Effects of Anteroposterior Talus Mobilization on Range of Motion,Pain, and Functional Capacity in Participants With Subacute and Chronic Ankle Injuries: A Controlled Trial

Objective

The purpose of this study was to measure the acute (1 session) and chronic effects (6 sessions) and the follow-up (2 weeks) of anteroposterior articular mobilization of the talus, grade III of Maitland, on the dorsiflexion range of motion (ROM), pain, and functional capacity of individuals with subacute and chronic traumatic injuries of the ankle.

Clinical Benefits of Joint Mobilization on Ankle Sprains: A Systematic Review and Meta-Analysis

Objective

To assess the clinical benefits of joint mobilization for ankle sprains.

The Immediate Effects of Mobilization Technique on Pain and Range of Motion in Patients Presenting With Unilateral Neck Pain: A Randomized Controlled Trial

Kanlayanaphotporn R, Chiradejnant A, Vachalathiti R. The immediate effects of mobilization technique on pain and range of motion in patients presenting with unilateral neck pain: a randomized controlled trial.

Objective

To determine the immediate effects on both pain and active range of motion (ROM) of the unilateral posteroanterior (PA) mobilization technique on the painful side in mechanical neck pain patients presenting with unilateral symptoms.

Design

Triple-blind, randomized controlled trial.

Setting

Outpatient physical therapy, institutional clinic.

Participants

Patients (N=60), 2 physical therapists, and 1 assessor involved in this study.

Interventions

The patients were randomly allocated into either preferred or random mobilization group by using an opaque concealed envelope. The first therapist performed the screening, assessing, prescribing the spinal level(s), and the grade of mobilization. The second therapist performed the mobilization treatment according to their allocated group stated in an envelope. The assessor who was blind to the group allocation conducted the measurements of pain and active cervical ROM.

Main Outcome Measures

Pain intensity, active cervical ROM, and global perceived effect were measured at baseline and 5 minutes posttreatment.

Results

After mobilization, there were no apparent differences in pain and active cervical ROM between groups. However, within-group changes showed significant decreases in neck pain at rest and pain on most painful movement (P<0.001) with a significant increase in active cervical ROM after mobilization on most painful movement (P=0.002).

Conclusions

The results of this study did not provide support for the preference of the unilateral PA mobilization on the painful side to the random mobilization.     

Effects of Early Mobilization on Unhealed Dysvascular Transtibial Amputation Stumps: A Clinical Trial

VanRoss ER, Johnson S, Abbott CA. Effects of early mobilization on unhealed dysvascular transtibial amputation stumps: a clinical trial.

Objective

To observe the effects of early mobilization on unhealed transtibial (TT) amputation stump wounds of dysvascular etiology. An “unhealed” stump was defined as having a wound greater than 1cm × 1cm at least 3 weeks after surgery.

Design

An observational cohort study.

Setting

This center receives about 250 new lower-limb amputees a year from over 50 surgeons working in 16 hospitals. Over 35% are unhealed.

Participants

Sixty-six consecutive new TT amputees (age 62.8±10.8y) of dysvascular etiology (diabetes 50%) with unhealed stumps were recruited. Sixty-one percent were current or past smokers. The mean ± SD stump wound size was 7.7±2.7cm × 3.2±2.0cm.

Interventions

The wound size was measured, and stump transcutaneous oxygen (TcpO₂) and transcutaneous carbon dioxide (TcpCO₂) were measured. Wounds were debrided and dressed by using a standard protocol. Mobilization using a Pneumatic Post-Amputation Mobility (PPAM) Aid for approximately 3 weeks was followed by provision of a TT prosthesis. A standard physiotherapy walking training program was performed.

Main Outcome Measures

Stump wound healing, time to achieve healing, and resting transcutaneous oxygen pressure pre- and posttherapy.

