Straight Leg Raise Research Articles

Effectiveness of Osteopathic Treatment in Adults with Short Hamstring Syndrome: A Systematic Review.

Background/Objective: Short hamstring syndrome is common in the general population and can lead to impaired balance, function, and posture, and increased risk of injuries. Local treatments have obtained controversial results, so it is necessary to evaluate the effectiveness of other types of therapy such as osteopathic treatment. To evaluate the efficacy of osteopathic techniques in increasing the elasticity of the hamstring musculature in short hamstring syndrome. Methods: A systematic review of randomised controlled trials was conducted in PubMed, Medline, Cinhal, Scopus, WOS, SPORTDiscuss, and PEDro. The PEDro scale was used to evaluate the methodological quality and the RoB2 for the evaluation of biases. Results: A total of eight articles were selected. Most of the participants were assessed with the Active Knee Extension or Straight Leg Raise tests. The osteopathic techniques used were the muscle energy technique, suboccipital inhibition, and vertebral mobilisations. As for the control interventions, they mainly included passive stretching and placebo. Conclusions: The results suggest that osteopathic techniques are more effective than placebo or other interventions in increasing flexibility in adult patients with short hamstring syndrome. This effect can be explained by neurophysiological (Golgi apparatus, neuromuscular spindle activity, and Hoffmann reflex) and structural factors (dura mater, posture, and myofascial chains). Nevertheless, the evidence suggests that it would be beneficial to incorporate this type of treatment into flexibility improvement programmes.

Surface Electromyography and Gait Features in Patients after Anterior Cruciate Ligament Reconstruction.

An important reason for the poor recovery of anterior cruciate ligament (ACL) injuries is the poor recovery of muscle function. Therefore, we used surface electromyography (sEMG) and gait analysis to explore the muscle activation patterns and gait characteristics between lower limbs under different exercise states in patients, following anterior cruciate ligament reconstruction (ACLR). Forty-one adults with unilateral ACL injuries in Binzhou Medical University Hospital from October 2022 to June 2023 were allocated to three groups according to the time after ACL reconstruction: group A (≤3 months, 16), group B (3 months-1 year, 13), and group C (>1 year, 12). Patients were tested by sEMG and gait, while straight leg raising (SLR), walking at normal speed, fast walking, and walking up and down the stairs. Two related sample tests were performed for the normalized root mean square (RMS) values and gait parameters. Muscle function changes varied in different training tasks. The RMS value of the involved side was more than the uninvolved side in biceps femoris and semitendinosus of group A (p < 0.010), and for the bilateral rectus femoris (RS), vastus medialis (VM), and vastus lateralis in group B, only the comparison of the RS was significant in group C during fast walking and going up and down the stairs. The ground impact (0.90 [0.63, 1.33] vs. 0.71 [0.43, 1.02], p = 0.035) of the uninvolved side was significantly decreased compared to those of the involved side in patients with ACLR when going down the stairs. Different muscles need to be focused on at different stages of the postoperative period. sEMG and gait analysis can guide the development of a rehabilitation program.

Comparable long-term functional outcomes of subvastus and medial parapatellar approach in total knee arthroplasty: A 10-year follow-up study.

Surgeons usually use the medial parapatellar or subvastus approaches for total knee arthroplasty (TKA). The subvastus approach is rapidly gaining recognition to reduce damage to the extensional mechanism and recover faster after surgery. This study compares the long-term outcomes of the conventional medial parapatellar and subvastus approaches in primary TKA during a minimum 10-year follow-up. In a retrospective longitudinal follow-up study from 2008 to 2013, 60 eligible patients for primary TKA were included. The patients were divided into two groups: one undergoing TKA with the subvastus approach (n = 30) and the other with the conventional medial parapatellar approach (n = 30). Postoperatively, the patients were followed up for 10-15 years. Patients were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Society Score (KSS), and Visual Analogue Scale index for pain. The time required to perform an active straight leg raise (SLR) was significantly shorter in the subvastus group (p < 0.001) at early postoperation evaluation. Patients in the subvastus group had lower pain and better knee functional scores at the one-year follow-up (p < 0.05). There was no difference between the two groups regarding duration of hospitalisation, blood loss, operation time, length of the scar, and postoperative complications. Both approaches had similar long-term results regarding pain and functional scores of WOMAC (6.2 ± 1.2 vs. 6.3 ± 1.3, p-value = 0.69) and KSS scores (93.1 ± 6.8 vs. 95.0 ± 3.2, p-value = 0.42). The subvastus approach was associated with a shorter time to achieve active SLR, higher functional scores, and better pain relief at early postoperative evaluations. However, both techniques had similar long-term outcomes in terms of pain and functional scores, as measured by the WOMAC and KSS scales. II.

