Treatment Of Musculoskeletal Conditions Research Articles

Does Radial Extracorporeal Shockwave Therapy Applied to the Achilles Tendon Influence Ankle Functionality?

This study aimed to determine the effectiveness of radial extracorporeal shockwave therapy (rESWT) in enhancing ankle function in patients with Achilles tendon injuries. The choice of rESWT was based on previous success in the treatment of musculoskeletal conditions. The study involved an intervention group that received rESWT, and a control group that received sham therapy. The results revealed that rESWT led to significant improvements in single-leg vertical jump (d = 0.55, p < 0.05), indicating enhanced power generation and ankle functionality that were not observed in the control group. Additionally, the therapy resulted in increased ankle mobility, as observed by improvements in plantar flexion and heel-rise tests. Interestingly, these functional gains were not accompanied by changes in the Achilles tendon stiffness, suggesting that the benefits of rESWT may be more functional than structural. This study highlights rESWT as a promising tool for rehabilitation, particularly following Achilles tendon injuries. The study concluded that, although rESWT appears to improve certain aspects of ankle function, further studies with a larger and more diverse population over a longer period are necessary to confirm these findings and establish comprehensive treatment protocols.

Polyimide biocomposites coated with tantalum pentoxide for stimulation of cell compatibility and enhancement of biointegration for orthopedic implant

Orthopedic implants are an important tool in the treatment of musculoskeletal conditions and helped many patients to improve their quality of life. Various inorganic-organic biocomposites have been broadly investigated particularly in the area of load-bearing orthopedic/dental applications. Polyimide (PI) is a promising organic material and shows excellent mechanical properties, biocompatibility, bio-stability, and its elastic modulus is similar to human bone but it lacks bioactivity, which is very important for cell adhesion and ultimately for bone regeneration. In this research, tantalum pentoxide (Ta2O5) coating was prepared on the surface of PI by polydopamine (PDA) bonding. The results showed that Ta2O5 was evenly coated on the surface of PI, and with the concentration of Ta2O5 in the PDA suspension increased, the content of Ta2O5 particles on the surface of PI increased significantly. In addition, the Ta2O5 coating significantly increased the roughness and hydrophilicity of the PI matrix. Cell experiments showed that PI surface coating Ta2O5 could promote the proliferation, adhesion, and osteogenic differentiation of bone marrow-derived stromal cells (BMSCs). The results demonstrated that fabricating Ta2O5 coating on the surface of PI through PDA bonding could improve the biocompatibility as well as bioactivity of PI, and increase the application potential of PI in the field of bone repair materials.

Effectiveness of TECAR Therapy and Therapeutic Exercise in the Treatment of Musculoskeletal Conditions: A Review Article

Effectiveness of TECAR Therapy and Therapeutic Exercise in the Treatment of Musculoskeletal Conditions: A Review Article

Effectiveness of TECAR Therapy and Therapeutic Exercise in the Treatment of Musculoskeletal Conditions: A Review Article

Effectiveness of TECAR Therapy and Therapeutic Exercise in the Treatment of Musculoskeletal Conditions: A Review Article

Using ultrasonography to improve fluoroscopic needle navigation in PM&R residents and medical students; a Randomised study

BackgroundFluoroscopy guided interventions are widely used procedures in the treatment of musculoskeletal conditions. Understanding the movement of the needle is part of a resident's initial training when performing these procedures. Needle navigation training is largely gained with fluoroscopy. ObjectiveThe purpose of this study is to determine whether the use of ultrasound training can lead to a decrease in time to reach a target under fluoroscopy. Methods32 medical students or residents. Exposure of one group of trainees to a practice session of needle navigation using ultrasound. The control group did not participate in ultrasound training. Time to reach the target during a fluoroscopy guided needle navigation test was measured in both groups. ResultsThe mean time to reach the target under fluoroscopy of the students unexposed to an ultrasound training (group 1 control group) was 183 ​s (standard deviation ​= ​160 ​s), while that after ultrasound training (group 2 experimental group) was 150,81 ​s (standard deviation ​= ​96 ​s) (p ​= ​0,483) ConclusionFluoroscopy needle navigation training was not improved by a 1-h group practice session with in-plane ultrasound needle navigation practice. Further studies need to be done with exposure for residents to a group practice session longer than 1-h

