The reaching movement in breast cancer survivors: Attention to the principles of rehabilitation

IntroductionBreast-cancer is leading cause of morbidity and mortality in women. The prognosis and survival rate of women with breast-cancer have significantly improved worldwide; more attention needs to be paid to rehabilitative interventions after surgery. This paper describes use of reaching movement to assess upper limb motorcontrol and functional ability after breast-cancer surgery (BC).Material and methodsWe conducted a cross-sectional observational study consisting of biomechanical evaluation of upper limb limitations in women BC, versus a controlgroup (CG). Thirty breast-cancer survivors and thirty healthy women participated in this study. Both groups were subjected to clinical evaluation of the shoulder joint ROM on the operated side, as an assessment of the muscular-strength of the shoulder with the MRC-scale. The Functional-Assessment was evaluated by the DASH and Constant-Murley-Score. The EORTC QLQ-C30 and VAS were used to measure the quality of life assessment and pain respectively. A Biomechanical evaluation was performed, using Reaching-Task and Surface-EMG.ResultsNormal Jerk for BC was higher than CG. Target approaching velocity and movement duration BC was lower than CG. Synergy Anterior Deltoid/Triceps Brachii muscles in CG was higher than BC.     

Short-term effect of myofascial trigger point dry-needling in patients with Adhesive Capsulitis

BackgroundAdhesive Capsulitis (AC) is a common disabling musculoskeletal pain condition of unknown etiology related to the shoulder joint. Literature reported the restricted range of motion (ROM) and pain could be the result of myofascial trigger points (MTrPs) in the muscles of the shoulder girdle. Hence, the objective of this study was to assess the short-term effectiveness of MTrP dry needling (DN) in improving ROM, pain, pressure pain threshold (PPT), and physical disability among patients having AC.MethodsIn a single group pre-post experimental study design, a total of 70 clinically diagnosed patients (both male & female, age group between 40 and 65 years) with AC were recruited from three multi-specialty hospitals. The informed consent forms were received from each patient before participating in the study. Each patient received DN for the MTrPs of shoulder girdle muscles for alternative six days. In addition to DN, each patient had received conventional physiotherapy for continuous twelve days which includes electrotherapy modalities and exercises. The pain intensity (visual analog scale), shoulder ROM (Goniometer), disability (shoulder pain and disability index) and PPT (Algometer) were the outcome measures assessed at the baseline and twelfth day of the intervention.ResultsThere was a statistically significant (p < 0.05) improvement in shoulder ROM, pain intensity, shoulder disability, and PPT at the end of the twelve days of intervention as compared to baseline assessment.ConclusionMTrPs-DN techniques may improve the pain, ROM, disability and PPT along with conventional physiotherapy management among patients with AC.     

体外冲击波对于肩袖修补术后患者功能恢复的疗效观察

目的：观察行肩关节镜下肩袖修补术的患者在术后康复训练的基础上配合使用体外冲击波治疗（ESWT）的临床效果。方法：此项研究选取肩袖损伤诊断明确且保守治疗无效的患者共计68例，随机分为观察组和对照组，每组34例。2组患者术后0～12周分3个阶段行制动康复训练、保护康复训练、增强康复训练。2组患者均采用被动功能训练，观察组同时增加体外冲击波辅助治疗。分别于患者术前、术后3周、6周及12周采用UCLASS评分、Constant评分、VAS评分和ROM评分评估患肩功能恢复情况。结果：术后3周、6周及12周，2组分别与组内术前比较，UCLASS、constant及ROM评分均有显著提高（P＜0.05），VAS评分显著降低（P＜0.05），术后3周、6周及12周，2组各评分行组间比较差异均有统计学意义（P＜0.05）。结论：对于肩关节镜下行肩袖修补术的患者在术后康复训练的基础上早期提供规律的体外冲击波治疗能够显著改善患者的患侧肩关节功能恢复情况，另外在缓解疼痛方面疗效显著。     

