range of motion and optical disc strain

BACKGROUND CONTEXT Single-level lumbar fusion had been performed for years with little concern with final segmental angle. However, subtle changes on a segmental lordosis may mechanically impact adjacent level motion and stress triggering a domino effect of adult spinal deformity with sagittal imbalance and failed back fusion. The objective of this study was to quantify adjacent segment motion and disc surface strain changes with altered segmental angles. PURPOSE Study adjacent-level motion and strain distribution in cadaveric specimens with a lumbar spine single segment fusion in an offset angle. STUDY DESIGN/SETTING Biomechanical cadaveric study. PATIENT SAMPLE Seven human cadaveric specimens. OUTCOME MEASURES Range of motion (ROM) and optic strain. METHODS Seven human specimens (L2-Sacrum) underwent L4-L5 pedicle screws and rods fixation and were tested in neutral angle (NEU), imposed +5° lordosis (LOR) and -5° kyphosis (KYP). Pure moments (7.5 Nm) were applied in flexion; extension; lateral bending (LB); axial rotation (AR) followed by 400 N of compression (C) alone, and combined with pure moments. Range of motion (ROM) and strain using digital image correlation (DIC) system were tracked. Principle maximum (E1) and minimum (E2) strains were analyzed within four quarters on the lateral disc surface antero-posteriorly (Q1; Q2; Q3 and Q4). Data were analyzed using one-way RM ANOVA. RESULTS At the upper adjacent level, significant increase in ROM was observed in both conditions KYP and LOR compared to NEU in flexion (p=0.001; p=<0.001) and extension (p=0.02; p=0.009). Increased ROM was also observed in LOR compared to NEU (p=0.026) and compared to KYP (p=0.004) during compression. KYP had increased ROM compared to NEU and LOR (p=0.031; p=0.025) in C+EX. LOR had increased E1 in Q3 compared to NEU in RLB (p=0.041); LOR and KYP had decreased E1 in Q3 compared to NEU in C (p=0.002; p=0.03). LOR had decreased E1 in Q3 compared to NEU (p=0.013) while KYP had increased E1 in all quartiles and increased E2 in Q2 compared to LOR in C+FL (p≤0.047). KYP decreased E1 in Q3 (p=0.021) and E2 in Q1 (p=0.006) compared to NEU while LOR had decreased E1 in Q3 (p=0.008) compared to NEU in C+EX. CONCLUSIONS Lumbar spine mono-segmental fixation with 5° offset from neutral/native individual segmental angle increases the motion at adjacent level and can also induces disc strain in most direction of loads with final angle in kyphosis being worse than in lordosis. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs. Single-level lumbar fusion had been performed for years with little concern with final segmental angle. However, subtle changes on a segmental lordosis may mechanically impact adjacent level motion and stress triggering a domino effect of adult spinal deformity with sagittal imbalance and failed back fusion. The objective of this study was to quantify adjacent segment motion and disc surface strain changes with altered segmental angles. Study adjacent-level motion and strain distribution in cadaveric specimens with a lumbar spine single segment fusion in an offset angle. Biomechanical cadaveric study. Seven human cadaveric specimens. Range of motion (ROM) and optic strain. Seven human specimens (L2-Sacrum) underwent L4-L5 pedicle screws and rods fixation and were tested in neutral angle (NEU), imposed +5° lordosis (LOR) and -5° kyphosis (KYP). Pure moments (7.5 Nm) were applied in flexion; extension; lateral bending (LB); axial rotation (AR) followed by 400 N of compression (C) alone, and combined with pure moments. Range of motion (ROM) and strain using digital image correlation (DIC) system were tracked. Principle maximum (E1) and minimum (E2) strains were analyzed within four quarters on the lateral disc surface antero-posteriorly (Q1; Q2; Q3 and Q4). Data were analyzed using one-way RM ANOVA. At the upper adjacent level, significant increase in ROM was observed in both conditions KYP and LOR compared to NEU in flexion (p=0.001; p=<0.001) and extension (p=0.02; p=0.009). Increased ROM was also observed in LOR compared to NEU (p=0.026) and compared to KYP (p=0.004) during compression. KYP had increased ROM compared to NEU and LOR (p=0.031; p=0.025) in C+EX. LOR had increased E1 in Q3 compared to NEU in RLB (p=0.041); LOR and KYP had decreased E1 in Q3 compared to NEU in C (p=0.002; p=0.03). LOR had decreased E1 in Q3 compared to NEU (p=0.013) while KYP had increased E1 in all quartiles and increased E2 in Q2 compared to LOR in C+FL (p≤0.047). KYP decreased E1 in Q3 (p=0.021) and E2 in Q1 (p=0.006) compared to NEU while LOR had decreased E1 in Q3 (p=0.008) compared to NEU in C+EX. Lumbar spine mono-segmental fixation with 5° offset from neutral/native individual segmental angle increases the motion at adjacent level and can also induces disc strain in most direction of loads with final angle in kyphosis being worse than in lordosis.