Prognostic factors for patient-reported satisfaction after percutaneous lumbar endoscopic discectomy at a minimum of two years' follow-Up.

Percutaneous endoscopic lumbar discectomy (PELD) is increasingly used in patients with lumbar disc herniation due to its less invasive nature and faster recovery. In this study, we aimed to investigate the prognostic factors associated with patient satisfaction index (PSI) in PELD. A retrospective study of 337 patients who underwent PELD between November 2015 and October 2020 in our department was conducted. Preoperative data of the enrolled patients were recorded. A logistic regression model was developed to explore the preoperative factors associated with postoperative PSI. After a mean follow-up of 28.7 ± 3.6 months, 310 patients were satisfied (NASS score of 1 or 2) and 27 patients were dissatisfied (NASS score of 3 or 4), resulting in a patient satisfaction rate of 91.99%. Demographic data, clinical symptom characteristics, and neurological physical examinations (including lower limb hypesthesia, muscle strength, and tendon flex) did not show any significant differences between the four groups (NASS1,2,3,4). The satisfactory group showed a higher rate of positive Lasegue sign (P = 0.010) and higher preoperative VAS (P = 0.002). The dissatisfaction group showed a higher rate of contiguous double-level disc herniation (P = 0.003). Our findings indicated that positive Lasegue sign and high preoperative VAS were prognostic factors for patient-reported satisfaction and PELD might not be the first choice for contiguous double-level disc herniation.

Comparison of Clinical Characteristics between Responders and Non-Responders to Hamstring Stretching in Individuals with Chronic Low Back Pain.

Background/Objectives: Hamstring muscle (HM) flexibility is frequently compromised in people with chronic low back pain (CLBP), contributing to disability and leading to a less favorable recovery. In a previous article, we presented the results of a study on the immediate effect of passive HM stretching on flexibility in 90 people with CLBP. There was considerable variability in the changes after stretching. The objective of this supplementary analysis was to compare the clinical characteristics of individuals who experienced a significant improvement in flexibility with those who did not. Methods: We fixed a threshold of 7° to indicate an improvement in passive Straight Leg Raise (SLR) angle and differentiate between 'Responders' and 'Non-responders' regarding passive HM stretching. Results: Only body mass index differed between groups; it was significantly smaller in Responders (p = 0.007). The majority of Non-responders experienced workplace accidents, but this was of marginal difference compared to Responders (p = 0.056). Conclusions: Further studies should consider a broader clinical analysis with a larger sample size to understand which factors influence the HM stretching response in CLBP patients.

Reliability and concurrent validity of the bubble inclinometer for visual estimation of straight leg raise in asymptomatic individuals