Pengaruh Lower Limb Tension Test Terhadap Penurunan Nyeri Terhadap Nyeri Punggung Bawah di RSUD KRMT Wongsonegoro

Background: Lower back pain (NPB) Ischialgia is a pinched ischialgia nerve in the lower back area which causes the buttocks, thighs, lower legs and even feet to become tingling, painful, and sometimes causing weakness. Nerve mobilization is a manipulation technique by moving and stretching nerve tissue to increase axonal transportation so that it can improve nerve conduction. Nerve mobilization can reduce the pressure in the nerves so that there is an increase in blood flow to the nerves, which can have a regenerative and healing effect on injured nerves (Butler, 1991). Nerve mobilization is often used as a form of diagnosis and treatment for musculoskeletal conditions with nerve involvement (Butler, 1991). Nerve mobilization in the Lower Limb Tension Test (LLTT) is carried out at the branches of the Brachial plexus such as the radial nerve, median nerve and ulnar nerve. But here the author only discusses LLTT in the ishiadic nerve, namely LLTT 1 which is related to lower back pain.&#x0D; The aim is to determine physiotherapy management and the effect of Ultrasoundtherapy therapy and nerve mobilization using the LLTT 1 method in cases of lower back pain on reducing pain and increasing the functional ability of the hand. Two group pre test and post test method. RESEARCH PLACE: Physiotherapy clinic, RSU Sidoarjo. TIME: Measuring instrument: Visual Analouge Scale (VAS). Results: treatment using the Mann-Whtney test. With confidence interval (CI) (95%) The results of the study revealed that there was a significant difference in pain in group 1 (p = 0.00) and group 2 (p = 0.00). But there was no significant difference between the two groups in pain improvement (p = 0.152), so there was no better treatment between the two groups. Conclusion: It is concluded that ULTT is useful in treating CTS patients to reduce pain in two groups. The targeted outcomes are publications in national journals indexed by Sinta and HAKI. The TKT target for implementing this gamelan accompaniment exercise is level 2.

Reader Response: Spinal Cord Injury, Vertebral Artery Dissection, and Cerebellar Strokes After Chiropractic Manipulation

We read with interest the case in which a “chiropraxis session” resulted in a severe C5-C6 fracture, associated with spinal cord injury, vertebral artery dissection, and cerebellar infarction.1 First, it is important to emphasize that chiropractic is a profession, not just a technique. Chiropractors are qualified for the diagnosis and treatment of musculoskeletal conditions and show effectiveness for the management of acute and chronic neck or back pain, with or without neurologic impairment.2

Study on the effects of the use of therapeutic ultrasound in the treatment of osteoarticular diseases

Introduction. The use of therapeutic ultrasounds is a method that proved its efficiency in articu-lar and periarticular pathology, in the subacute and chronic stages. The biological effects of the ultrasound use are determined by their interaction with the cellular structures whereas the re-sults depend on the used parameters. The purpose of the survey is to evaluate / identify the ef-fects of using ultrasounds in the treatment of musculoskeletal conditions (lumbar discopathy), knee osteoarthritis). Material and method. The survey was conducted on an outpatient basis in a period of 7 months and it is of the longitudinal type. It included 151 patients diagnosed with low back pain and knee osteoarthritis. The evaluated parameters were: pain, functional skills, articu-lar rigidity and the quality of life. Results. The effects of the use of ultrasounds is found in the decrease of pain, the stiffness of the joints and the contracture of the muscles, as shown by the re-sults of several surveys. Our survey proves that the use of ultrasounds decreases pain and in-creases the functional skills, it influences the physical function more obviously in patients with knee osteoarthritis, which is an aspect found in others surveys. Discussion. The use of a complex ultrasound treatment (in the pulsed way to avoid thermal effects) and kinesiotherapy enabled in our research the decrease of the pain and of the rigidity in the joints, the increase of the function-al skills and the quality of life, whereas these obtained results are in accordance with those of others surveys. Conclusions. The use of the therapeutic ultrasounds can have the following ef-fects: the decrease of the pain and of the joint rigidity, the improvement of the physical capacity for daily activities and the improvement of the quality of life. The use of low intensity ultra-sounds can determine biological effects with actions for a short period or for an average one. Keywords: therapeutic ultrasound, treatment, osteoarticular diseases, quality of life

