Review Article

Neck pain is one of the most common problems seen in medical practice. There are various factors that can cause or provoke neck pain. Myofascial trigger points in shoulder and neck regions are among the most effective factors that may provoke neck and head pain. Recently, it has been revealed that there is a clinical relationship between myofascial trigger points and joints dysfunction. Accordingly, different studies have been conducted in order to evaluate therapeutic effects of different manual approaches including mobilization and manipulation on improving Pressure Pain Threshold (PPT) as an indicator of changes in sensitivity of muscles. The aim of the present study was to conduct a narrative review to evaluate effects of manipulation and mobilization techniques of cervical spine on PPT in neck and shoulder muscles. From among different studies which have assessed the effectiveness of manual techniques directed on cervical spine, 10 most related studies were selected and the therapeutic approaches and results of these studies were studied. Review of these studies indicated that the application of manual techniques on cervical spine, such as manipulation and mobilization, could increase range of motion in cervical spine and even mouth opening according to relationship between cervical spine and tempromandibular joints. On the other hand, according to the relationship between joints and muscles, applying these techniques on cervical spines could improve PPT.

Keywords: Manipulation, Mobilization, Pressure Pain Threshold, Cervical Spine

Original Articles

Knee Muscle Reciprocal Co-Activation in Patellofemoral Pain Syndrome During Isokinetic Exercise: A Voluntary Response Index Analysis

Fahimeh Khaleghi, Gholam Reza Olyaei, Saeed Talebian, Kazem Malmir, Hosein Bagheri, Noureddin Nakhostin Ansari, Shohre Jalaie

Journal of Clinical Physiotherapy Research, Vol. 1 No. 1 (2016), , Page 6-11

Introduction: The origin of the Patellofemoral Pain Syndrome (PFPS) is not still completely clear and may have a biomechanical or biochemical cause. Motor control dysfunction may have a role in this condition. Voluntary Response Index (VRI) is able to show changes in the central nervous system motor output that occur with intervention, recovery, or progression of the disorder. Therefore, the outcomes may contribute to offer another tool for PFPS motor control evaluation. The aim of the present study, therefore, was to assess the changes in the quadriceps and hamstring reciprocal coactivation patterns that may be observed in individuals with PFPS using the VRI. Methods and Materials: A total of 24 female participants, 12 with sound knees and 12 with PFPS participated in the present study. The study was accomplished in the Biomechanics Laboratory at Rehabilitation School of Tehran University of Medical Sciences in 2015. The participants sat on a Biodex dynamometer. They were asked to perform 10 continuous knee extension and flexion motions with maximal strength at 45˚/s and 300˚/s, distinctly. Simultaneously, electromyographic activities of the vastus medialis (VM), vastus lateralis (VL), rectus femoris (RF), and biceps femoris (BF) were recorded and VRI was calculated. A two-way analysis of variance was run to assess the effect of group and velocity on the VRI (similarity index and magnitude). Results: There was no velocity or group main effect observed for the VRI (P>0.05). In addition, no significant velocity × group interaction was found for the VRI (P>0.05). Conclusion: PFPS may not be linked to altered quadriceps and hamstring reciprocal co-activation patterns during isokinetic exercise. In addition, angular velocity may not be an important parameter in voluntary motor control assessment during isokinetic exercise.

Keywords: Reciprocal co-activation; Voluntary response index; Patellofemoral pain syndrome; Isokinetic

Comparing the Effect of Voluntary and Electrical Fatigue of Quadriceps on Postural Control