Results

Of the 66 amputees, 4 did not start. Sixty-two started; 6 withdrew, and 56 completed the trial. Complete wound healing was achieved in 74% (46/62) over a mean of 141 (87-270) days. The mean ± SD stump TcpO₂ at baseline was 41.3±19.8mmHg and increased significantly to 50.6±21.9mmHg (P<.02) after 97 (34-185) days of mobilization. Nine of 46 required revision plastic surgery. Five subjects, whose wounds were healing, became unwell, dropped out, and later deceased. Five subjects, all current smokers, did not heal and underwent higher amputation.

Conclusions

Patients with large unhealed TT stump wounds can simultaneously undergo walking training by using a prosthesis and can achieve wound healing. Seventy-four percent of subjects achieved full wound healing. The small minority of patients who did not heal were current smokers whose TcpO₂ levels did not improve throughout the trial. Rising levels of stump TcpO₂were associated with wound healing.     

Effects of Taping and Exercise on Ankle Joint Movement in Subjects With Chronic Ankle Instability: A Preliminary Investigation

Delahunt E, O'Driscoll J, Moran K. Effects of taping and exercise on ankle joint movement in subjects with chronic ankle instability: a preliminary investigation.

Objective

To examine the effects of ankle joint taping and exercise on ankle joint sagittal plane and rear-foot frontal plane movement in subjects with chronic ankle instability.

Design

Laboratory-based, repeated-measures study.

Setting

University biomechanics laboratory.

Participants

Subjects with chronic ankle instability (N=11) as defined by the Cumberland Ankle Instability Tool.

Interventions

Each participant performed 3 single-leg drop landings onto a forceplate under 3 different conditions. These conditions were: condition 1 (no tape), condition 2 (taped), and condition 3 (postexercise taped).

Main Outcome Measures

Kinematic data were used to identify ankle joint sagittal plane and rear-foot frontal plane positions at 50ms before initial contact (IC) and at IC, under each of the conditions.

Results

There was a significant effect on the angle of ankle joint plantar flexion, both at 50ms before IC (F_2,18=29.4, P<.001) and at IC (F_2,18=16.1, P<.001), as a result of the application of tape. Post hoc analysis revealed that condition 1 (no tape) resulted in significantly greater plantar flexion angle at 50ms before IC than condition 2 (taped) (7.7±3.0°; P=.002) and condition 3 (postexercise taped) (8.3±4.8°; P=.01). Similarly, condition 1 (no tape) resulted in significantly greater plantar flexion at IC than both condition 2 (taped) (5.3±3.2°; P<.001) and condition 3 (postexercise taped) (5.3±4.4°; P=.001). No significant differences were evident between condition 2 (taped) and condition 3 (postexercise taped) (P>.05).

Conclusions

These results indicate that taping acted to reduce the degree of plantar flexion at both 50ms before and at IC with the ground, and that these reductions were retained even after exercise.     

Immediate Effect of Grade IV Inferior Hip Joint Mobilization on Hip Abductor Torque: A Pilot Study