Adverse Events of Thread Embedding Acupuncture for the Musculoskeletal Conditions and Diseases: A Narrative Review of Clinical Studies

This study aimed to analyze the status of adverse events (AEs) in the treatment of musculoskeletal conditions/ diseases using thread embedding acupuncture (TEA). Five electronic databases were searched to retrieve data on clinical studies published in the last 5 years (2016 to 2021). Of the 151 studies retrieved, 22 studies analyzed AEs and were selected for this review. There were no AEs reported in 6 studies (27.3%); of the remaining 16 studies, 4 studies (18.2%) reported AEs that were not related to TEA. The most common AEs reported in the Chinese studies were redness of skin with/without swelling and tingling sensation, and in the Korean studies they were stiffness, a foreign body sensation, and bruising. The percentage of patients with AE experience was 5.1% in the Chinese studies and 19.9% in the Korean studies. The discrepancies between the findings in the Chinese and Korean studies may be attribute to differences in the diameter of needles, thread materials, TEA treatment procedure, and evaluation methods for AEs. Most of the reported AEs were of a mild status and did not last for a long time. However, further research on the clinical course after TEA treatment is needed.

Patients' attitudes toward alternative medicine as a treatment for musculoskeletal conditions: One center's experience

Patients' attitudes toward alternative medicine as a treatment for musculoskeletal conditions: One center's experience

Current Trends in Orthobiologics: An 11-Year Review of the Orthopaedic Literature

Background: The use of “orthobiologics” or regenerative therapies in orthopaedic surgery has grown in recent years. Particular interest has been raised with regard to platelet-rich plasma, bone marrow aspirate, adipose-derived cells, and amniotic cells. Although studies have analyzed outcomes after orthobiologic treatment, no study has analyzed how the literature as a whole has evolved. Purpose: To evaluate trends in platelet-rich plasma, bone marrow aspirate, adipose-derived cells, and amniotic cell publications and to assess how these might inform efforts to establish minimum reporting standards and forecast future use. Study Design: Systematic review; Level of evidence, 4. Methods: A database was compiled systematically using PubMed to identify articles published between 2009 and 2019 within 9 prominent orthopaedic journals and pertaining to the use of platelet-rich plasma, bone marrow aspirate, adipose-derived cells, and amniotic cells in the treatment of musculoskeletal conditions. Included articles were classified as clinical, nonclinical (translational or basic science), or review, and a variety of study parameters were recorded for each. Additional queries were performed to identify articles that utilized minimum reporting standards. Results: A total of 474 articles (132 clinical, 271 nonclinical, 71 review) were included, consisting of 244 (51.5%) platelet-rich plasma, 146 (30.8%) bone marrow aspirate, 72 (15.2%) adipose-derived cells, and 12 (2.5%) amniotic cells. The greatest annual increase in publications for each orthobiologic topic was from 2018 to 2019. The American Journal of Sports Medicine demonstrated the highest number of overall (34.2%) and clinical (50.0%) publications, and accounted for 44.3% of all platelet-rich plasma publications. The Journal of Orthopaedic Research accounted for the second highest overall number of publications (24.9%) and highest nonclinical publications (41.0%). Platelet-rich plasma accounted for 91.5% of all level 1 clinical studies, while much greater than half of bone marrow aspirate, adipose-derived cells, and amniotic cell publications were level 3 or lower. Out of the 207 articles that used some form of reporting protocol, 59 (28.5%) used an established algorithm and 125 (60.4%) used their own. Conclusion: Interest in orthobiologics continues to grow, as evidenced by an increasing trend in publications over an 11-year period. However, current reporting on orthobiologic formulations is largely heterogeneous, emphasizing the need for minimum reporting standards and higher-quality studies.