Comparison of the effectiveness of proprioceptive neuromuscular facilitation exercises and shoulder mobilization patients with Subacromial Impingement Syndrome: A randomized clinical trial

IntroductionThe aim of this study was to compare the effectiveness of Proprioceptive Neuromuscular Facilitation (PNF) exercises and shoulder mobilization (SM) in addition to conventional physiotherapy on pain, range of motion (ROM), functionality, and muscle strength in patients with Subacromial Impingement Syndrome (SIS).MethodsForty-four patients were randomly allocated into three groups as conventional physiotherapy (control group; n = 14), conventional physiotherapy + PNF exercises (PNF group; n = 15), and conventional physiotherapy + SM techniques (SM group; n = 15). Pain, ROM, muscle strength, and functionality were evaluated by using VAS (Visual Analog Scale), goniometer, push-pull dynamometer, Constant-Murley score and DASH (Disabilities of the Arm, Shoulder and Hand) score. Patients were received 20 sessions (4 weeks) of treatment. Assessments were performed at baseline, and weeks two, four, and sixteen.ResultsAfter treatment, significant improvements in outcome measurements were observed in all groups (all p < 0.05). PNF or SM groups were not superior to each other in terms of improving pain and functionality. SM group was superior to PNF group for improving shoulder flexion ROM at week 4 (p = 0.009). The improvements in shoulder extension muscle strength were greater in PNF group at weeks 2 and 16 compared with other groups (p = 0.030, 0.035).ConclusionPNF or SM, in addition to conventional physiotherapy, might help to improve pain and functionality more in patients with SIS. It is recommended to add SM or PNF to conventional treatment to maintain the ROM increase gained with SIS treatment after treatment, and to apply this treatment for 4 weeks for muscle strength increase.     

Cumulative Effects of a Week’s Training Loads on Shoulder Physical Qualities and Wellness in Competitive Swimmers

BackgroundCompetitive swimmers are exposed to high training loads, which can contribute to the development of shoulder pain. There is a lack of research investigating the interactions between the accumulation of training loads and factors associated to shoulder pain in swimmers.PurposeThe primary objective was to analyze the changes in shoulder physical qualities and wellness factors over a week of training in competitive swimmers. A secondary objective was to compare the changes in these variables between different swim-training volumes performed during the week.DesignCross-sectional.MethodsThirty-one national and regional-level swimmers were included (18 females, 13 males; age= 15.5 ± 2.2 years). Active shoulder external rotation (ER) range of motion (ROM), shoulder-rotation isometric torque, and wellness factors using the Hooper questionnaire were measured twice over the week: a baseline measurement (before Monday´s training session) and a follow-up during the week. Participants were divided into a high-volume group (HVG) and low-volume group (LVG) based on the day follow-up was performed. HVL (n= 15) was tested at the end of the training week (after Saturday´s session) and LVG (n= 16) during the week (after Thursday or Friday´s session). Rating of perceived exertion (RPE) of the whole week was recorded after the follow-up session.ResultsAt follow-up, the LVG averaged a volume of 26.2 ± 2.2 km, whereas the HVG averaged a volume of 37.5 ± 3.7 km. LVG and HVG participants decreased active shoulder ER ROM on dominant (p= 0.002; p= 0.006) and nondominant sides (p= 0.001; p= 0.004), displayed increased muscular soreness (p= 0.001; p= 0.007) and worsened overall wellness (p< 0.001; p= 0.010). Fatigue (p= 0.008) and poor sleep quality were increased (p= 0.023) in HVG, but not in LVG. There were no changes in shoulder-rotation torque and stress in any group. Regarding between-groups differences, only weekly RPE was higher (p= 0.004) in HVG.ConclusionsThe accumulation of training loads over the week negatively affect physical and wellness factors. Greater swim-volumes were associated with an increase perception of training loads. The regular monitoring of multiple factors to assess swimmers’ response to training might be necessary.Level of evidence3     

Biologically based therapies are commonly self-prescribed by Brazilian women for the treatment of advanced breast cancer or its symptoms

Purpose

Breast cancer (BC) might be associated with loss of function in affected patients, with a direct impact on their quality of life (QOL). Many women with metastatic BC seek relief of symptoms, including the use of complementary and alternative medicine (CAM) to cure cancer. The present study aimed to identify the pattern of CAM used by patients with metastatic BC and to assess the correlation between CAM use and scores on anxiety, depression, and QOL scales.

