Original Articles

Comparison of Vertical Ground Reaction Force during Walking in Patients with Sacroiliac Joint Pain and Healthy People

Akram Arezoomandi, Abbas Rahimi, Mehri Ghsemi, Alireza Akbarzadeh, Khosro Khademi Kalantari

Journal of Clinical Physiotherapy Research, Vol. 2 No. 3 (2017), , Page 99-103

Introduction: Vast majority of the muscular disorders are known to be related to Sacroiliac joint. Due to the main role played by Sacroiliac joint, the current study was conducted to examine the effect of the pain among the people suffering from Sacroiliac joint pain on the vertical ground reaction force parameter. Materials and Methods: This case control study was carried out on 19 participants with Sacroiliac joint pain, VAS 3-5 and average age of 27±5.7, and 19 subjects with normal health conditions and average age of 29±7.6. The relevant data were collected while the participants were asked to walk at their desired speed over the force plate located on their way. Later on, all the parameters of vertical ground reaction force in the stance phase were recorded. At the end, data collected were compared by independent T-test in SPSS. Results: The results of the study revealed that participants distributed in control (healthy individuals) and experimental (individuals with Sacroiliac joint pain) groups were significantly different regarding the parameters of time and speed required to reach the stage of weight transition to the heel. Discussion: Considering the findings, it can be concluded that some compensatory strategies were adopted by the individuals with Sacroiliac joint- related problems in order to decrease the force that body experienced during walking.

Key words: Force Plate, Sacroiliac Joint, Vertical Ground Reaction Force

The Effect of Weight Bearing Exercise on Bone Mineral Density of Premenopausal Women

Safoura Ghasemi, Heydar Sadeghi, Ahmad Tahamoli Roudsari, Zahra Basiri

Journal of Clinical Physiotherapy Research, Vol. 2 No. 3 (2017), , Page 104-109

Introduction: Maintaining optimal level of bone mineral density during Premenopause plays an important role in reducing the risk (relative risk of 1.5-3 times mire) of osteoporosis and the subsequent fractures in post-menopausal , therefore aim of this study was to explore the effect of weight-bearing exercise on bone mineral density of premenopausal women. Materials and Methods: In this semi-experimental pretest-posttest with control group design, 20 premenopausal women in the 40 to 45 age range were randomly selected and distributed in two experimental and control groups. Experimental group completed 12 weeks of training, three times a week and 70 minutes per session. Before and after the period of 12 weeks, femoral bone mineral density in all samples were measured by DEXA bone mineral densitometry. We used K-S test for normality assumption, independent sample t-test in within-subject design and paired t-test, ANCOVA for between-subject design. Significance level was 0.05 SPSS-21 was used. Results: The results revealed that 12 week weight bearing exercise resulted in an increase in femoral bone mineral density among participants in experimental group with the significant decrease in control group. Bone mineral density of femoral neck and total hip among the subjects distributed in experimental group, was significantly different from corresponding areas in control group. Discussion: It should be emphasized that exercise is the harmless and appropriate approach to prevent any decrease in bone mineral density in menopausal period which can prevent decrease in bone mineral density due to aging in this period.

Key words: Bone Density, Premenopausal, Weight-Bearing Exercise

Introduction: mal-alignment of lower extremity especially at the, aligned with the change of gravity line passing the lower limb joints can cause disorders in neuromuscular control of muscles around the joints and increase the risk of injury during sport activities. Therefore the aim of present study was to evaluate the effects of genu varum deformity on the pattern and amount of Electromyography muscle activity lower extremity during the stance phase of gait respectively. Materials and Methods: Thirty active male (two groups of Genu varum and normal) participated in the current semi-experimental study with the age ranged 20-25 years. Utilizing Electromyography data, the amount and the onset time of muscle activity were calculated. Data were analyzed utilizing MANOVA for between-group differences and paired samples t-test for within-group differences at a.05 level of significance. Results: The results showed that Gluteus Medius muscle during the loading response phase of walking in the active male with genu varum significantly higher levels of activity than control group in the dominant (P=0.031) and non-dominant limb(P=0.004). But the Rectus Femoris and Medial Gastrocnemius muscles activity was not significantly different between the two groups in none of the phase walking (P>0.05). Also there was no significant difference between the onset of muscle activity (P>0.05). Moreover, no significant difference could be observed between dominant and non-dominant limbs in the amount and onset of muscle activity (P>0.05). Discussion: Based on the results of this study, it is concluded that subjects with Genu Varum deformity are more active than normal subjects in the gluteus medius. This increase in activity can be accompanied with the increase of compressive forces and articular loads which can cause osteoarthritis joint in the long run.