Exploring the Effectiveness of Acupuncture as an Adjunct to Physiotherapy in the Treatment of Musculoskeletal Conditions: A Systematic Review

Background: Acupuncture is one of the most popular forms of complementary and alternative medicine, and its usage is linked to an improvement of physical and psychological symptoms. Main Objectives: Determine whether the use of acupuncture as an adjunct to physiotherapy treatment is more effective than physiotherapy alone or acupuncture alone in MSK conditions. Methodology: A systematic review of the literature was conducted using three major databases, from March 2019 to May 2019, i.e., Cochrane Library, PubMed, and PEDro (Physiotherapy Evidence Database). The inclusion criteria were limited to randomized controlled trials (RCT) published in English, only studies published within the past decade, and investigating adult populations with MSK conditions. Results: From the 227 titles and abstracts that were identified, 75 were duplicates, leaving us with 152 studies for the initial screening. Eight studies [13-20] were included in this review for a qualitative analysis. The studies that assessed pain did not found statistically significant results that support the combination of physiotherapy and acupuncture, the same results were also obtained for Range of motion in knee osteoarthritis. Muscular tension was found statistically significant within-group improvements for all parameters in comparison with the baseline. For Isometric Neck Muscle Strength (INMS), the studies reported significant improvements within the groups, with Physiotherapy combined with Acupuncture being more effective than Acupuncture or Physiotherapy alone. The Constant Shoulder Assessment (CSA), for shoulder function was significantly higher in the exercise plus acupuncture group compared with the exercise group. Conclusion: As an integrative or complementary therapy for pain, acupuncture has been increasingly used. However, this review did not find significant evidence to support that the addition of acupuncture to physiotherapy treatment has an added benefit to pain relief. This review did, however, find benefits of adding acupuncture to treatment to reducing neck disability and improving muscular strength and shoulder function.

Extracorporeal Shockwave Therapy in the Management of Sports Medicine Injuries.

Treatment of musculoskeletal conditions in athletes with extracorporeal shockwave therapy (ESWT) is gaining popularity as greater evidence supports its use. ESWT protocols (describing energy flux density, number of impulses, type of shockwave (focused or radial), number/frequency/duration of treatment session, area of application, and postprocedural therapy protocols) can be adjusted in the clinical setting. Protocols vary across studies, and optimal protocols for most indications are yet to be determined. ESWT can safely be used to treat various musculoskeletal conditions in athletes, including rotator cuff tendinopathy, lateral elbow epicondlyopathy, greater trochanteric pain syndrome, hamstring tendinopathy, patellar tendinopathy, Achilles tendinopathy, other tendinopathies, plantar fasciopathy, bone stress injuries, and medial tibial stress syndrome. ESWT can be used to treat in-season athletes, as it often requires no/minimal time away from sport and may result in rapid benefits. ESWT should be used in conjunction with physical therapy to facilitate longer-term gains in function and to optimize healing.

Design and Preliminary Implementation of an Air Microfluidics Enabled Soft Robotic Knee Brace Towards the Management of Osteoarthritis.

A dynamic and low-profile unloader tibiofemoral knee brace is designed and prototyped by synergizing concepts from the fields of microfluidics and soft robotics. Microfluidics provides strategies for miniaturization and multiplexing while soft robotics afford the tools to create soft fluidic actuators and allow compliant and inherently safe robotic assistance as part of clothing. The unloader knee brace provides dynamic response during the gait cycle, where a three-point leverage torque is provided only during the stance phase to contribute to joint stability when required and enhance comfort and compliance.Clinical Relevance- This novel soft robotic brace has the potential to reduce device abandonment due to aesthetics, user non-compliance and discomfort due to a constant three-point leverage torque during the gait cycle. Also, this air microfluidics enabled soft robotic knee brace could be expanded upon to improve the efficacy of braces in general and augment the effects of physical therapy, rehabilitation and treatment of musculoskeletal conditions.

Taping, Bracing, and Injection Treatment for Patellofemoral Pain and Patellar Tendinopathy.

This article will focus on additional treatment options for the two most common causes of anterior knee pain, patellofemoral pain syndrome, and patellar tendinopathy. Conservative management is the first-line treatment for these conditions. For clinicians to maximize the efficacy of conservative treatment options for their patients, they must understand the most up-to-date literature evaluating the potential benefit of taping, bracing, and injections as adjunctive treatments for maximizing treatment success. Recent studies of bracing and taping have found them to be helpful for patients in the short-term management of pain and improving function. However, less is known about their exact mechanism but studies are encouraging that they have a subtle role in changing patellofemoral biomechanics. Injections remain a commonly used treatment for musculoskeletal conditions; however, the evidence for their use in patellofemoral pain and patellar tendinopathy is limited. The use of platelet-rich plasma (PRP), sclerosing, high volume, or stem cell injections is an exciting new area in the treatment of patellar tendinopathy. However, evidence at this time to recommend these treatments is lacking, and more well-designed studies are needed. The treatment of patellofemoral pain and patellar tendinopathy consists of a multi-faceted approach of physiotherapy and physical modalities. There is evidence for short-term use of taping and bracing for these conditions. The evidence for injections at this time is limited and remains under investigation. Future well-designed randomized controlled studies will provide insight into the efficacy of several different types of injections in the treatment of patellar tendinopathy. Physicians should feel comfortable integrating taping and bracing into their anterior knee pain treatment paradigm while making cautious use of invasive injections as adjunctive therapy.