IntroductionThe straight leg raise (SLR) test is commonly used to investigate neurodynamic problems or hamstring muscle length. Visual estimation can be used to identify the degrees of hip flexion during the SLR test. However, intra-tester and inter-tester reliability, as well as concurrent validity, await formal investigation.MethodsThis study was an experimental study. Two testers, a novice and an experienced physical therapist, measured hip flexion angles during the SLR test using visual estimation for two sessions and the bubble inclinometer method during the first session in 31 asymptomatic participants, in random order. Intra-tester reliability (intraclass correlation coefficient, ICC&lt;sub&gt;3,3&lt;/sub&gt;), inter-tester reliability (ICC&lt;sub&gt;2,3&lt;/sub&gt;), concurrent validity (Pearson correlation with bubble inclinometer), and measurement error was represented as standard error of measurement (SEM) and minimal detectable change (MDC), were calculated.ResultsThe concurrent validity and intra-tester reliability of visual estimation for both testers were good (ICC&lt;sub&gt;3,3&lt;/sub&gt; = 0.885 with 95% confidence interval = 0.775–0.943, &lt;i&gt;p&lt;/i&gt; &lt; 0.001) and excellent (ICC&lt;sub&gt;3,3&lt;/sub&gt; = 0.904 with 95% confidence interval = 0.810–0.952, &lt;i&gt;p&lt;/i&gt; &lt; 0.001), respectively. Inter-tester reliability of visual estimation was poor (ICC&lt;sub&gt;2,3&lt;/sub&gt; = 0.373 with 95% confidence interval = 0.027–0.639, &lt;i&gt;p&lt;/i&gt; = 0.018).ConclusionsAlthough the concurrent validity of visual estimation with the bubble inclinometer was good, and intra-tester reliability was excellent, the inter-tester reliability was poor. Therefore, caution should be exercised if more than one tester is involved in visual estimation.

Comparison of muscle tightness between knees in individuals with unilateral osteoarthritis and its relationship with pain and function.

Unilateral osteoarthritis (OA) affects single knees and presents a unique scenario where individuals experience varying degrees of symptoms between their affected and unaffected knees. This study aims to investigate differences in muscle tightness between symptomatic and asymptomatic knees in individuals with unilateral knee OA while exploring the interplay among pain, functionality, and muscle tightness. In this cross-sectional study, thirty knee OA patients underwent assessments for hamstring (Active Knee Extension, Straight Leg Raise), iliotibial band (Ober Test), and quadriceps tightness (Modified Thomas Test). Pain intensity was measured using the Visual Analog Scale (VAS), and functional limitations were evaluated via the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). A negative correlation was observed between participants' pain and AKE (p= 0.004, r=-0.515), ASLR (p= 0.27, r=-0.403), Ober (p= 0.010, r=-0.461) values. However, no significant correlation was found with the Modified Thomas value (p= 0.204, r=-0.239). There was also a negative correlation between participants' WOMAC scores and AKE (p= 0.019, r=-0.427), OBER (p= 0.004, r=-0.510), and Modified Thomas (p= 0.022, r=-0.416) values, while ASLR (p= 0.286, r=-0.202) values showed no significant correlation. Comparisons between AKE, Ober, and Modified Thomas values showed higher values in asymptomatic extremities (AKE: p= 0.025, Ober: p= 0.021, Modified Thomas: p= 0.030). This study emphasizes the significance of muscle tightness in the symptomatic extremities of individuals with unilateral knee OA. The results indicate that increased muscle tightness makes pain worse and limits movement. It's crucial for healthcare providers treating OA to focus on improving muscle flexibility, reducing pain, and enhancing overall function.

213. A NEW MANOMETRIC TOOL TO EVALUATE THE EFFICACY OF LAPAROSCOPIC ANTIREFLUX SURGERY

Abstract Background High resolution manometry (HRM) has been proven able to describe the pathophysiological pathway leading to gastroesophageal reflux disease (GERD). Recently, a new manometric tool, the Milan Score (MS), has been introduced and validated to evaluate the risk of pathologic GERD, defined as Acid Exposure Time (AET) &amp;gt;6% at pH-study. Aim of this study is to validate this score in the post-operative assessment after laparoscopic antireflux surgery (LARS). Methods All patients who underwent HRM after LARS between October 2020 and May 2023 were included. The MS was calculated assessing four manometric variables: esophagogastric junction (EGJ) type, EGJ contractile integral (EGJ-CI), ineffective esophageal motility (IEM) and response to the straight leg raise (SLR) manoeuvre. The MS was considered pathologic if ≥137 (risk of GERD ≥50%). The risk of GERD was categorized into six classes, according to the MS score. The MS was compared with validated questionnaires for reflux symptoms, including GERD Questionnaire (GERD-Q), GERD Health-Related Quality of Life (GERD-HRQL) and Reflux Symptom Index (RSI), and with postoperative endoscopy findings. Results A total of 160 patients were included (63% males, age: 53 years, time from surgery: 30 months). Surgical techniques included magnetic sphincter augmentation in 54% of patients, Toupet fundoplication in 29% and Nissen or Dor fundoplication in 17%. The proportion of patients with MS ≥137 among those with pathologic questionnaires was 73% for GERD-Q (p&amp;lt;0.001), 75% for GERD-HRQL (p&amp;lt;0.001) and 78% for RSI (p&amp;lt;0.001). The rate of pathologic questionnaires increased for higher MSs. A MS ≥137 was related to recurrent hiatal hernia (23%, p=0.046) and esophagitis (21%, p=0.007) at endoscopy. Clinical and manometric outcomes were similar among different surgical techniques. Conclusions The MS is an efficient tool to assess the efficacy of LARS. Various surgical techniques have similar distribution in the different risk classes for GERD identified by MS, and similar clinical results. HRM with MS represent an easy and feasible assessment of surgical outcomes after LARS, providing an objective evaluation of the antireflux barrier after surgery.