Effects of Myofascial Self-Release on Range of Motion, Pressure Pain Threshold, and Hamstring Strength in Asymptomatic Individuals: A Randomized, Controlled, Blind Clinical Trial.

Myofascial self-release is performed using a roller to exert pressure on the soft tissues and to promote effects similar to those of traditional massage. However, there is no standardization regarding its application, mainly in relation to time. To evaluate the effects of myofascial self-release with a rigid roller on range of motion (ROM), pressure pain threshold (PPT), and hamstring strength in asymptomatic individuals following 2 different times of intervention. Randomized, controlled, blind, clinical trial comparing preintervention and immediately postintervention within 2 groups. Institutional physiotherapy clinic. A total of 40 university students (18-30y), who had no symptoms, participated. Foam roller for 30seconds and 2minutes for group 2. Hamstring PPT, knee-extension ROM, and peak knee-flexion torque measured before and immediately after the intervention. Both groups experienced a statistically significant increase in ROM compared with baseline (30s and 2min for group 2 P < .024). There were no statistically significant differences comparing peak knee-flexion torque or PPT. Hamstring myofascial self-release using a roller for 30seconds or 2minutes produced an increase in ROM in healthy individuals. PPT and peak knee-flexion isometric torque showed no effects.

Intermediate to long-term clinical outcomes and survival analysis of the Salto Mobile Bearing total ankle prothesis

IntroductionOsteoarthritis of the ankle is a major burden to affected patients. While tibio-talar arthrodesis has been the gold-standard regarding the treatment of osteoarthritis of the ankle joint for many years, at present total ankle arthroplasty (TAA) provides appealing clinical outcomes and is continually gaining popularity.The aim of this study was to evaluate the intermediate- to long-term clinical outcome including the survival rate of Salto Mobile Bearing TAA (Tonier SA, Saint Ismier, France).Material and methodsIn this retrospective study intermediate- to long-term outcomes measures [Ankle Range of Motion (ROM), American Orthopaedic Foot and Ankle Score (AOFAS score) and survival rate] of 171 consecutive TAA were analysed and compared before and after surgery. Revision was defined as secondary surgery with prothesis component removal, while reoperation was defined as a non-revisional secondary surgery involving the ankle.ResultsAt a mean follow-up (FU) period of 7.2 ± 2.7 years (range 2.0 to 14.1 years) there was a significant improvement in ankle ROM (total ROM improved from 25.0° ± 15.0° to 28.7° ± 11.3°, p = 0.015; plantarflexion improved from 18.4° ± 11.7° to 20.6° ± 8.2°, p = 0.044; dorsiflexion improved from 6.6° ± 5.7° to 8.1° ± 4.9°, p = 0.011). AOFAS score increased significantly by 41 ± 15 points after surgery (43.3 ± 11.1 before and 84.3 ± 12.0 after surgery, p < 0.001). Overall survival rate within the FU was 81.3% (95% CI 75.3% to 87.3%) with any secondary surgery, 89.9% (95% CI 84.1% to 93.6%) with revision and 93.6% (95% CI 89.8% to 97.3%) with reoperation as endpoint.ConclusionThis study endorses the previously reported appealing intermediate- to long-term outcomes of the Salto Mobile Bearing TAA. There was a significant increase in ROM and AOFAS score as well as decent implant survival at final FU.

Optimal duration of stretching of the hamstring muscle group in older adults: a randomized controlled trial.