Platelet-Rich Plasma Is an Equal Alternative to Surgery in the Treatment of Type 1 Medial Epicondylitis.

Background:Medial epicondylitis (ME) is characterized as an overuse injury resulting in pathological alterations of the common flexor tendon at the elbow. Platelet-rich plasma (PRP) has recently become of interest in the treatment of musculoskeletal conditions as an alternative to operative management.Purpose:To compare the outcomes of recalcitrant type 1 ME after treatment with either PRP or surgery.Study Design:Cohort study; Level of evidence, 3.Methods:To compare the 2 methods of treatment, we performed a retrospective review of 33 patients diagnosed with type 1 ME from 2006 to 2016 with a minimum clinical follow-up of 1 year who had failed an initial nonoperative treatment program of injections, medication, topical creams, and/or physical therapy. Overall, 15 patients were treated with a series of 2 leukocyte-rich PRP injections, and 18 patients were treated with surgery. Outcome measures included time to pain-free status, time to full range of motion (ROM), the Mayo Elbow Performance Score (MEPS), and the Oxford Elbow Score (OES). Each patient had at least 1-year follow-up. They were then contacted by telephone to determine final scores at a minimum 2-year follow-up. Unsuccessful outcomes were determined by the Nirschl grading system and failure to reach pain-free status, achieve baseline ROM, or return to previous activity.Results:The mean final follow-up was 3.9 years. A statistically significant improvement was noted in both time to full ROM (42.3 days for PRP vs 96.1 days for surgery; P < .01) and time to pain-free status (56.2 days for PRP vs 108.0 days for surgery; P < .01). Successful outcomes were observed in 80% of patients treated with PRP and 94% of those treated operatively (P = .37). No significant difference was found in return-to-activity rates, overall successful outcomes, MEPS scores, or OES scores.Conclusion:In this case series, the use of PRP showed clinically similar outcomes to those of surgery in recalcitrant type 1 ME. PRP can be considered as an alternative to surgery in the treatment of recurrent ME, with an earlier time to full ROM and time to pain-free status compared with surgery.

Ultra-Low-Level Laser Therapy and Acupuncture Libralux: What Is so Special?

Background: Contrary to the most credited theories on laser therapy that see power/energy as the major factors to its effectiveness, a technique using an extremely low power/energy laser stimulation to treat musculoskeletal pain and dysfunction is proposed. The stimulus consists of a 20 s train of modulated pulses with an average power below 0.02 mW and is applied on sequences of acupuncture points selected according to the impaired segment of the patient’s body. Methods: Modifications on the extracellular soft tissue matrix and on the “fascia” were sonographically demonstrated. Laboratory and clinical tests confirmed the effectiveness. Results: Responses similar to those experienced in acupuncture were observed. The device—a CE Class IIa certified medical device named Libralux—affords a clinically proven effectiveness exceeding 80% in the treatment of musculoskeletal conditions and associated motor dysfunctions. An average of just three application sessions was generally sufficient to overcome the dysfunction. Conclusions: The development of the method is supported by over 20 years of R&D activities, with a range of experiments discussed in several papers published in indexed peer-reviewed journals. A few considerations regarding the possible physiological action mechanisms involved are proposed in this paper.