Methods

A total of 126 women with metastatic BC were interviewed using four instruments: (1) a questionnaire containing socioeconomic, clinical, and demographic data and CAM use; (2) European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ)-C30; (3) EORTC QLQ-BR23; and (4) the Hospital Anxiety and Depression Scale.

Results

Fifty percent of the participants reported the use of at least one CAM modality. Biologically based practices were the most frequently used to treat BC and/or its symptoms, the most commonly discussed with the oncologists, and one of the CAM categories in which more patients reported a desire to learn more about. The overall use of CAM was not correlated with the scores on the anxiety, depression, and QOL scales. However, analysis of the association of the QOL scores with specific CAM modalities revealed some potential associations (especially for food supplements, art therapy, psychotherapy, and prayer).

Conclusions

Women with metastatic BC frequently make use of CAM to treat the cancer and/or its symptoms. Biologically based practices seem to be particularly important in Brazil. An association between specific CAM modalities and some QOL domains was suggested, but it needs further confirmation.     

Motions and functional performance after supervised physical therapy program versus home-based program after arthroscopic anterior shoulder stabilization: A randomized clinical trial

ObjectiveTo compare the effects of a standardized supervised physical therapy versus a controlled home-based programs on the rate of shoulder motion and functional recovery after arthroscopic anterior shoulder stabilization.MethodsTwenty-seven patients (18–35 years) underwent arthroscopic anterior shoulder stabilization. Patients were randomized into two groups. A supervised group (n = 14) received a rehabilitation program, 3 sessions/week for 24 weeks and a controlled home treated group (n = 13) who followed a home-based program for same period. Range of motion (ROM) of the shoulder was assessed 4 times after each phase of rehabilitation and function was assessed after the 3rd and 4th phase of rehabilitation.ResultsBoth groups achieved a significant progressive increase in all shoulder motions throughout the study period. Patients in the supervised group achieved 92.6% and 94.2% of the contralateral side in abduction and forward elevation respectively. The controlled home-based group achieved 87.1% and 94.7% of abduction and forward elevation respectively. For external rotation, the percentage ROM achieved was 81.1% for the supervised group and 76.4% for the controlled home-based group. For function assessment, the two groups showed a significant improvement. However, the two groups were not significantly different from each other in all measured variables.ConclusionA controlled home-based physical therapy program is as effective as a supervised program in increasing shoulder range of motion and function after arthroscopic anterior shoulder stabilization.     

Referral Patterns of Patients for Palliative Radiation Therapy in British Columbia: A Comparison Between Rural and Urban Family Physicians

BackgroundPrevious studies have shown that palliative radiation therapy (PRT) is often underused, especially in rural and remote settings despite evidence supporting its effectiveness in managing symptoms from advanced or metastatic cancer.PurposeTo identify factors which influence family physicians (FPs) in British Columbia (BC) to refer patients for PRT at the BC Cancer Agency (BCCA) and to compare referral patterns between FPs in rural and urban areas.Methods and MaterialsA total of 1,001 questionnaires were sent to all FPs practicing in rural areas and randomly to FPs in urban areas (351 and 650, respectively). Rural and urban areas were chosen based on our previous study of utilization rates of PRT in BC. The questionnaire was adapted from a previously validated survey, and was used to obtain information on referral practices of FPs in BC. FPs who did not practice family medicine or where 80% of their practice was spent with either obstetrical or pediatric patients were excluded.ResultsThe overall response rate was 33% (44% rural vs. 28% urban). Rural FPs were more involved in both palliative care and metastatic cancer management of their patients (88% vs. 74%; P = .01 and 58% vs. 39%; P = .01). No difference was observed in the FPs' awareness of the BCCA's Radiation Oncology Program. The most significant factors influencing an FP to refer a patient for PRT were: poor functional status, inconvenience to travel and life expectancy. A higher proportion of rural FPs had 10 years or less of experience in family practice than the urban FPs (P = .03). There was no significant difference in the formal training or additional training between the rural and urban FPs.ConclusionsThis study found that FPs practicing in rural areas were more involved in palliative management of their patients and participated more in the care of patients with advanced or metastatic cancer than those in urban areas. They also more commonly referred patients for palliative radiotherapy than their urban counterparts. The reported factors that influenced rural and urban FPs to refer were patients' functional status and life expectancy, combined with uncertain benefit and potential side effects of radiotherapy. More than twice as many FPs from rural compared to urban areas were influenced by perceived inconvenience to travel for palliative radiotherapy. After controlling for potential confounding factors, FP awareness of the radiotherapy program, high participation in advanced, metastatic, or palliative care of cancer patients, formal training in radiation oncology, and additional training in palliative care were all associated with an increased probability of ever referring for palliative radiotherapy.     