Key words: Electromyography Activation, Genu Varum Deformity, Muscle Activity Timing, Walking

Effects of Short-term Whole Body Vibration Training on Knee Proprioception in Healthy Adults and People with Knee Osteoarthritis

Abdolreza Zahedi, Siamak Bashardoust Tajali, Golamreza Oliaye, Sedigheh-Sadat Naemi, Khosro Khademi

Journal of Clinical Physiotherapy Research, Vol. 2 No. 3 (2017), , Page 119-125

Introduction: many researches have studied the short and long term effects of whole body vibration on muscle strength and proprioception. The effect of this modality in athletes and healthy population have been studied by several researchers; however, to accept it as a therapeutic procedure, it needs more studies.  In knee osteoarthritis, muscle weakness and joint instability can affect proprioception. Since some researchers reported the effect of whole body vibration on kinematic and neuromuscular control and some others have rejected this effect, the purpose of this study is to investigate the short term effect of whole body vibration on proprioception of the knee joint in patients with knee osteoarthritis and healthy individuals. Materials and Methods: In this experimental study, two groups of the same size (21 in healthy and patient groups) went through whole body vibration ( 60 Hz frequency, low amplitude and 25 Hz frequency , high amplitude) and the knee joint properioception accuracy was assessed ( by joint angle replication test) and was compared with the no-vibration baseline results. Results The joint angle reconstruction error was different between two groups and also before and after whole body vibration. Whole body vibration with 25Hz frequency and high Amplitude was ineffective in improvement of knee properioception in osteoarthritis patients (p=0.09). But the vibration with 60 Hz and low amplitude was effective significantly in properiception improvement and decrease of joint angle reconstruction error in healthy (p=0.01) and patients groups. (p=0.02). Discussion: This study shows that the whole body vibration with proper frequency and amplitude (60 Hz and low amplitude) can have immediate effect on the knee joint properioception in patients with knee osteoarthritis and healthy people.

Key words: Whole Body Vibration; Knee; Osteoarthritis; Properioception

The Effect of Muscular Fatigue on Neck Proprioception Performance between Elite Athletes and Non-Athletes

Amir Letafatkar, Malihe Hadadnezhad, Somayeh Hasanzadeh, Mahmoud Hatami

Journal of Clinical Physiotherapy Research, Vol. 2 No. 3 (2017), , Page 126-132

Introduction: The poor performance of neck proprioception is a risky factor for athlete’s head and neck injury. Muscle fatigue as an inevitable factor of any physical activity can cause disorder in proprioception performance. This study intends to investigate the effect of cervical muscular fatigue on neck proprioception performance in elite karate athletes in comparison to non-athletes. Materials and Methods: Sixteen professional karate athletes and sixteen non-athletes participated in this study. Cervicocephalic relocation test measuring angle repositioning error during active cervical extension and rotation movements was used to assess neck proprioception ability, before and after isotonic muscular fatigue. Data were analyzed by independent T-test and paired T-test with SPSS (version 20) and alpha level set at 0/05. Results: There is no significant difference in neck sense status before and after neck muscular fatigue in both groups. Also, there is significant difference in neck proprioception performance between karate athletes and non-athletes following extension (P<0.05). In addition, athletes had greater joint position errors than non-athletes. Discussion: Although muscular fatigue did not affect proprioceptive neck performance, probably the effects of degenerative changes in neck proprioception and the acceleration repeated movements in karate athletes weaken their neck proprioception function in some direction in comparison to non-athletes. Therefore, it is important to improve the performance of neck proprioception in karate athlete's trough special neck proprioception training.

Key words: Martial Arts, Proprioception, Muscle Fatigue

Purpose: Research has shown that there are some risk factors for creating and developing low back pain with prolonged standing. For attempt to recognition of predisposing factors to development of LBP during prolonged standing, the purpose of this study was to investigate to maximal voluntary contraction (MVC) at selected groups of muscles and some of the psychological aspects in back-healthy subjects who developed LBP during prolonged standing.

Methods: In this cross sectional study, 25 back-healthy subjects and 14 chronic nonspecific LBP completed anxiety inventory (STAI), Tampa Scale for kinesiophobia (TSK) and pain catastrophizing scale (PCS) questionnaires. Dynamometer was used to assess MVC of the selected groups of muscles. Finally back-healthy subjects get tested for 2 h prolonged standing protocol and based on a visual analog scale (VAS) were categorized as pain developers (PD) or non-pain developers (NPD).