"Flexibility" is defined as "the range of movement or motion of a single or multiple joints." Its limits decline significantly with age, reaching maximum flexibility in the mid-to-late twenties for males and females, respectively. Conclusions regarding appropriate stretching time duration are mainly based on mechanical factors such as range of motion (ROM) and flexibility and tend to ignore the adverse neural mechanical tension that may be created during stretching exercises. It appears that longer-duration stretching increases flexibility for geriatric populations. To explore the effect of variable stretching intervals on neural function and ROM. Double blind randomized controlled trial. University research laboratory. One hundred participants, 60-65 years old, with a diagnosis of tight hamstring muscles, bilaterally, were randomly assigned to either a control group or one of three intervention groups. Participants who were randomly placed in one of the three intervention groups, were further randomized by selection of right or left limb for intervention. Intervention groups consisted of either 15-, 30-, or 60-s stretches to hamstring muscles; whereas the control group was given a sham stretch for 20 seconds. Main Outcome Measures included the neurophysiological outcome measures; peak to peak amplitude of somatosensory evoked potential for dermatomes L4, L5, and S1. Secondary outcome measures included knee ROM. All outcome measures were assessed before, immediately after, and 24 hours after the treatment session. Mixed linear model analysis was used to evaluate group, time, and group x time interaction effects for outcome measures. Stretching for 30 and 60 s gave significant increase in ROM compared to control (4.64 [95% CI: 3.35, 5.93]; P<0.01) (10.30 [95% CI: 9.01, 11.6]; P<0.01) and the improvement was persistent at 24-hours' follow-up (P<0.01). However, the analysis showed significant reduction in dermatomal somatosensory evoked potentials' amplitudes for L4 (-1.19 [95% CI: -1.35, 1.02]; P<0.01), L5 (-1.34 [95% CI: -1.56, -1.13]; P<0.01), S1 (-0.99 [95% CI: -1.16, -0.83]; P<0.01) after 60-s static hamstring muscle stretch. The reduction was persistent at 24-hours' follow-up (P<0.01). Stretching hamstring for 30 seconds was optimal in increasing the knee range of motion and minimizing the negative effects on the neural function of the involved nerve roots. Thus, 60-second static hamstring muscle stretching, places increased stress and strain on the nervous system and should be avoided. It is well established that stretching is an effective intervention to treat many neuromuscular and musculoskeletal problems. However, which exact parameters to follow during stretching procedures remains controversial. Our findings indicate that 60-s static stretching of hamstring at end ranges of motion, likely place increased stress and strain on the nerve roots and central nervous system, and should be avoided.

The acute mechanism of the self-massage-induced effects of using a foam roller

IntroductionMaintaining flexibility, often defined as range of motion (ROM), is important. Recently, self-massage using a foam roller (FR) has been used in clinical and/or sports settings to effectively and immediately improve ROM. Many studies have found significant increases in ROM following the FR intervention; however, the mechanism of the effect is unclear. We aimed to clarify this mechanism regarding the ROM effects following the FR intervention by evaluating local tissue and autonomic nervous system responses. MethodThe study employed a crossover design that included a comparison between non-intervention (CON trial: left leg) and intervention (FR trial: right leg) groups. Fourteen volunteers participated. Nine outcomes (passive maximum ankle ROM [ROM with a specified and non-specified passive strength], tissue hardness, skin temperature, water contents, circumference, blood flow velocity, pressure pain threshold, autonomic nervous system, and heart rate) were investigated before (PRE) and 0 min (POST0), 20 min (POST20), 40 min (POST40), and 60 min (POST60) post intervention. ResultsSkin temperature, impedance, and circumference changed significantly following the intervention, and increased ROM with non-specified strength was observed. DiscussionAlthough we found that the FR intervention influenced skin temperature, impedance, circumference, and ROM, adaptability to the intervention may differ depending on an individual's characteristics. Females and/or individuals with a high body water content could obtain greater positive ROM effects than males and/or individuals with a low body water content. ConclusionThese findings suggest that the FR intervention may be an effective method to improve ROM, with alterations of skin temperature, impedance, and circumference.

The optimal dosage, route and timing of glucocorticoids administration for improving knee function, pain and inflammation in primary total knee arthroplasty: A systematic review and network meta-analysis of 34 randomized trials.