Characteristics in patients with very early therapeutic response of condoliase chemonucleolysis for lumbar disc herniation.

Treatment of lumbar disc herniation (LDH) using condoliase chemonucleolysis (CC) requires more time than surgery to demonstrate therapeutic effects. This study aimed to identify patients who show significant improvement in leg pain very early after CC and to determine pretreatment factors that can predict a very early therapeutic response. The study included 52 patients who underwent CC for treatment-resistant LDH. Scores for low back and leg pain measured by a numerical rating scale were assessed at four time points (1day, 1 week, 1 month, and 3 months after CC). Patients who reported subjective pain relief the day after treatment and further exhibited an improved straight leg raising (SLR) angle compared to pretreatment were classified as "very early responders (VER)". Of the 52 patients, 39 (75%) were VER, and 13 (25%) were non-VER. The VER showed earlier improvement in leg pain. The VER had a significantly higher proportion of positive SLR test patients (p = 0.01) and a significantly smaller pretreatment SLR angle compared to the non-VER (VER vs. non-VER: 40.6 ± 19.0 vs. 63.1 ± 16.9, p < 0.001). There were no significant differences in the level, type, and size of LDH and the disc regression rate between the two groups. Patients with a smaller pretreatment SLR angle are more likely to experience very early or early symptomatic relief, with a significant and sustained reduction in leg pain up to 3 months after CC treatment.

Nalbuphine versus morphine: an adjuvant to spinal anesthesia for controlling pain after total knee arthroplasty: a propensity score-matched analysis.

Nalbuphine, a synthetic k-agonist and µ-antagonist, provides efficient pain relief while reducing opioid-related adverse effects. This study aims to compare the efficacy of intrathecal nalbuphine (ITN) with intrathecal morphine (ITM) for post-TKA pain. A retrospective cohort analysis of 131 patients who underwent TKA with spinal anesthesia (SA), a single shot of adductor canal block, and periarticular injections was conducted. The patients were divided into 2 groups, Group N received 0.8mg nalbuphine, and Group M received 0.2mg morphine as an adjuvant to SA. Propensity-score matching was employed to compare the visual analog scales (VAS) of postoperative pain intensity, cumulative morphine use (CMU), maximum knee flexion angle, straight leg raise (SLR) ability, incidence of postoperative nausea and vomiting (PONV), and length of hospital stay (LHS). The mean VAS of group M were significantly lower than group N at 6, 12, 18, and 24h (P < 0.01). Group M had lower CMU than group N at 24h (P < 0.01) and 48h (P < 0.01), while there was no significant difference between groups in terms of knee flexion angle and SLR at any time point. Additionally, 29.3 and 57.9% of patients in group N and M experienced PONV, respectively (p = 0.04), and group N had significantly shorter LHS compared to group M (P < 0.001). Although, intrathecal morphine (ITM) still provides better pain control particularly in the first 24h, patients who received intrathecal nalbuphine (ITN) had significantly fewer incidence of PONV, and shorter LHS.