Mostafa Cyrus, Mohammad Akbari, Mehdi Dadgoo, Zahra Teymuri

Journal of Clinical Physiotherapy Research, Vol. 1 No. 1 (2016), , Page 12-16

Introduction: Postural control is necessary for conducting all activities and is the result of corporation of somatosensory, visual and vestibular systems. Impairment in each of these systems leads to disturbance of postural control and increases the risk of falling and injury. Fatigue is one of the common conditions that can affect postural control. The aim of this study was to elucidate different effects of Electrical Stimulation (ES) and Voluntary (Vol) quadriceps fatigues on postural control. Methods and Materials: This cross-sectional randomized order of testing study was performed at Biomechanics Laboratory of Iran University of Medical Sciences, Tehran, Iran from December 2014 to May 2015. Sixteen healthy active males (24.5±1.36 yr; height: 155.37±53.79 cm and body weight: 70.93±4.5 kg) participated. All the participants underwent two fatigue protocols: ES and VOL contractions. Each fatigue procedure contains isometric contraction with five seconds holding contraction, two seconds rest between each contraction and intensity of voluntary contraction was 20% of Maximal Voluntary Contraction (MVC). In each fatigue protocols, muscles MVC decreased to 30% in both ES and VOL protocols. MVC and postural control measured by using a digital dynamometer and a force plate that registered the Canter of Pressure (COP). Data collected before and after completion of each fatigue protocol. Monopedal postural control was recorded in eyes closed condition. Results: Results did not show significance effect of fatigue on area and mean velocity while showed significant effect on the anterior-posterior (Y-axis) and on the mediolateral direction (X-axis). Conclusion: Thirty percent loss of MVC in quadriceps muscle did not impair postural control.

Keywords: Postural control, Quadriceps muscle fatigue, Voluntary contraction, Electrical stimulation

Pedobarography of the coper and non-coper ACL-deficient knee subjects during single and double leg stance

Abbas Rahimi, Narjes Soltani, Sedigheh Sadat Naimi, Khosro Kalantari Khademi, Hassan Saeedi

Journal of Clinical Physiotherapy Research, Vol. 1 No. 1 (2016), , Page 17-22

Introduction: Biomechanical studies have frequently shown a close relationship between the knee and ankle joint movements. ACL-deficiency may change the foot pressure pattern of the ACL-deficient knee subjects. The current study aimed to investigate the pattern of the foot pressure in coper and non-coper ACL-deficient knee subjects during standing on one and both feet. Methods and Materials: This case-control study was conducted on 12 coper and 12 non-coper ACL-deficient knee subjects and 25 age-sex matched healthy subjects. The subjects were tested barefoot during single and bilateral standing on the platform of a Zebris pedobarograph tool. The outcome measures included the measurements of the pressures of each part of the foot during the tests. Results: The results showed a significantly decreased total pressure only between the non-coper and control groups during double leg stance test. In terms of the forefoot pressure, a significant increased pressure was shown only in the non-coper ACL-deficient knee subjects during both single and double leg stance tests (P<0.05). In both test conditions, the coper ACL-deficient knee subjects showed forefoot and hind foot pressures very close to the control group (P>0.05). Conclusion: This study revealed marked changes following ACL-deficiency mainlyin non-coper ACL-deficient knee subjects. The increased forefoot pressure in non-coper ACL-deficient knee subjects was probably due to the forwarded line of gravity in these patients aligned with their base of support to keep their knees more stable. Further studies are needed to verify the differences between the male and female ACL-deficient knee subjects.

Keywords: Coper/non-coper ACL-deficient knee subjects; Stability; Pedobarograph; Foot pressure system; Postural control

Effect of 670 Nm Laser Beam on the Action Potentials of Sural Nerve in Healthy Individuals

Behroz Attarbashi Moghadam, Mohammad Reza Hadian, Hosein Bagheri, Golam Reza Oliaie, Saeed Talebian, Ali Arabkheradmand, Kamran Tavako, Maryam Rahele Dadras, Mohammad R Eshraghian, Fateme Ghiasi

Journal of Clinical Physiotherapy Research, Vol. 1 No. 1 (2016), , Page 23-26

Introduction: Low Level Laser (LLL) is being used in physiotherapy for pain relief in various pathologies and particularly on peripheral nerve entrapments. In the present study, the effect of LLL on the electrophysiological parameters of sural in humans was investigated. The results might be used as a basis for further clinical research in abnormal conditions. Methods and Materials: Thirty-eight normal men voluntarily participated in the current study and 670 nm LLL beam was applied to the left sural nerve at 5 points for 10 sessions. The electrophysiological parameters such as onset latency, peak latency, negative peak amplitude, peak to peak amplitude, and duration were measured before and after the application of LLL (0.5, 1.5 & 2.5 J/cm² energy density). Results: Overall, 670 nm laser beam increased the latency and reduced the nerve conduction velocity (NCV). In addition, LLL beam decreased the amplitude of action potentials. Among the various values of energy densities, application of 2.5 J/cm² had the most effective results (P < 0.001). Conclusion: These results might suggest that 670 nm laser beam could affect the latency and reduce the NCV in sural nerve of human. Probably, LLL affects the bioelectric and bioenergetic properties of the neural biomembrane. These findings might have clinical signlificance in non-surgical treatment of entrapment syndromes, such as carpal, tarsal syndromes and trigeminal entrapment in human. Further investigations are needed to elucidate the effects of LLL beam on the human peripheral nerves in pathological conditions.