Joint mobilization and manipulation stimulate mechanoreceptors, which may influence the joint and surrounding muscles. The purpose of this pilot study was to determine the effect of grade IV inferior hip joint mobilization on hip abductor torque. Thirty healthy subjects were randomly assigned to a control group (grade I inferior hip joint mobilization) or an experimental group (grade IV inferior hip joint mobilization). Subjects performed a pre- and post-intervention test of five isometric repetitions on the Cybex Normö dynamometer; the average torque was determined for both pre- and post-intervention measurements. These data were analyzed using the independent samples t-test with the significance level set at P<0.05. The results showed a statistically significant difference between the two groups for an increase in hip abductor torque in the experimental group (P=0.03). The experimental group demonstrated a 17.35% increase in average torque whereas the control group demonstrated a 3.68% decrease in average torque. These findings are consistent with other studies demonstrating that the use of grade IV non-thrust mobilization improves strength immediately post-intervention in healthy individuals. The results of this pilot study provide physical therapists with further support for the utilization of manual therapy in conjunction with therapeutic exercise to enhance muscle strength.Key Words: Arthrokinetic Reflex, Hip Abductors, Hip Joint, Isometric Torque, Manual Therapy, Non-Thrust Mobilization, Muscle StrengthThe hip joint is a ball-and-socket joint composed of the acetabulum and femur^{1, 2}. The hip has strong muscular support, with the gluteus medius functioning as an important stabilizer with a main function of hip abduction. The anterior portion of this muscle also assists in the secondary function of internal rotation^{1, 3}, and the posterior portion of the gluteus medius assists in external rotation of the hip⁴. The gluteus medius functions to stabilize the hip at mid-stance of gait in the coronal plane; it provides lateral pelvic stabilization at terminal stance^{5 – 7}. Compromise in hip abductor muscle function can lead to a Trendelenburg gait pattern, described as a contralateral pelvic drop during stance phase. This may be compensated for by an upper body shift toward the involved side to maintain the center of gravity over the affected hip^{1, 8}; the contralateral quadratus lumborum then compensates by pulling the pelvis superiorly⁹ or the lumbar spine may compensate with ipsilateral lateral trunk flexion¹⁰.The hip abductors transfer forces from the lower extremity to the spine, explaining their frequent involvement in patients with spinal complaints^{9, 11 – 13}. Beckman and Buchanan¹⁴ demonstrated differences in the firing and strength of the hip abductor muscles in the presence of distal lower extremity involvement. Studies have shown that chronic ankle instability was associated with delayed firing of the hip abductor muscles^{9, 14, 15}. Further studies have correlated weakness with isokinetic testing of hip abductor and adductor muscles with ankle and foot injuries^{16, 17}. Friel et al¹⁸ demonstrated a correlation between chronic ankle sprains and ipsilateral hip abductor weakness. Powers¹⁹ described the influence of altered lower extremity kinematics on the patellofemoral joint by identifying two possible mechanisms leading to patellofemoral pain: femoral rotation and knee valgus. Increased femoral internal rotation—as might be caused by gluteus medius weakness—results in an increased Q-angle. Powers et al²⁰ demonstrated that this femoral rotation was the primary contributor to patellar tilts and displacements. Using pressure-sensitive film, these authors reported that 30° of femoral internal rotation significantly increased patellofemoral stress (force per unit) when the knee was flexed beyond 30°. Hip abductor weakness can also lead to valgus at the knee during dynamic tasks. Knee valgus also leads to an increase in the Q-angle, displacing the patella laterally with respect to the patellar groove of the distal femur. Excessive pronation is the end result of tibial abduction, as it compensates for femoral adduction.Joints influence motor unit activation and, therefore, muscle function. The capability of a joint to alter muscle function is mediated by the articular receptors; the articular receptors can inhibit or facilitate muscle tone²¹. In this paper, the term arthrokinetic reflex is used to refer to the tonic and phasic reflex neuromuscular activity, both facilitating and inhibiting, emanating primarily from the Type I and II articular mechanoreceptors^{21, 22}.The Guide to Physical Therapist