Comparative evaluation of single versus double leg raise maneuver in high-resolution esophageal manometry.

The straight leg raise (SLR) maneuver, often performed during esophageal manometry, requires patients to lift their leg(s) to augment intraabdominal pressure (IAP). Diverse techniques have been applied for SLR. This study aimed to evaluate and compare the effects of SLR between single and double leg raises. During esophageal manometry, patients were asked to raise one leg, followed by elevating both legs. The efficacy of SLR for (1) detecting hiatal hernia, (2) increasing IAP, and (3) predicting gastroesophageal reflux disease (GERD) with intraesophageal pressure (IEP) was assessed. The value of change in impedance to indicate reflux during SLR in predicting esophageal acid exposure was investigated. The leg raise procedures were performed in 86 patients undergoing high-resolution esophageal manometry. Both the single and double leg raises exhibited a higher hiatal hernia detection rate compared to the landmark (p = 0.008 and 0.005, respectively). Double leg raise was more effective in raising IAP by >50% compared to single leg raise (100% vs. 65.1%, p < 0.001), increasing yield by 53.6%. The change in IAP showed a positive correlation with the change in IEP during double leg raise (r = 0.31; p = 0.004), higher than that for single leg raise (r = 0.23; p = 0.03). Lower intraesophageal impedance during SLR was associated with AET > 6% with double leg raise (1.5 kΩ vs. 2.5 kΩ, p = 0.04). Our study demonstrates the efficacy of both single and double leg raise maneuvers during HREMI in increasing hiatal hernia detection and possible value in predicting GERD. The double leg raise resulted in a higher rate of effective increase in IAP, potentially enabling more patients to undergo effective SLR during HREMI.

The Low Back Pain - Looking For a Physiotherapeutic Approach

BACKGROUND: Low back pain (LBP) is one of the most common neurological complaints. It affects young people but has a slow progression even at a later age. LBP is a condition with a rich clinical picture – pain, severely limited range of motion in the spinal column (especially in the area of the L4-L5 segment) and sacro-iliac joints, difficulty walking. Physiotherapy has an essential role in maintaining the general condition and improving the quality of life for this contingent of patients. AIM: The aim of the present study is to create and approve a physiotherapy methodology for pain reduction in patients diagnosed by a neurologist – radiculitis of the lumbo-sacral plexus. METHODS: 20 clinically proven patients divided into two groups were included in the study. After signing informed consent declarations and assessment of anthropometric data (age, height, and weight), the subjects were evaluated with neurological tests such as Lasegue test and dolorimetry. Results were also reported on the Barthel index scale. RESULTS: The dynamics of dolorimetry results, quality of life, and mobility in the spine area (especially the lumbar segment) were monitored in the two studied groups, with the results in the experimental group demonstrating better values (p &lt; 0.0001). CONCLUSION: There is no unified system for pain reduction in patients with LBP. As a result of applied physiotherapy, including modern techniques for myofascial massage, a faster increase in joint mobility in the area of the spine and sacroiliac joints, an improvement in muscle strength and, above all, a reduction in pain symptoms were found.

The Effects of TMR® Fab 6 on Hamstring Flexibility in Healthy Subjects; An Exploratory Observational Investigation.

Stretching programs are designed to improve hamstring flexibility by attempting to mechanically increase the length of the target tissue. However, other manual treatment approaches such as those utilized in Total Motion Release (TMR®), could be beneficial by identifying body asymmetries to assess and treat soft tissue impairments leading to diminished extensibility. The purpose of this study was to determine the effectiveness of the TMR® Fab 6 assessment and treatment to increase hamstring flexibility in healthy participants following one session of TMR®. Observational Cohort study. A convenience sample of 20 healthy participants (10 males, 10 females) were recruited from three institutions. Following collection of demographic information and a brief medical history, each participant performed a five minute warm-up on the stationary bike at a moderate intensity (80-90 RPMs) followed immediately by the bilateral performance of the Active Knee Extension Test (AKET) and Passive Straight Leg Raise (PSLR) to assess hamstring muscle length. Participants were randomly placed in the TMR® or control group. The TMR® group completed the "Fab 6" evaluation and treatment, while the control group performed one repetition of standing active hip flexion every 30-seconds for 15-minutes with both knees in full extension. Upon completion of treatment, control and TMR® groups were immediately re-evaluated on the AKET and the PSLR in the same order and fashion as baseline testing. Participants were asked to return in 24-hours for the same objective measurements as previously described. A significant time by group interaction was identified across all variables (p ≤ 0.001) for AKET and PSLR except the PSLR preferred leg from post-treatment to 24hr follow-up. The most significant increase in the AKET occurred in the TMR® group between baseline and post-treatment of the non-preferred leg (12.15°±2.94) when compared to the control group (7.15°±1.56). The results of the study suggest that implementing a regionally interdependent treatment approach like TMR® results in significant improvements in hamstring extensibility and hip ROM compared to the control group. 3.