Effectiveness of neuromuscular taping on painful hemiplegic shoulder: a randomised clinical trial

Purpose: The purpose of this trial was to investigate changes in pain, the range of motion (ROM) and spasticity in people with painful hemiplegic shoulder (PHS) after the application of an upper limb neuromuscular taping (NMT). Methods: We conducted a randomised clinical trial. The study included 32 people, 31% female (mean?±?SD age: 66?±?9 years), with PHS after stroke with pain at rest and during functional movements. The experimental group received the application of NMT and a standard physical therapy programme (SPTP), whereas the control group received SPTP. The groups received four 45-minute long sessions over four weeks. The VAS, ROM and spasticity were assessed before and after the intervention with follow-up at four weeks. Results: The experimental group had a greater reduction in pain compared to the control group at the end of the intervention, as well as at one month after the intervention (p?Conclusion: Our study demonstrates that NMT decreases pain and increases the ROM in subjects with shoulder pain after a stroke.

• Implications for Rehabilitation

• Painful hemiplegic shoulder is a frequent complication after stroke with negative impacts on functional activities and on quality of life of people, moreover restricts rehabilitation intervention.

• Neuromuscular taping is a technique introduced by David Blow for the treatment of neuromuscoloskeletal problems.

• This study shows the reduction of pain and the improvement of range of motion after the application of an upper limb neuromuscular taping.

• Rehabilitation professionals who are involved in the management of painful hemiplegic shoulder may like to consider the benefits that neuromuscular taping can produce on upper limb.

     

Effectiveness of Botulinum Toxin A in Treatment of Hemiplegic Shoulder Pain: A Systematic Review and Meta-analysis

ObjectiveTo evaluate the effectiveness of botulinum toxin A (BTX-A) in the treatment of hemiplegic shoulder pain.Data SourcesPubMed, EMBASE, Elsevier, Springer, Cochrane Library, Physiotherapy Evidence Database, CNKI, and VIP were researched from the earliest records to September 1, 2020.Study SelectionRandomized controlled trials that compared shoulder BTX-A injections vs a control intervention in patients with a history of hemiplegic shoulder pain after stroke were selected. Among the 620 records screened, 9 trials with 301 eligible patients were included.Data ExtractionOutcome data were pooled according to follow-up intervals (1, 2, 4, and 12 wk). The primary evaluation indices were pain reduction (visual analog scale [VAS] score) and range of motion (ROM) improvement. The second evaluation indices were upper limb functional improvement, spasticity improvement, and incidence of adverse events. Cochrane risk-of-bias was used to assess the methodological quality of studies independently by 2 evaluators.Data SynthesisMeta-analysis revealed a statistically significant decrease in the VAS score in the BTX group vs the control group at 1, 4, and 12 weeks postinjection (wk 1: standardized mean difference [SMD], 0.91; 95% confidence interval [CI], 0.27 to 1.54; wk 4: SMD, 1.63; 95% CI, 0.76 to 2.51; wk 12: SMD, 1.96; 95% CI, 1.44 to 2.47). Furthermore, the meta-analysis demonstrated a statistically significant increase in abduction at 1, 4, and 12 weeks postinjection (wk 1: SMD, 3.71; 95% CI, 0 to 7.41; wk 4: SMD, 8.8; 95% CI, 2.22 to 15.37; wk 12: SMD, 19.59; 95% CI, 9.05 to 30.13) and external rotation at 1, 2, 4 weeks postinjection (wk 1: SMD, 5.67; 95% CI, 0.88 to 10.47; wk 2: SMD, 9.62; 95% CI, 5.57 to 13; wk 4: SMD, 6.89; 95% CI, 2.45 to 11.33) in the BTX group.ConclusionsBTX-A injection provided greater analgesic effects and increased shoulder abduction and external rotation ROM compared with steroid or placebo injection for the treatment of HSP.     

