Journal of Clinical Physiotherapy Research

Myofascial trigger points (MTrPs) of the upper trapezius muscle causes impairment of functional activity and reduces the quality of life. Several physical therapy interventions can be used to treat myofascial trigger points. Currently, dry needling (DN) is emerging as a physical therapy technique for use in treating MTrPs. The aim of this narrative review was to evaluate the effectiveness of dry needling in treating myofascial trigger points of the upper trapezius muscle. The PubMed database was searched for articles published through December, 2018. The main problem of most articles exists in the methods section; therefore, their results may be affected by bias. A standardized guideline for both the training and practice of using DN to treat MTrPs should be developed to minimize the risk of DN complications.

Introduction: Today, the use of clinical guidelines is increasing. Unfortunately, their use in therapeutic clinics is facing barriers.   The purpose of this study is to investigate the barriers to the use of clinical guidelines to try to resolve them. Methods and Materials: Qualitative study method was used to study the barriers of using clinical guidelines. 15 physiotherapists from the private and public centers of Tehran participated in the study. In one interview, all of their comments were recorded in relation to the clinical management of back pain. Results: After interviewing each other, their views were summarized and eventually classified into five groups. Conclusions: Despite the positive attitude of interviewed people towards using clinical guidelines, the results showed that there are significant barriers in this regard. Some of the most important barriers are: Content validity of the guide , Individual attitudes , Authorities influencing the implementation process , Financial factors and Publishing and implementation strategy

Introduction: The purpose of this study was to assess the within-day and between-day reliability of abdominal and lumbar multifidus muscle size in patients with unilateral lumbar disc herniation (LDH) using ultrasonography (US). Materials and methods: In this study, 15 patients with unilateral LDH (20-60 years old) were recruited. To assess within-day and between-day reliability, three images were taken with one hour and one week intervals respectively. The images were taken at rest and during contraction. Results: The within-day and between-day reliability of abdominal muscle thickness measurements using US in patients with unilateral lumbar disc herniation (LDH) in both rest and contraction state was found to be high with ICC=0.87 for within and ICC=0.75 for between-day rates of transverse abdominis (TrA) muscles at rest and ICC=0.78 and 0.75, respectively, in contraction state. For internal oblique muscles, ICC=0.70 at rest and 0.79 in contraction state and ICC=0.73 at rest and 0.77 in contraction state were found for within-day and between-day, respectively. Within-day and between-day reliability at rest with ICC=0.76 and 0.76 and in contraction state with ICC=0.75 and 0.74 were demonstrated for the external oblique muscle. Within-day and between-day reliability rates at rest with ICC=0.88 and 0.84, respectively, and in contraction state with ICC=0.84 and 0.80, respectively were demonstrated for the lumbar multifidus muscle. Conclusion: The results of the present study suggest that US is a reliable method for evaluating the thickness of the abdominal and lumbar multifidus muscles. However, further research is recommended to support the findings of the present study.

Introduction: This study evaluated the acute responses to static stretching versus the proprioceptive neuromuscular facilitation stretching technique with and without applying kinesio tape on hamstring muscle flexibility, as scarce evidence exists in this field. Materials and Methods: Twenty teenage professional black/red belt taekwondo players participated in this study. Proprioceptive Neuromuscular Facilitation (PNF) and static hamstring stretching was performed for both legs of each subject. Then a Y-shape Kinesio Tape (KT) with 30% tension was applied over one leg chosen randomly. Active Knee Extension Test (AKET) and Passive Straight Leg Raise (PSLR) were performed at base line, immediately and 24 hours after interventions. Results: Repeated measures ANOVA was used to statistically analyze the data. PSLR test results demonstrated a significant increase in hamstring flexibility over time, while the AKET results showed no significant changes. No significant differences were observed between PNF and Static stretch (SS) or the KT and Non-Taped (NT) groups immediately or after 24 hours. Conclusion: The current study showed that there is no superiority in SS or PNF stretching techniques for increasing hamstring flexibility, and using KT over stretched muscles could not help improve flexibility.

Introduction: Low back pain, knee disorders and rheumatoid arthritis are the most common musculoskeletal diseases in Iran and throughout the world. The studies conducted in the developed countries have shown that this disease has considerable effect on the functional abilities and quality of life of patients. There are a few studies about this issue in Iran. Therefore, this study aims to evaluate the effect of knee and low back pain on the functional disability and quality of life of patients resident in Tehran. Materials and Methods: 220 musculoskeletal disorders (knee and low back pain and rheumatoid arthritis) from one hospital in Tehran, Iran participated in the study. Persian versions of Arthritis Impact Measurement Scale 2-short form (AIMS2-SF) and Short form health survey (SF-12) were used to measure the functional disability and quality of life. AIMS2-SF questionnaire that has been designed exclusively for rheumatoid arthritis patients measures the functional disability of patients in five dimensions: physical (upper and lower limbs), symptoms, feelings and social condition. Results: mean age and education of patients in this study was 53(low back pain), 45 (knee pain), and 58 (RA) years old, respectively. 59% of subjects were women. Mean of physical dimensions, upper limbs, lower limbs, symptoms, feelings, and social conditions were 1.46, 1.32, 2.12, 3.65, 3.40, and 3.78 (of 10), respectively. The mean of eight dimensions of quality of life based on the SF-12 questionnaire was 43 to 64 (of 100). Conclusion: The results of this study showed that the quality of life and functional abilities of musculoskeletal disorders are influenced significantly by diseases. Based on this, the increasing of physical activity and the intensive physiotherapy programs result in improvement of quality of life in these diseases.

Introduction: The current study compared the effect of pelvic floor muscle (PFM) contraction on thickness of abdominal muscles during an abdominal hollowing maneuver (AHM), which is a specific contraction of transverse abdominis(TrA)and internal oblique(IO) muscles in healthy and low back pain (LBP) subjects. Materials and Methods: Thirty subjects (15 with LBP and 15 without LBP) participated in this study. In ultrasonographic evaluation, the thickness of the TrA and IO muscles in AHM with and without PFM contraction were measured. Results: No significant difference was seen in the thickness of abdominal muscles in contraction alone and in combination with PFM contraction during AHM between the two groups. No difference was seen in the thickness of abdominal muscles with and without PFM contraction between the LBP and healthy subjects in AHM. Conclusions: Adding PFM contraction had no significant effect on abdominal-muscle contraction in subjects with or without LBP.

Introduction: Cervicogenic headache is known to be the most controversial type of headache, because its diagnosis is difficult and usually associated with errors. The signs and symptoms of this headache confuse therapists and cause misdiagnosis; definitive diagnostic criteria and physical tests should be used to accurately diagnose cervicogenic headaches. The current study investigated patients suffering from headaches, then reassessed them using a new diagnosis protocol, and finally provided them with physiotherapy using clinical reasoning strategies. Materials and Methods: In this study, three patients who had suffered headaches and tolerated inappropriate treatment due to misdiagnosis were evaluated using diagnostic criteria and physical examination based on the International Headache Society (IHS) criteria. Cervicogenic headache was diagnosed, and accordingly, physiotherapy with a multi-modal intervention approach based on clinical reasoning was administered. The outcome of treatment was assessed using the headache index questionnaire. Conclusion: Subjects who had suffered, on average, 15 years of chronic, medicine resistance headaches were evaluated. Cervicogenic headache was diagnosed in each of them and physiotherapy was begun. An average improvement rate of 74% was achieved based on the headache index formula. It can be concluded that the use of physical tests in addition to diagnostic criteria will decrease the rate of misdiagnosed cervicogenic headache, and physiotherapy can be the appropriate treatment.