Practice ²³ has defined mobilization and manipulation as synonymous terms describing a manual therapy technique comprising a continuum of skilled passive movements to the joints and/or related soft tissues that are applied at varying speeds and amplitudes, including a small-amplitude/high-velocity therapeutic movement. During mobilization/manipulation, the capsuloligamentous tissues of a joint are mechanically stretched²¹. One primary goal of mobilization is to improve extensibility of restricted capsuloligamentous tissue; secondarily, articular mechanoreceptor activation level is affected. Joint mobilization has been demonstrated to improve physiologic and accessory motions to hypomobile structures²⁴. This in turn causes an alteration in the articular mechanoreceptor resulting by way of arthrokinetic reflex activity in enhanced muscle strength^{21, 22}. These arthrokinetic reflex actions have been hypothesized to occur through the down-regulation of inhibitory input on motor unit activity^{21, 22}. Joint mobilization not only has an impact on the motor unit activity in muscles functioning over the joint, but it also has been shown to affect more remote muscles as well, including muscles on the contralateral side of the body²². Herzog et al²⁴ demonstrated that distracting cervical facet joints stimulated the articular mechanoreceptors exerting significant coordinated reflexogenic influences on the activity of the neck and limb musculature. Cibulka²⁵ performed mobilization to a dysfunctional sacroiliac joint and restored the normal length-tension relationship of the hamstrings, thereby increasing the main torque produced. Liebler et al²⁶ demonstrated a significant increase in lower trapezius strength with the utilization of grade IV spinal mobilization: The Cybex Norm® dynamometer recorded a 6% increase in lower trapezius strength in the experimental group as compared to a 0.2% increase in the control group. Cleland et al²⁷ similarly demonstrated improved lower trapezius strength in response to manipulative treatment of the lower thoracic spine (T6-12) using grade V thrust techniques; they reported a statistically significant increase (P<0.01) in peak strength of 14.5% for the experimental group versus 3.9% for the control group. Yerys et al²⁸ demonstrated a significant effect of grade IV mobilization on gluteus maximus strength; the experimental group demonstrated a 14% increase in strength as compared to a 4% increase in the control group. As in the present study, both Liebler et al²⁶ and Yerys et al²⁸ applied a grade IV non-thrust mobilization to the subjects in the experimental group and a grade I to those in the control group.The above studies highlight the role of the joint capsule and its reflexogenic influence on muscles. Failure to recognize the importance of these arthrokinetic reflex circuits may explain the difficulty in neuromuscular re-education and strengthening of muscle groups. This in turn leads to failure of an exercise regime to achieve the desired results with regard to improved muscle function²⁹. Many rehabilitation programs focus on strengthening exercises using resistance regimens; however, few focus on the actual quality and control of movement. Manual techniques may effectively be used in cases of muscle imbalances, which are a form of dysfunction. Bookhout²⁹ suggested that greater success in rehabilitation might be achieved through the use of manual techniques, either before or in conjunction with resistive exercises.Mobilizing a restricted joint may increase muscular strength by removing the reflexogenic inhibition emanating from the joint mechanoreceptors^{21, 22, 24, 26, 29}. For example, a mechanical hip joint disorder associated with ipsilateral adductor muscle contracture, inferior capsuloligamentous hypomobility, and gluteus medius weakness, especially of the posterior fibers³⁰, will theoretically impose inhibitory neural input on the gluteus medius while simultaneously imposing reflex facilitation on the adductor muscles each time that the hip abducts against its restrictive barrier of motion^{21, 22}. This may lead to further functional destabilization of the hip joint. Above we discussed the important role of the gluteus medius muscle not only at the hip but also in the entire lower extremity and in the spine. Considering this important role of the gluteus medius muscle and the information on arthrokinetic reflex circuits discussed above, the research hypothesis in this pilot study is that grade IV inferior hip joint mobilization performed at the end of abduction will result in an immediate increase in hip abductor torque when compared to a grade I inferior hip joint mobilization.     