RESISTANCE BAND TRAINING AFTER TRIAMCINOLONE ACETONIDE INJECTION FOR SUBACROMIAL BURSITIS: A RANDOMIZED CLINICAL TRIAL

ObjectiveTo investigate the effect of progressive resistance training using resistance (elastic) bands on subacromial bursitis following triamcinolone acetonide injection.DesignRandomized clinical trial.PatientsA total of 68 patients with subacromial bursitis were randomized to a triamcinolone acetonide group or a triamcinolone acetonide plus resistance band training group.MethodsVisual analogue scale, Constant scores, range of motion, proprioception, and muscle strength were evaluated at pretreatment and at 3, 12 and 24 weeks’ follow-up. Re-treatment ratio was calculated at one-year follow-up.ResultsAt 3 and 12 weeks, both the triamcinolone acetonide group and triamcinolone acetonide plus resistance band training group showed a significant improvement in Visual analogue scale score, Constant score, range of motion, proprioception and muscle strength. Although the scores in the triamcinolone acetonide group had not increased at 24 weeks compared with baseline, the scores in the triamcinolone acetonide plus resistance band training group showed continued improvement at 24 weeks. A lower proportion of patients in the triamcinolone acetonide plus resistance band training bands group than in the triamcinolone acetonide group had received re-treatment at one-year follow-up (12.1% vs 82.9%).ConclusionProgressive resistance training with resistance (elastic) bands has the advantages of extending the benefits of corticosteroid injection and maintaining long-term effects on shoulder function in patients with subacromial bursitis.LAY ABSTRACTSubacromial bursitis is characterized by pain and stiffness of the shoulders. Corticosteroid injection is widely used in treating subacromial bursitis; however, with differing views on its long-term effects in preventing shoulder symptoms. Resistance (elastic) band training is commonly used to promote muscle activation during shoulder rehabilitation. The aim of this study was to investigate the effect of progressive resistance training with elastic bands on subacromial bursitis following triamcinolone acetonide injection. Patients with subacromial bursitis were randomized to a triamcinolone acetonide group or a triamcinolone acetonide plus resistance band training group. The triamcinolone acetonide group received triamcinolone acetonide injection only. Meanwhile, the triamcinolone acetonide plus resistance band training group received triamcinolone acetonide injection and resistance band training. At 3 and 12 weeks, both the triamcinolone acetonide group and triamcinolone acetonide plus resistance band training group showed a significant improvement in pain relief, mobility, and muscle strength. A lower proportion of patients in the triamcinolone acetonide plus resistance band training group than in the triamcinolone acetonide group had received re-treatment at the oneyear follow-up (12.1% vs 82.9%). Thus, training with resistance (elastic) bands has the advantages of extending the benefits of corticosteroid injection and maintaining long-term effects on shoulder function in subacromial bursitis.Key words: triamcinolone acetonide, elastic band training, resistance band training, subacromial bursitis