Glucocorticoids are a mainstay to control postoperative pain, inflammation, nausea and vomiting (PONV) in total knee arthroplasty (TKA). Understanding the optimal dose and route of glucocorticoids administration in TKA is of great significance in speedy functional recovery. We aimed to summarize, evaluate and rank order the efficacy of glucocorticoids regimens in TKA. Electronic databases (PubMed et al.) were systematically searched from inception up to April 30, 2020. The primary outcomes were visual analogue scale (VAS), range of motion (ROM) and knee society score (KSS). C-reactive Protein (CRP) and PONV were also evaluated. Multivariable Bayesian random effects models were used to synthesize and rank the comparative efficacy of glucocorticoids regimens. A total of 34 eligible randomized controlled trials with 11 different glucocorticoids regimens were assessed. Overall inconsistency and heterogeneity were acceptable. Multiple medium dose perioperative intravenous injection (IV) ranked first in the analgesia network and a single high doses of preoperative IV ranked first in the inflammation and PONV network. There was no statistically significant increase in ROM or KSS in all the glucocorticoid formulations and doses compared with controls on postoperative day 30. Glucocorticoid multiple intravenous injection was preferable to a single intravenous injection (preoperative and postoperative), periarticular injection and intra-articular injection in analgesia. Based on the available evidence, a medium dose of hydrocortisone of 2-4mg/kg is optimal.

AB1310-HPR EFFECTS OF INSTRUMENT-ASSISTED SOFT TISSUE MOBILIZATION ON FROZEN SHOULDER: A RANDOMIZED CONTROLLED TRIAL

Background:Frozen shoulder has a greater incidence, more severe course, and resistance to treatment in patients. Management is based on the underlying cause of pain and stiffness. Joint mobilization has been reported to improve joint range of motion in frozen shoulder. However, there is no information regarding the effect of instrument-assisted soft tissue mobilization (IASTM) in frozen shoulder. We proposed that there would be no significant difference between the two manual physical therapy techniques with relatively similar treatment effects in the frozen shoulder.Objectives:The aim of this randomized controlled study was to compare the effectiveness of IASTM and joint mobilization in the treatment of patients with frozen shoulder.Methods:Thirty patients with phase II frozen shoulder (mean age 50,9 years, age range 39–65 years) were randomly assigned to one of the two treatment groups: Group I received joint mobilization combined with manual stretching exercise and Group II received IASTM with manual stretching exercise (two days per week for six weeks) (Figure 1). The pain level was evaluated with a visual analogue scale (VAS) and the active range of motion (ROM) was measured with a universal goniometer. The Disabilities of the Arm, Shoulder and Hand score and the Constant-Murley score were used for functional assessment. The assessments were performed at baseline and after the 6-week intervention.Figure 1.Instrument-Assisted Soft Tissue MobilizationResults:Both groups had a significant decrease in pain according to VAS and a significant increase in ROM and function level (p&lt;0.05). After the 6-week intervention, improvement of shoulder abduction ROM in Group I was found significantly higher than Group II (p=0.01), on the other hand, Constant-Murley score in Group II was found significantly higher compared to Group I (p=0,001).Conclusion:Our results supported the hypothesis that either joint mobilization or IASTM, performed in addition to stretching exercise, provided similar improvements in pain levels in patients with the frozen shoulder.

The acute time course of muscle and tendon tissue changes following one minute of static stretching

The purpose of this study was to investigate the time course of the changes of various muscle and tendon mechanical properties and the function responses of the plantar flexor muscles following 1 min of static stretching.Twenty-five healthy volunteers were assigned into a static stretching group or a control group. The static stretching group was tested with three different rest times (0 min,20 min,40 min) after 2x30s of stretching. Controls were tested before and after a control period (10 min) without stretching. Dorsiflexion range of motion (RoM), passive resistive torque (PRT), and maximum voluntary contraction (MVC) were measured with a dynamometer. Ultrasonography of the medial gastrocnemius (GM) muscle-tendon junction (MTJ) displacement allowed us to determine the length changes in the tendon and muscle, respectively, and hence to calculate their stiffness.Following the stretching, we observed a significant increase in RoM directly following the stretching, 20 min post-stretching, and 40 min post-stretching. However, no changes were found in other functional parameters (PRT, MVC) or structural parameters (muscle and tendon stiffness). No changes were detected in any variable in the control group.We conclude that a static stretching exercise of 2x30s increases the RoM for at least 40 min. However, this gain in RoM is not accompanied with more compliant muscle and/or tendon tissue, suggesting that 60s of static stretching might not be stimulus enough to induce changes in the muscle-tendon structure. Hence, we speculate that other factors, such as increased stretch tolerance, might be responsible for the changes in the RoM observed in the present study.