Ambulation During Neuraxial Analgesia in Obese Patients: A Pilot Study

Objective: Obese patients are known to have prolonged labors and an increased risk of cesarean delivery in comparison to their normal weight counterparts. Movement has previously been shown to have beneficial effects on the labor process; however, neuraxial analgesia is often recommended in obese women and in common practice limits mobility. The benefits of continuing to ambulate during neuraxial analgesia are not known. As prior studies have postulated a soft tissue dystocia as a potential etiology for prolonged labor among obese patients, ambulation and encouraged movement throughout the labor process may be of particular benefit for these patients. The purpose of this study was to evaluate the feasibility of ambulation with neuraxial analgesia in nulliparous obese patients admitted for labor. Study Design: This is a pilot study conducted at a single tertiary care center. Patients with a BMI of &gt;=35 were approached if they were nulliparous, term, and planned vaginal trial of labor. Patients were excluded if there were contraindications to ambulation, including magnesium administration. Participants were identified at &gt;=34 weeks estimated gestational age through clinic templates and induction of labor schedules, and were approached either in person or with a standard phone consent. Combined spinal-epidural analgesia was initiated per our institution’s policy, with the exception that during the latter portion of the study the test dose was eliminated in order to decrease the immediate motor block from this dose. Following epidural catheter placement, serial blood pressure measurements and motor assessments were completed to ensure safety including a straight leg test and a step stool test. Patients who passed these assessments were enrolled in the trial. Patients were encouraged to ambulate for 20 minutes of every hour while maintained on fetal and uterine telemetry. Ambulation was discouraged after complete dilation. Demographics and delivery outcomes were collected. Results: 105 patients were identified for consent for the trial, of whom 20 were ineligible for the study, 20 were not approached, and 40 declined study participation, leaving 25 patients who were consented. Of those 25, 14 completed the study. Reasons for not completing the study included ineligible by motor assessment, BMI less than 35 at time of delivery admission, preterm delivery, withdrawal, complete dilation at time of epidural without time to ambulate, magnesium administration during labor. A total of 14 participants were enrolled in the pilot trial, of which 11 were able to ambulate. The average BMI of participants was 43 kg/m2. Patients received epidural analgesia at a median cervical dilation of 4 cm and the average time from initiation of epidural analgesia to delivery was 15.4 hours. 65% of patients enrolled had a cesarean delivery. Of the 5 patients with a vaginal delivery, there was 1 shoulder dystocia. The median time spent ambulating was 58.5 minutes, with a range of 20-230 minutes. No patients fell during the trial. While one patient developed a spinal headache, it was not thought to be related to ambulation. Conclusions: A pilot trial of ambulation during neuraxial analgesia demonstrated no safety concerns among an obese nulliparous population. This pilot study was underpowered and is not designed to determine if there is an effect of ambulation with neuraxial analgesia on mode of delivery. Strengths of this study were interdisciplinary collaboration and biologic plausibility of decreased cesarean delivery through ambulation. Limitations included a low enrollment rate and the COVID pandemic, which halted the study as well as limited patients from being able to ambulate in the hallways. A larger study is needed to assess the efficacy of this intervention.

Prognosticating Return-To-Play Time Following a Hamstring Strain Injury Using Early Flexibility Asymmetry and Musculoskeletal Ultrasound Imaging Outcomes: An Exploratory Study Among Canadian University Football Players.