Subacromial bursitis (SB) is one of the most common clinical conditions characterized by anterior shoulder pain and restriction of range of motion (ROM) of the shoulder, which usually occurs during abduction and sometimes during rotation of the shoulder (1).Corticosteroid injections are widely used to treat shoulder pain in conditions such as rotator cuff disease, bursitis, and adhesive capsulitis, reducing inflammation and relieving pain (2–4). In some clinical studies, corticosteroid injections are defined as an effective short-term treatment and have potential side-effects with repeated injection. A controlled trial investigating the correlation between injection schedule and shoulder benefits found that the therapeutic effect lasted only 6 weeks after the injection and that the clinical improvements disappeared by 12 weeks, with more than half of patients experiencing recurrence of symptoms (5). Similarly, a study of methylprednisolone injection in the treatment of impingement syndrome also showed significant improvement in activities of daily living (ADL) variables and a decrease in sleep-disturbing pain, although these differences disappeared by 3 months (6). In addition, a review by Buchbinder et al. concluded that corticosteroid injection can be beneficial for shoulder pain, although its effect may be slight and temporary (7). In agreement with the above studies, our clinical practice has found that corticosteroid injection alone does not produce long-term benefits. Therefore, the clinical effect of corticosteroid injection in SB requires discussion and reconsideration.The muscles around the shoulder joint contribute to maintaining shoulder stability. Weakness or imbalance in shoulder muscle strength causes excessive stress on the joint and may lead to changes in shoulder biomechanics and shoulder disease. Muscle strength-training exercises are used to increase muscular development and improve neuromuscular control (8, 9). Progressive resistance training with a gradually increasing load is recommended to achieve neuromuscular activation and muscle strengthening and hypertrophy. Resistance training has been shown to enhance muscle strength and may be important in preventing shoulder injuries (10–12). Elastic bands (EB), a type of resistance training apparatus, can provide variable resistance and allow changes over a range of motions, which can prevent the risk of excessive weight loading during strength-training exercises. In addition, EB can provide efficient resistance and promote high levels of muscle activation for enhancing muscle strength in treating shoulder disease (13–15). Because of their simplicity and their economic and safety advantages, EB are commonly used during rehabilitation programmes and are available in most rehabilitation centres.Based on the above observations, this study aimed to examine the effect of EB training after triamcinolone acetonide (TA) injection on the treatment of SB. It was hypothesized that resistance training with EB could effectively treat SB with long-term benefits.     

肩周肌群训练联合肌内效贴治疗肩袖损伤的疗效观察

目的：研究肩周肌群训练联合肌内效贴治疗肩袖损伤的临床疗效。方法：选取符合肩袖损伤标准的患者40例,随机分成研究组和对照组各20例。对照组进行肩周肌群训练,研究组在对照组基础上增加肌内效贴布,治疗疗程为4周。2组在治疗前（T1）、治疗4周后（T2）、治疗结束后1个月随访时（T3）进行评估,评价指标采用视觉模拟评分法（VAS）、Constant-Murley肩关节评分系统(CMS)、美国加州大学肩关节评分系统(UCLA)、患侧肩关节活动范围(ROM)。结果：在T2和T3时,2组患者VAS评分均较T1时明显下降（均P＜0.05）,CMS及UCLA评分均较T1时明显提高（均P＜0.05）,前屈、外展、内外旋活动度均较T1时明显增加（均P＜0.05）,且研究组VAS评分均更低于对照组（均P＜0.05）,CMS及UCLA评分均更高于对照组（均P＜0.05）,前屈、外展、内外旋活动度均更高于对照组（均P＜0.05）;在T3随访时,研究组VAS评分较T2时明显下降（P＜0.05）,CMS及UCLA评分均较T2时明显提高（均P＜0.05）,前屈、外展、内外旋活动度均较T2时明显增加（均P＜0.05）,而对照组各项评分和肩关节ROM较T2时差异均无统计学意义。结论：说明肩周肌群训练联合肌内效贴治疗肩袖损伤效果更好,而且在治疗结束后1个月内肌内效贴仍能够维持一定的效果,值得临床推广应用。     