Effect of Chiropractic Manipulation on Vertical Jump Height in Young Female Athletes with Talocrural Joint Dysfunction: A Single-Blind Randomized Clinical Pilot Trial

Objective

The main objective of this pilot study was to explore the effect of chiropractic high-velocity, low-amplitude (HVLA) manipulation on vertical jump height in young female athletes with talocrural joint dysfunction.

Methods

This was a randomized assessor-blind clinical pilot trial. Twenty-two female handball players with talocrural joint dysfunction were randomized to receive either HVLA manipulation (n = 11) or sham treatment (n = 11) once a week during a 3-week period. The main outcome was change in vertical jump height from baseline to follow-up within and between groups after 3 weeks.

Results

Nineteen athletes completed the study. After 3 weeks, the group receiving HVLA manipulation (n = 11) had a statistically significant mean (SD) improvement in vertical jump height of 1.07 (1.23) cm (P = .017). The sham treatment group (n = 8) improved their vertical jump height by 0.59 (2.03) cm (P = .436). The between groups' change was 0.47 cm (95% confidence interval, − 1.31 to 2.26; P = .571) in favor of the group receiving HVLA manipulation. Blinding and sham procedures were feasible, and there were no reported adverse events.

Conclusion

The results of this pilot study show that a larger-scale study is feasible. Preliminary results suggest that chiropractic HVLA manipulation may increase vertical jump height in young female athletes with talocrural joint dysfunction. However, the clinical result in favor of HVLA manipulation compared with sham treatment needs statistical confirmation in a larger randomized clinical trial.     

Immediate Effects of Mulligan Mobilization on Elbow Proprioception in Healthy Individuals: A Randomized Placebo-Controlled Single-Blind Study

ObjectiveThe aim of this study was to investigate the immediate effects of Mulligan's mobilization with movement (MWM) on elbow proprioception.MethodsThe study included 26 participants in the intervention group and 30 participants in the control group. The intervention group received MWM, while the control group received a sham application. Proprioception was assessed with joint position sense error at baseline, immediately after mobilization, and 30 minutes after mobilization with 70° and 110° of elbow flexion. The hypothesis of interest was the group × time interaction.ResultsAt 110° of elbow flexion, group × time interaction was significant (F[2, 108] = 11.48, P = .001). In the paired comparisons, there was a statistically significant difference in favor of the control group in the first measurement (P = .003). No difference was detected in other time points (P = 1.00). At 70° of elbow flexion, there was no significant difference between the time point × group interaction (F[2, 108] = 1.37, P = .10). Therefore, no pairwise comparison was made.ConclusionIn this study of healthy participants, no immediate difference was found between MWM and sham application on elbow proprioception.     

Changes in Kinetic,Kinematic, and Temporal Parameters of Walking in People With Limited Ankle Dorsiflexion: Pre-Post Application of Modified Mobilization With Movement Using Talus Glide Taping

Objective

The purpose of this study was to investigate the changes in passive ankle dorsiflexion range of motion (ROM), maximum plantar force, force-time integral, and time to heel off during walking between pre- and postapplication of modified mobilization with movement (MWM) using talus glide taping in people with limited ankle dorsiflexion.

Methods

Eighteen feet with limited ankle dorsiflexion in 13 people were examined. Participants performed 3 different walking tasks in the following order: walking before and immediately after applying the modified MWM using talus glide taping and walking after 5-minute walking with the modified MWM using talus glide taping. A floor-mat pressure measurement system (HR-mat) was used to measure maximum plantar force, force-time integral, and time to heel off; and passive ankle dorsiflexion ROM was measured using a standard goniometer. The significance of differences was assessed using repeated one-way analysis of variance.

Results

Passive ankle dorsiflexion ROM and time to heel off were significantly increased after 5-minute walking with the modified MWM using talus glide taping compared with walking before and immediately after applying the tape. Significantly increased maximum plantar force and force-time integral on the hindfoot and significantly decreased force-time integral on the forefoot during walking after 5-minute walking were observed with the modified MWM using talus glide taping compared with before applying the tape. No significant difference between before and immediately after applying the tape was observed in any variable.

Conclusions

Our results suggest that walking an additional 5-minute with the modified MWM using talus glide taping increased passive ankle dorsiflexion ROM and time to heel off and improved dynamic plantar loading during walking.     

中药熏蒸联合关节松动术治疗胫骨平台骨折术后关节僵硬的临床观察

目的:观察中药熏蒸联合关节松动术治疗胫骨平台骨折术后关节僵硬的临床疗效.方法:将2019年1月～2020年4月福建省福州市第二医院康复医学科诊治的50例胫骨平台骨折术后关节僵硬患者随机分为对照组和观察组,各25例.对照组在常规康复治疗基础上予关节松动术治疗,观察组在常规康复治疗基础上予中药熏蒸联合关节松动术治疗.评估两...     

Immediate Effects of Thoracic Spinal Manipulation on Pulmonary Function in Stroke Patients: A Preliminary Study

Objectives

The purpose of this study was to investigate the immediate effects of thoracic spinal manipulation (TSM) on pulmonary function in stroke patients.