Effect of Static Stretching, Dynamic Stretching, and Myofascial Foam Rolling on Range of Motion During Hip Flexion: A Randomized Crossover Trial.

Siebert, T, Donath, L, Borsdorf, M, and Stutzig, N. Effect of static stretching, dynamic stretching, and myofascial foam rolling on range of motion during hip flexion: A randomized crossover trial. J Strength Cond Res 36(3): 680-685, 2022-Static and dynamic stretching (DS) are commonly used in sports and physical therapy to increase the range of motion (ROM). However, prolonged static stretching (SS) can deteriorate athletic performance. Alternative methods to increase ROM are thus needed. Foam rolling (FR) may initiate muscle relaxation, improve muscular function, physical performance, and ROM. Previous studies that examined effects of FR on ROM did not control for increased tissue compliance or shifted pain threshold. In this study, the isolated influence of altered tissue compliance on ROM after FR, SS, and DS was investigated using a randomized crossover design. Hip flexion ROM at given joint torques before and after SS, DS, and FR was randomly assessed in 14 young male adults (age: 23.7 ± 1.3 years; height: 182 ± 8 cm; body mass: 79.4 ± 6.9 kg). Hip flexion ROM was measured in the sagittal plane with the subjects lying in a lateral position (no gravitational effects on ROM measurements). Surface electromyographic (EMG) analysis of 2 representative hip extensors (M. biceps femoris and M. semitendinosus) was applied to control for active muscle contribution during ROM measurements. Significant increases in ROM for SS (3.8 ± 1.1°; p < 0.001) and DS (3.7 ± 1.8°; p < 0.001) were observed, but not for FR (0.8 ± 3.1°; p = 0.954). Because stretch forces on tendon and muscle tissue during SS and DS predominately act in longitudinal direction, FR induces mainly transversal forces in the muscle tissue. Thus, increased ROM after FR reported in the literature is more likely due to a shift in the pain threshold. These results provide a better understanding of differential loading conditions during SS, DS, and FR for coaches and practitioners.

Long-term Radiological Evidence of Affected and Adjacent Segment Disease after Anterior Cervical Foraminotomy.

Anterior cervical foraminotomy (ACF) is a surgical procedure for cervical radiculopathy to avoid fusion and adjacent segment disease (ASD), but its long-term outcome has yet to be investigated. It is also unclear whether ACF enables preservation of range of motion (ROM) and decreases ASD compared with anterior cervical discectomy and fusion (ACDF). This study included nine patients who underwent ACF, and 12 who underwent ACDF and with follow-up period of at least 5 years (average follow-up: 8.7 years). Preoperative and postoperative radiological findings were investigated, comparing the changes in ACF versus ACDF. All disc height (DH) levels (C2/3-C7/Th1) were measured preoperatively and postoperatively in all 21 patients to compare with the change due to the natural history. The ACF group experienced significant loss of DH (0.6 mm, 13.5%, p <0.01) and ROM (p <0.01) at the operated level postoperatively. However, loss of DH was not significantly different from natural changes at unaffected levels, and ROM was maintained. The ACDF group experienced a significant increase in the ROM of the cranial adjacent segment from 6.46 to 7.45 mm (p <0.01), and the dislocation in dynamic X-ray was also significantly increased from 1.61 to 2.89 mm (p <0.01), indicating radiological ASD. The ACF group had no significant increase in ROM and dislocation. ACF causes significant loss of DH and ROM, but this change is not significantly different compared with natural changes at unaffected levels. Furthermore, ACF causes less ASD than ACDF in the long term.