Addition of intra-articular hyaluronate injection to physical therapy program produces no extra benefits in patients with adhesive capsulitis of the shoulder: a randomized controlled trial

Hsieh L-F, Hsu W-C, Lin Y-J, Chang H-L, Chen C-C, Huang V. Addition of intra-articular hyaluronate injection to physical therapy program produces no extra benefits in patients with adhesive capsulitis of the shoulder: a randomized controlled trial.ObjectiveTo compare the efficacy of intra-articular hyaluronic acid (HA) injections plus physical therapy (PT) with that of PT alone for the treatment of adhesive capsulitis (AC) of the shoulder.DesignProspective, randomized controlled trial.SettingRehabilitation and orthopedics department of a private teaching hospital.ParticipantsPatients (N=70) with AC of the shoulder were randomly placed into either of the following treatment groups: group 1, HA injections with PT (HAPT group); or group 2, PT alone (PT group).InterventionsThe patients in group 1 received intra-articular glenohumeral joint injections of HA, 20mg, once per week for 3 consecutive weeks and also participated in a PT program for 3 months. The patients in group 2 received PT alone.Main Outcome MeasuresActive and passive range of motion (ROM) of the affected shoulder, pain, disability, and quality of life.ResultsBoth groups experienced improvements in terms of pain, disability, and quality of life after the treatments; furthermore, the active and passive ROM improved linearly with increasing treatment duration. When the groups were compared, no significant group effect was found for any of the outcome measurements.ConclusionsIntra-articular HA injections did not produce added benefits for patients with AC of the shoulder who were already receiving PT. Thus, the use of intra-articular HA injections for patients with AC of the shoulder should be carefully assessed to reduce unnecessary medical expenditures.     

Effect of neuromuscular training on functional throwing performance and speed in asymptomatic cricket players

ObjectiveTo determine the effect of neuromuscular training on functional throwing performance and speed among asymptomatic cricket players.DesignSingle-subject A-B-A design.MethodForty-three male asymptomatic sub-elite cricket players were recruited from Karnataka Institute of Cricket, Bangalore, India, with a mean age of 20.4 ± 2.03 years. Throwing accuracy and throwing speed were measured using Functional Throwing Performance Index (FTPI) and radar gun respectively, at zero, 12, 24 and 30 weeks in accordance with the A-B-A single-subject design. The neuromuscular training of the throwing arm was performed for 12 weeks, two days a week of supervised training including rhythmic stabilization drills were performed. A non-supervised training session including shoulder strengthening programme was conducted three days a week.ResultParticipants demonstrated significant improvement in throwing accuracy (p < 0.001) and speed (p < 0.001) after 12 weeks of neuromuscular training. Six weeks post-withdrawal of the neuromuscular training on throwing accuracy was not significant (p = 0.117), However, speed was sustained (p = 0.013).ConclusionNeuromuscular training showed an improved efficiency in throwing performance following 12 weeks of training in sub-elite cricket players. The sustained effect was not observed following 6 weeks of withdrawal of training.     

Exploration of the clinical course of frozen shoulder: A longitudinal multicenter prospective study of functional impairments