Keywords: Low-level laser, Sural nerve, Electrophysiology, Pain

Postural and Musculoskeletal Disorders in Women with Urinary Incontinence: A Research Report

Farideh Dehghan Manshadi, Zinat Ghanbari, Elaheh-Sadat Miri, Hadi Azimi

Journal of Clinical Physiotherapy Research, Vol. 1 No. 1 (2016), , Page 27-31

Introduction: To investigate and compare the prevalence of some postural and musculoskeletal disorders in women with and without Urinary Incontinence (UI). Urinary Incontinence (UI) is one of the most important social and health problems in women. Limited studies have shown that UI prevalence is around 35%-55% in Iran. Nevertheless, to the best of our knowledge, there is no exact and reliable data reported in the literature on the prevalence of musculoskeletal, postural, or other related disorders in UI patients in Iran. Methods and Materials: The current study was conducted based on the data obtained from 166 incontinent and 90 continent women attending Vali-e-Asr University Hospital between 2010 and 2012. After collecting participants’ demographic information, postural status was assessed. In addition, we measured values for pelvic inclination and lumbar lordosis angles. Finally, vaginal tone and pelvic floor muscle strength and endurance were evaluated. Kolmogorov-Smirnov (K-S) goodness-of-fit, Independent t, X2, and Pearson correlation tests were used for the purposes of data analysis. Results: The prevalence of low back pain, chronic pelvic pain, and pelvic asymmetry were significantly higher in incontinent women compared with that in continent women (p<0.05). It was found that lumbar lordosis was significantly different between the two groups (P=0.021); however, no significant difference was observed regarding pelvic inclination (P=0.20). Conclusion: The present study confirms the hypothesis that incontinent women have higher prevalence of low back and pelvic pain and pelvic asymmetry. It is recommented that further epidemiologic and comprehensive etiologic investigations be conducted on these findings.

Keywords: Urinary Incontinence, Posture, Musculoskeletal Disorders, Women

Reliability of Rehabilitative Ultrasound Imaging In Measuring Thickness of Levator Scapula Muscle in Asymptomatic Women

Fateme Bokaee, Asghar Rezasoltani, Farideh Dehghan Manshadi, Sedighh Sadat Naimi, Fateme Etemadi, Alireza Akbarzadeh Baghban, Hadi Azimi

Journal of Clinical Physiotherapy Research, Vol. 1 No. 1 (2016), , Page 39-41

Introduction: Levator Scapula Muscle (LSM) is one of the stabilizers of the scapulae. Shortening of this muscle disrupts shoulder biomechanics and results in shoulder pain. Rehabilitative Ultrasound imaging (RUSI) has been introduced as a non-invasive method to measure muscle thickness. The present study aimed to determine the intra-rater reliability of RUSI to measure thickness of LSM in a group of asymptomatic women. Materials and method: Images of LSM were taken using RUSI at the level of the forth cervical vertebra in sitting position in 20 asymptomatic women aged 20-36 years. Images were obtained by one examiner on two separate days and muscle thickness was measured using RUSI. Intraclass Correlation Coefficients (ICC), Standard Error of Measurement (SEM), Smallest Detectable Difference (SDD), and Bland-Altman plot were used for the assessment of reliability. Results: The results of ICC (0.9), SEM (0.26 mm), and SDD (0.72 mm) values revealed an excellent intra-rater reliability and accuracy of RUSI to measure LSM thickness in asymptomatic women. Conclusion: The method of RUSI used in the current study is recommended to measure LSM thickness. It can be used to measure thickness of LSM in patients with shoulder pain where the thickness of the muscle varies according to the level of pain and spasm.

Keywords: Levator Scapula; Ultrasonography; Muscle; Reliability; Shoulder