Identify key flexibility and point-of-care musculoskeletal ultrasound (POCUS) measures for prognosticating return-to-play (RTP) following a first hamstring strain injury (HSI) and informing the clinical decision-making process. Exploratory prospective cohort study. Sport medicine and rehabilitation clinic of a Canadian university. One hundred and sixty-seven elite Canadian university football athletes followed over 5 seasons. Clinical and POCUS measures collected within 7 days after HSI and preseason clinical measures. Active knee extension (AKE) and Straight Leg Raise (SLR) to quantify hamstring flexibility, POCUS-related outcomes to characterize tissue alteration, and RTP until full sport resumption were documented (categorized as Early [1-40 days] or Late [>40 days] RTP). A total of 19 and 14 athletes were included in the Early RTP (mean RTP = 28.84 ± 8.62 days) and Late RTP groups (mean 51.93 ± 10.54 days), respectively, after having been diagnosed with a first HSI. For the clinical results, height and a greater flexibility asymmetry measure with the AKE or SLR when compared with both ipsilateral preseason and acute contralateral values significantly increases the chance of facing a long delay before returning to play (ie, RTP). For the POCUS-related results, the Peetrons severity score, extent of the longitudinal fibrillary alteration, and novel score lead to similar results. Early hamstring flexibility asymmetry following acute HSI, particularly the AKE, along with some POCUS-related measures are valuable in prognosticating late RTP following among Canadian university football athletes.

Lumbar and Cervical Concurrent Muscle Activity Analysis During Hamstring Length Testing to Design a Customized Treatment Plan: An Observational Cross-Sectional Study.

Hamstring length plays a significant role in a spectrum of clinical entities, from injury prevention and gait dysfunction to posture correction. Evidence suggests that the prevalence of hamstring tightness (HT)/reduced length is increasing. Despite the number of available tests and treatment protocols, HT is still a functional diagnosis. This study's primary goal is to evaluate concurrent muscle (CM) usage during these testing procedures to design a unique, customized treatment protocol. The study was conducted in two stages. In phase 1, Active Straight Leg Raise (ASLR), Active Total Knee Extension (ATKE), and Active Seated Total Knee Extension (ASTKE) were carried out. Next, two pressure gauges (PGs) were placed to align with the natural lumbar and cervical curvatures while testing ASLR and ATKE. After analyzing the results for pressure gauge placement, phase 2 data were collected for tests ASLR and ATKE with PG. The results of ASLR and ATKE, both with and without PG, indicate a high prevalence rate, whereas the results of ASTKE show no prevalence. Changes in the PG values indicate CM usage. Dichotomization revealed that participants with normal test scores (non-HT group) had increased usage of CM work. Positive and negative changes in PG indicate the involved CM group. In regular practice, most healthcare professionals and fitness trainers prefer ASTKE due to the ease of the testing procedure. Directing co-professionals on their choice of tests is challenging, whereas providing knowledge about CM use paves the way for creating customized treatment plans.

Effect of Digital Therapeutics on Range of Motion, Flexibility, Dynamic Balance, Satisfaction, and Adherence: A Randomized Controlled Trial

This study investigated the effect of digital therapeutics on ROM, flexibility, dynamic balance, satisfaction, and adherence. A sample of 34 volunteers was randomly assigned into a Digital Therapeutic Group (DTG) (n = 17) and a Non-Digital Therapeutic Group (NDG) (n = 17). The groups performed four calf muscle stretches and two hamstring stretches for 4 weeks. Flexibility and balance were evaluated to assess the effectiveness of the exercise program. A survey was conducted to assess subjects’ satisfaction, and exercise performance record papers and video records were assessed for exercise adherence. The paired t-test was used to compare the two populations before and after the program. The independent t-test was used to compare the change scores between groups. In the pre- and post-comparison within each group, the DTG group showed significant differences in all items except the dorsiflexion range of motion (ROM) (p &lt; 0.05). The left straight leg raise (SLR) was significantly different (p &lt; 0.05), and there was a significant difference in exercise satisfaction and participation between the two groups (p &lt; 0.05). DTG showed improved flexibility, dynamic balance, and higher exercise satisfaction and adherence than NDG. The application, providing lower extremity stretching, can improve dorsiflexion ROM, flexibility of the lower extremity, dynamic balance, exercise satisfaction, and exercise adherence.