The Success Rate of Shock Wave in the Treatment of Musculoskeletal Conditions: A Systematic Review

AbstractBackground: Extracorporeal shock wave therapy (ESWT) is an effective and safe non-invasive treatment option for tendon and other pathologies of the musculoskeletal system.Aim of Study: To provide the physical therapist with an objective guideline about the success rate of shock wave in the treatment of musculoskeletal conditions.Methods: Systematic review and meta-analysis. Sources of data: PubMed, PEDro, Cochrane and science direct were searched from January 2007 till September 2017 for studies of any design investigating the effectiveness of ESWT in GTPS, PT, and AT. Citation tracking was performed using PubMed and Google Scholar. Animal and non-English lan-guage studies were excluded. A quality assessment was per-formed by 2 independent reviewers, and effect size calculations were computed when sufficient data were provided.Results: The meta-analysis of the selected studies revealed significant effects of the shockwave on the ligament, tendon, muscle and joint disorders.Conclusion: Shockwave either focused or radial has a significant effect in treatment of musculoskeletal disorders.

Reporting of Mesenchymal Stem Cell Preparation Protocols and Composition: A Systematic Review of the Clinical Orthopaedic Literature

Background: Mesenchymal stem cells (MSCs) are increasingly being used in the treatment of a wide variety of sports-related conditions. Despite this enthusiasm, the biological properties of MSCs and their effects on musculoskeletal tissue healing remain poorly understood. MSC-based strategies encompass cell populations with heterogeneous phenotypes isolated from multiple tissues and using different methods. Therefore, comprehensive reporting of the source, preparation methods, and characteristics of MSC strategies is essential to enable interpretation of results. Purpose: To perform a systematic review of levels of reporting of key variables in MSC preparation and composition for clinical studies evaluating MSC-based therapies in the treatment of musculoskeletal conditions. Study Design: Systematic review. Methods: A systematic review of the clinical orthopaedic and sports medicine literature from 2002 to 2017 was performed. The following inclusion criteria were used: human clinical trials, published in the English language, involving the administration of MSC-based therapies for orthopaedic or sports medicine applications. In vitro or ex vivo studies, editorials, letters to the editor, and studies relating to cosmetic, neurological, or dental applications were excluded. Results: Of the 1259 studies identified on the initial search, 36 studies were found to satisfy the inclusion criteria for analysis on comprehensive review. Fifty-seven percent of studies evaluated bone marrow–derived MSCs, 41% evaluated adipose-derived MSCs, and 2% evaluated synovium-derived MSCs. Considerable deficiencies in the reporting of key variables, including the details of stem cell processing, culture conditions, and the characteristics of cell populations delivered, were noted. Overall, studies reported only 52% (range, 30%-80%) of variables that may critically influence outcome. No study provided adequate information relating to all of these variables. Conclusion: All existing clinical studies evaluating MSCs for orthopaedic or sports medicine applications are limited by inadequate reporting of both preparation protocols and composition. Deficient reporting of the variables that may critically influence outcome precludes interpretation, prevents others from reproducing experimental conditions, and makes comparisons across studies difficult. We encourage the adoption of emerging minimum reporting standards for clinical studies evaluating the use of MSCs in orthopaedics.

A novel boswellic acids delivery form (Casperome®) in the management of musculoskeletal disorders: a review.

Standard pharmacological treatment of musculoskeletal conditions is often associated with relevant side effects. Botanical preparations endowed with a good tolerability profile, therefore, could have a role in the management of these disorders. Among different natural products, Boswellia serrata extracts have long been used for the treatment of musculoskeletal disorders, given their marked anti-inflammatory activity and their ability to promote tissue regeneration. However, standard preparations of Boswellia serrata show overall modest pharmacokinetic properties, a limitation which may ultimately lead to reduced efficacy. In an effort to improve the pharmacokinetic properties, Casperome®, a lecithin-based formulation of Boswellia serrata extract representing the whole natural bouquet, has been developed. This formulation was effective in the treatment of Achilles tendonitis, epicondylitis, radiculopathies, ankle sprains and sport injuries as shown in several clinical studies, the majority of which with a randomized design and all evaluating a number of well-recognized parameters of efficacy for the therapy of musculoskeletal disorder. All studies were consistent in showing a prompt decrease of pain and improvement of functionality of the affected area after supplementation with Casperome®, without any relevant adverse effect. Remarkably, these symptomatic improvements were paralleled by reduced plasmatic levels of inflammatory markers and by a diminished need for rescue analgesics. On these bases, Casperome® may have a role in the treatment of musculoskeletal disorders. Clinical studies in other similar conditions (e.g., osteoarthritis) appear warranted to further investigate the efficacy of this botanical product in more specific settings.