Effect of Posterior Pelvic Tilt Taping in Women With Sacroiliac Joint Pain During Active Straight Leg Raising Who Habitually Wore High-Heeled Shoes: A Preliminary Study

Objective

The purpose of this study was to assess whether a 1-day application of posterior pelvic tilt taping (PPTT) using a kinesiology tape would decrease anterior pelvic tilt and active straight leg raising test scores in women with sacroiliac joint who habitually wore high-heeled shoes.

Methods

Sixteen women (mean age, 23.63 ± 3.18 years) were enrolled in this study. Anterior pelvic tilt was measured using a palpation meter before PPTT application, immediately after PPTT application, 1 day after PPTT application, and immediately after PPTT removal after 1 day of application. Active straight leg raising scores were measured at the same periods. Posterior pelvic tilt taping was applied in the target position (posterior pelvic tilt position).

Results

The anterior pelvic tilt was decreased during and after 1 day of PPTT application (before and after kinesiology tape removal) compared with the initial angle (all P < .05). Active straight leg raising scores were decreased during and 1 day after PPTT application (before and after kinesiology tape removal) compared with the initial score (all P < .05).

Conclusion

The results of this preliminary study suggests that PPTT may temporarily decrease anterior pelvic tilt and active straight leg raising score in women with sacroiliac joint pain who habitually wear high-heeled shoes.     

Neural Mobilization: A Systematic Review of Randomized Controlled Trials with an Analysis of Therapeutic Efficacy

Neural mobilization is a treatment modality used in relation to pathologies of the nervous system. It has been suggested that neural mobilization is an effective treatment modality, although support of this suggestion is primarily anecdotal. The purpose of this paper was to provide a systematic review of the literature pertaining to the therapeutic efficacy of neural mobilization. A search to identify randomized controlled trials investigating neural mobilization was conducted using the key words neural mobilisation/mobilization, nerve mobilisation/mobilization, neural manipulative physical therapy, physical therapy, neural/nerve glide, nerve glide exercises, nerve/neural treatment, nerve/neural stretching, neurodynamics, and nerve/neural physiotherapy. The titles and abstracts of the papers identified were reviewed to select papers specifically detailing neural mobilization as a treatment modality. The PEDro scale, a systematic tool used to critique RCTs and grade methodological quality, was used to assess these trials. Methodological assessment allowed an analysis of research investigating therapeutic efficacy of neural mobilization. Ten randomized clinical trials (discussed in 11 retrieved articles) were identified that discussed the therapeutic effect of neural mobilization. This review highlights the lack in quantity and quality of the available research. Qualitative analysis of these studies revealed that there is only limited evidence to support the use of neural mobilization. Future research needs to re-examine the application of neural mobilization with use of more homogeneous study designs and pathologies; in addition, it should standardize the neural mobilization interventions used in the study.     

Immediate Effects of Ankle Non-elastic Taping on Balance and Gait Ability in Patients With Chronic Stroke: A Randomized,Controlled Trial

ObjectiveThe purpose of this study was to determine the immediate effects of ankle non-elastic taping on balance and gait ability in patients with chronic stroke.MethodsThirty patients (inpatients and outpatients) with stroke were randomly assigned to 2 groups: the non-elastic taping group (n = 15) and the placebo-taping group (n = 15). Patients in the non-elastic taping group received Endura sports taping for their ankle joint, and patients in the placebo-taping group received Endura fix tape for their ankle joint. The Balance System SD assessed balance, and the GAITRite system assessed gait ability. We recorded measurements before and after intervention.ResultsThe non-elastic taping group showed a significant improvement in static and dynamic standing balance (P ≤ .001) after intervention; in addition, this group showed significant increases in the velocity, cadence, step length, and stride length of gait (P ≤ .001) after intervention. However, the placebo-taping group showed no significant improvements in standing balance and gait ability after intervention (P >.05). Furthermore, significant differences in static and dynamic standing balance, cadence, and velocity were observed between the 2 groups after intervention (P ≤ .001).ConclusionsOur results demonstrate that the application of ankle non-elastic taping is effective at improving balance and gait abilities in patients with stroke. Ankle non-elastic taping appears to be an effective method to facilitate active rehabilitation in patients with hemiplegia.     