The atlantoaxial capsular ligaments and transverse ligament are the primary stabilizers of the atlantoaxial joint in the craniocervical junction: a finite element analysis

OBJECTIVEPrior studies have provided conflicting evidence regarding the contribution of key ligamentous structures to atlantoaxial (AA) joint stability. Many of these studies employed cadaveric techniques that are hampered by the inherent difficulties of testing isolated-injury scenarios. Analysis with validated finite element (FE) models can overcome some of these limitations. In a previous study, the authors completed an FE analysis of 5 subject-specific craniocervical junction (CCJ) models to investigate the biomechanics of the occipitoatlantal joint and identify the ligamentous structures essential for its stability. Here, the authors use these same CCJ FE models to investigate the biomechanics of the AA joint and to identify the ligamentous structures essential for its stability.METHODSFive validated CCJ FE models were used to simulate isolated- and combined ligamentous–injury scenarios of the transverse ligament (TL), tectorial membrane (TM), alar ligament (AL), occipitoatlantal capsular ligament, and AA capsular ligament (AACL). All models were tested with rotational moments (flexion-extension, axial rotation, and lateral bending) and anterior translational loads (C2 constrained with anterior load applied to the occiput) to simulate physiological loading and to assess changes in the atlantodental interval (ADI), a key radiographic indicator of instability.RESULTSIsolated AACL injury significantly increased range of motion (ROM) under rotational moment at the AA joint for flexion, lateral bending, and axial rotation, which increased by means of 28.0% ± 10.2%, 43.2% ± 15.4%, and 159.1% ± 35.1%, respectively (p ≤ 0.05 for all). TL removal simulated under translational loads resulted in a significant increase in displacement at the AA joint by 89.3% ± 36.6% (p &lt; 0.001), increasing the ADI from 2.7 mm to 4.5 mm. An AACL injury combined with an injury to any other ligament resulted in significant increases in ROM at the AA joint, except when combined with injuries to both the TM and the ALs. Similarly, injury to the TL combined with injury to any other CCJ ligament resulted in a significant increase in displacement at the AA joint (significantly increasing ADI) under translational loads.CONCLUSIONSUsing FE modeling techniques, the authors showed a significant reliance of isolated- and combined ligamentous–injury scenarios on the AACLs and TL to restrain motion at the AA joint. Isolated injuries to other structures alone, including the AL and TM, did not result in significant increases in either AA joint ROM or anterior displacement.

3. Fatigue analysis of multilevel anterior cervical fusion with stand-alone anchored spacer vs interbody cage with anterior plate

BACKGROUND CONTEXT Anterior cervical discectomy and fusion (ACDF) is the surgical standard for treating anterior based cervical spine pathology with interbody spacers and plating most common. Complications are more prevalent in multilevel cases. Stand-alone anchored spacers were designed to resolve these issues. For 1-level ACDF they provide similar clinical results, fewer implant related complications and decreased compensatory motion at adjacent levels. Reporting on fatigue analysis of multilevel plating vs anchored spacers is limited. PURPOSE Perform fatigue analysis and compare spinal stability of 3-level cervical ACDF constructs using either anchored spacers or standard cages with anterior plating. STUDY DESIGN/SETTING In-vitro biomechanical study. OUTCOME MEASURES Range of motion (ROM) of index levels, adjacent segments, and overall construct. METHODS Spinal stability testing was performed on cadaveric cervical spines (C2-T2) in sagittal, coronal and transverse planes. Specimens tested intact and assigned to either anchored spacer or anterior plate group. Each had a 3-level discectomy (C4/5, C5/6, and C6/7), followed by assigned instrumentation. Specimens retested followed by a fatigue protocol of 5k cycles of flexion/extension and then 5k cycles of axial rotation. Spinal stability testing was performed following each 5k cycles of fatigue. ROM was measured from the index levels, adjacent segments, and overall construct. Peak directional ROMs were compared between groups and analyzed with ANOVA and post hoc t-tests. RESULTS There were similar and significant (p CONCLUSIONS For 3-level ACDF, there was a significant increase in ROM in the index levels using anchored spacers with no significant change in adjacent segment ROM when compared to standard cages and anterior plate. After fatigue, an increase in index ROM and adjacent segment ROM was seen with the anchored spacer compared to anterior plating. Future studies are needed to determine if differences in motion have any clinical significance regarding fusion in 3-level ACDF. FDA DEVICE/DRUG STATUS Stand-alone anchored spacer (Approved for this indication), interbody cage with anterior place (Approved for this indication)