Effects of Pelvic Floor Muscle Contraction on Abdominal Muscle Activity and Pelvic Rotation Angle during Active Straight Leg Raise: Cross-Sectional Study

Effects of Pelvic Floor Muscle Contraction on Abdominal Muscle Activity and Pelvic Rotation Angle during Active Straight Leg Raise: Cross-Sectional Study

Reliability of range of motion in straight leg raise and hip extension tests among healthy young adults using a smartphone application

IntroductionMeasuring range of motion (ROM) is an important skill for clinicians because it can help in the accurate interpretation of a patient's condition. Recently, ROM tests using smartphone applications have been performed in clinical settings, with the tests demonstrating high reliability and validity. This study aimed to identify the usefulness of ROM tests conducted using smartphone applications by examining the reliability of straight leg raise (SLR) and hip extension (HE) tests. MethodsThis cross-sectional observational study included 72 lower limbs of 36 participants (19 men and 17 women; mean age, 21.6 ± 0.8 years). Passive SLR-ROM and HE-ROM were measured in 1° increments using an iPhone goniometer (IG). Intra-rater and inter-rater reliabilities were calculated using intraclass correlation coefficients (ICCs). ROM test systematic error was confirmed using Bland–Altman analysis, and ROM measurement error was calculated. ResultsThe ICCs of the IG ROM tests were 0.820 or higher. According to Bland–Altman analyses, SLR-ROM and HE-ROM did not acknowledge fixed and proportional biases. Thus, ROM measurement error was calculated as the minimal detectable change (MDC). The intra-rater and inter-rater MDC 95% confidence interval (MDC95) values of SLR-ROM were 3.3° and 10.2°, respectively. The intra-rater and inter-rater MDC95 values for HE-ROM were 3.9° and 9.6°, respectively. ConclusionIG ROM tests were highly reliable, simple, and easy to perform. SLR-ROM and HE-ROM tests conducted using smartphone applications may be useful indices for clinical decision-making.

Comparison of Analgesic Efficacy of Continuous Adductor Canal Block versus Single-shot Adductor Canal Block Using Ropivacaine for Unilateral Total Knee Arthroplasty: A Randomized Controlled Trial

Abstract Context: Total knee arthroplasty (TKA) associated with moderate-to-severe surgical site pain postoperatively requires multimodal analgesia for which adductor canal block (ACB) is an effective modality. Aims: The aim of this study was to compare the analgesic efficacy of continuous versus single-shot ACB in patients undergoing unilateral TKA. Settings and Design: It was a prospective randomized controlled trial carried out in a tertiary care hospital. Materials and Methods: Sixty patients (18–65 years) undergoing unilateral TKA were prospectively randomized into continuous (CACB) and single (SACB) shot adductor canal blockade groups. Postoperative ultrasound-guided ACB was given, and the Visual Analog Scale (VAS) scores, time to first rescue analgesia, and total amount of analgesia required in 24 and 48 h were noted. Straight leg raise (SLR) test and maximum knee extension test were performed to check for quadriceps muscle strength. Statistical Analysis: Both the groups were compared using appropriate statistical tests, with P &lt; 0.05 considered statistically significant. Results: In both the demographically comparable groups, VAS scores were similar at 0, 4, 8, and 12 h postsurgery, but higher in the SACB group at 24 (P &lt; 0.0001) and 48 h (P = 0.02), needing rescue analgesia in 4 out of 30 patients. One out of 30 patients of the SACB group could not perform the SLR test on the 1st postoperative day. Knee extension was present in all 60 patients. Conclusions: ACB is a pure sensory block. CACB provides a longer duration of analgesia; however, SACB can be an equally useful alternative in resource-limited settings, to avoid catheter dislodgement, risk of infection, and need for continuous monitoring.