Results: Ten subjects (% 40) with developing pain were categorized as PD. There were no significant difference at psychological aspects between three groups of PD, NPD and LBP had. But analysis of MVC showed PD and LBP groups had less MVC at the left plantar flexors than left plantar flexors of the NPD group. Also PD and LBP groups had significantly more between two sides asymmetry at MVC at the plantar flexors compared to  NPD group.

Conclusion: This preliminary data suggests less MVC and asymmetry of MVC at plantar flexor muscles maybe related to development of the LBP during prolonged standing in the back-healthy peoples. Future study is needed to investigate other function of plantar flexors and their probably relations to development of LBP during prolonged standing.

The Comparison between Exercise Therapy and Biofeedback Therapy in Facial Function and Quality Of Life of Bell’s palsy

Navid Mirzakhani, Leila Angooti Oshnari, Alireza Akbarzadeh Baghban, Dariuosh Eliyspoor, Atiyeh Javantash, Mahvash Kamalifar, Tayebeh Parsamanesh

Journal of Clinical Physiotherapy Research, Vol. 2 No. 3 (2017), , Page 140-144

Introduction: Bell’s palsy is the side effect of peripheral nerve palsy that causes low function of face and quality of life. This study was conducted to assess the effect of two different methods; exercise therapy and biofeedback therapy, accompanied with massage in two groups on facial function and quality of life of these patients. Materials and Methods: In this interventional research with before- after design, 20 patients with acute unilateral peripheral facial palsy participated in two separate programs. Function of face was measured by House Brackman and quality of life was evaluated by SF-36 questionnaire. In each group data were recorded before the intervention and 4 weeks (3 sessions per week) after it. Exercise therapy included receiving massage, doing patterns of Proprioceptive Neuromuscular Facilitation (PNF) and some exercises in front of mirror; besides, biofeedback therapy contained massage and muscular education by biofeedback set. After employing Kolmogorov-Simonov as a Test for normality, Independent T-test was utilized to compare means. Results: After one month doing two different programs in two exercise and biofeedback groups, remarkable increase of quality of life (P≤0.001) and also improvement of function of face (P=0.004) were noticed in each group, but there was not any significant difference between quality of life (P=0.07) and function of face (P=0.85) in two groups. Discussion: This study indicated that with regard to suffering paralysis in Bell’s palsy and its bad effects on patients’ quality of life, the use of both biofeedback and exercise therapies as treatment is effective. It seems that increasing awareness of patients and training early movements have important role in improvement improve.

Key words: Bell’s Palsy, Biofeedback, Massage, Exercise Therapy, Facial Function, Quality of Life

Case Report

Physical Therapy Approach in Shoulder Impairment Along With Lymphedemea after Breast Cancer Surgery: A Case Study

Sahar Zamani, Shahpar Hagigat, Farshad Okhovatian

Journal of Clinical Physiotherapy Research, Vol. 2 No. 3 (2017), , Page 145-151

A 52-year-old woman with a history of breast cancer and mastectomy surgery and axillary lymph nodes dissection was referred to a physical therapy clinic. Lymphotherapist assessment revealed that there was a grade II upper limb lymph edema; pitting and palpable fibrotic tissue existed in volar side of forearm. Water displacement measurement to assess the limb volume in affected and unaffected side indicated an obvious difference. In physical examination, there was a significant limitation in shoulder range of motion (ROM) and tightness in shoulder girdle muscles. A multimodal physical approach based on manual therapy, electrotherapy and exercise therapy was conducted to eliminate shoulder impairment along with Manual Lymph Drainage (MLD) and lymphological compression bandage to eliminate lymphedema. The results of final re- assessment indicated that combination of lymphatic massage and compression bandage can lower the lymph edema following the mastectomy. Also, physical therapy approach can reduce the symptoms of shoulder disability caused by mastectomy and lymph nod dissection surgery. It should be taken into account that in patients who are suffering from lymph edema, recovering the shoulder movements and early return to normal function are very effective in improving lymph flow and reducing edema. Therefore, by restoring shoulder movement, in addition to reducing shoulder pain and increasing performance, can improve lymph flow as well among these patients.

Key words: Breast Cancer, Lymph Edema, Physiotherapy, Shoulder