BackgroundContradictory evidence exists regarding the clinical course of frozen shoulder (FS).ObjectivesTo explore the clinical course of FS regarding disabilities, pain, range of motion (ROM), muscle strength, scapular upward rotation, and proprioception and to establish longitudinal correlations between these variables.MethodsPatients with FS were prospectively followed for 9 months at 3-month intervals. Assessment included the Disabilities of the Arm, Shoulder and Hand questionnaire; visual analogue scale for pain; an inclinometer for shoulder external rotation (ER), internal rotation (IR), flexion, and abduction ROM, and scapular upward rotation and proprioception, as well as handheld dynamometry for muscle strength in shoulder abduction, ER, and IR.ResultsInitially, 149 patients (98 females; mean (SD) age 53 (9) years) were included, with 88 completing all follow-up assessments. Most variables showed early improvement in the clinical course of FS, particularly ER and IR at 90° abduction, which continued to improve from 6 to 9 months of follow-up. Associations were observed between disabilities and pain (r = 0.61), disabilities/pain and ROM (r=-0.62 to -0.59 and r=-0.47 to -0.39, respectively), disabilities/pain and muscle strength (r=-0.24 to -0.35 and r=-0.36 to -0.17, respectively), and between disabilities/pain and scapular upward rotation below shoulder level (r = 0.23 to 0.38 and r = 0.24 to 0.30, respectively). ROM correlated with muscle strength (r = 0.14 to 0.44), while both ROM and ER muscle strength correlated with scapular upward rotation below shoulder level (r=-0.37 to -0.23 and r=-0.17 to -0.12, respectively). Muscle strength correlated with scapular upward rotation above shoulder level (r = 0.28 to 0.38) and lift-off muscle strength correlated with joint repositioning (r=-0.17 to -0.15).ConclusionAlmost all factors improved in the early phase (3–6 months) after baseline assessment, while ER and IR ROM at shoulder level continued to improve long term.     

Manual lymphatic drainage versus exercise in the early postoperative period for breast cancer

Abstract

Objective: To compare the effect of active exercise and manual lymphatic drainage (MLD) on postoperative wound healing complications, shoulder range of motion (ROM) and upper limb (UL) perimetry in women undergoing radical mastectomy for breast cancer. Methods: Controlled non-randomized clinical trial with 89 women undergoing breast cancer surgery with axillary lymph node dissection (Brazilian Registry of Clinical Trials: 906). Women were matched for staging, age and body mass index, with 46 women allocated to the exercise group and 43 in the MLD group, receiving 2 weekly sessions during one month. Assessments were performed in the preoperative and 60?d after surgery, including inspection, palpation, goniometry and perimetry. Results: No significant difference existed between groups relative to individual and clinical surgical characteristics. The incidence of seroma, number of punctures performed, dehiscence and infection was similar in both groups. A comparison of shoulder ROM and UL perimetry between groups, obtained in the preoperative and postoperative period, did not show any significant difference. Conclusion: The performance of active exercise or MLD did not demonstrate difference in wound healing complications, shoulder ROM and UL perimetry at 60?d after surgery, suggesting that these techniques may be employed, according to the complaints or symptoms of each woman and physical therapist experience.     

Test-retest reliability of movement-evoked pain and sensitivity to movement-evoked pain in patients with rotator cuff-related shoulder pain

BackgroundThe number of researchers and clinicians using movement-evoked pain and sensitivity to movement-evoked pain to assess shoulder pain has increased. However, the intrarater test-retest reliability of movement-evoked pain and sensitivity to movement-evoked pain in people with rotator cuff-related shoulder pain (RCRSP) is still unknown.ObjectiveWe examined the intrarater test-retest reliability of movement-evoked pain and sensitivity to movement-evoked pain in participants with RCRSP.MethodsSeventy-four participants with RCRSP performed five trials of active shoulder abduction to elicit pain under two experimental conditions: active shoulder abduction to the onset of pain and maximum range of motion (ROM). The primary outcome measures were pain intensity and ROM. Test-retest reliability of movement-evoked pain and sensitivity to movement-evoked pain was examined using intraclass correlation coefficient (ICC_3,1) and minimal detectable change (MDC₉₀).ResultsThe reliability of movement-evoked pain under both experimental conditions was good to excellent (ICC: 0.81 to 0.95), while the reliability of sensitivity to movement-evoked pain was poor in both conditions (ICC≤0.45). The MDC₉₀ for pain intensity was 1.6 and 1.8 during shoulder abduction to the onset of pain and maximum ROM, respectively. The MDC₉₀ for ROM was 17.5° and 11.2° during shoulder abduction to the onset of pain and maximum ROM condition, respectively.ConclusionThis study confirms movement-evoked pain testing during active shoulder abduction to the onset of pain or maximum ROM condition is reliable to assess pain associated with movement in patients with RCRSP. The minimal detectable change score of movement-evoked pain can guide clinicians and researchers on how to interpret changes in these outcomes.