Immediate Effects of Single-Session Proprioceptive Neuromuscular Facilitation Exercises on the Sit-to-Stand Strategy in Patients With Chronic Lumbar Spinal Disc Disease: A Preliminary Study

ObjectiveThe purpose of this study was to measure the immediate effects of single-session proprioceptive neuromuscular facilitation exercises on the sit-to-stand (STS) task and level of pain in patients with chronic low back pain.MethodsFifty-three patients were assigned to the control and intervention groups. The total time was 30 minutes (each exercise 5 minutes). The minimum vertical ground reaction force (VGRF_min) and maximum vertical ground reaction force (VGRF_max) and time phases (T_min – time to counterforce, T_max – time to peak force, T_tot – time to post-peak rebound force) were measured with a Kistler force plate in eyes-open and eyes-closed conditions during the STS task. Pain level was determined on a numeric rating scale.ResultsMain effects were observed only in the intervention group: decreasing pain value (F = 25.398, P < .0001), increasing T_min (F = 5.72, P = .0044), decreasing T_max (F = 3.43, P = .04), and decreasing T_tot (F = 3.935, P = .02258). There was a main effect of the eyes factor on VGRF_min (F = 12.53, P < .0001) and VGRF_max (F = 7.16, P < .01).ConclusionImmediate effects of single-session proprioceptive neuromuscular facilitation exercises were observed in decreasing the level of pain. Adaptation effects were noted in the retention test. The STS task could be optimized in time phases and dynamic movements in patients with chronic low back pain.     

Immediate Effects of Thoracic Spine Manipulation Upon Shoulder Functionality in Patients With Sutured Rotator Cuff Repair: A Prospective Study

Objectives

The purpose of this study was to evaluate the immediate effect of thoracic spine manipulation upon active flexion and abduction mobility of the shoulder, spine temperature, and the size of the subacromial space as measured by ultrasound in 3 positions (internal, neutral, and external rotation) of the glenohumeral joint in patients who have undergone surgery because of subacromial impingement.

Use of a Combination of Ankle Pressure and SENSERite System to Treat Older Adults With Impaired Ankle Proprioception: A Single-Blind Experimental Study

You JH, Saliba S, Saliba E. Use of a combination of ankle pressure and SENSERite system to treat older adults with impaired ankle proprioception: a single-blind experimental study.

Objective

To investigate the effects of a combination of visual biofeedback and ankle pressure on ankle position sense in elderly adults with and without impaired ankle joint position sense (JPS).

Design

Independent 2 × 3 factorial design with an experimenter-blind study.

Setting

University motion laboratory.

Participants

Older adults (N=40) were recruited from local community centers. Among them, 21 elderly subjects had relatively normative score, whereas 19 subjects had impaired ankle position sense.

Intervention

Both the normative and impaired elderly subjects underwent either ankle JPS visual feedback training alone or a combination of ankle JPS visual feedback training and circumferential ankle pressure for one 30-minute training session.

Main Outcome Measures

The outcome measures included ankle JPS errors measured in absolute constant error (ACE) and variable error (VE) during standing at pretest, posttest, and 1-week follow-up test. A separate repeated measures analyses of variance was performed to evaluate the differential training effects on ACE and VE, respectively. The Pearson chi-square test and Bonferroni test were performed. Significance was assigned at P less than .05 for all analyses.

Results

Regardless of intervention conditions, older adults with and without ankle position sense impairment showed immediate treatment benefits, which relatively remained stable even at the follow-up test. These effects were reflected in significant improvements of JPS accuracy and consistency (P<.05).

Conclusions

Our findings may suggest that both interventions were equally effective in increasing ankle JPS accuracy and consistency in older adults with and without impairments, and therapeutic effects lasted for a week, reflecting long-term effect.