فرشاد اخوتیان

Massage therapy is widely used by athletes for various reasons such as recovery from fatigue, preventing injury, and relaxation. It is believed that massage improves the performance of the athletes by increasing their blood flow, removing lactic acid, and stimulating the nervous system. This review study aims to investigate the physiological and neurophysiological effects of sports massage on the athletes’ performance, to find out whether the clinical beliefs of sports physiotherapists about the effects of sports massage on sports injuries are supported by scientific evidence or not.

In this review study, a search was conducted in Google Scholar PubMed, and ScienceDirect databases on studies published in English from 1975 to 2020 using the keywords: Sports massage, sports injuries, physiological mechanisms, neurophysiological mechanisms, and performance of athletes. Fifty articles about the effects of sports massage were assessed for eligibility. Finally, 14 clinical trial studies and one case report study were included in the review.

Few studies have been conducted on the effect of sports massage on the athletes’ performance. The existing studies are heterogeneous, i.e., they have examined the effect of massage on different factors and reported contradictory results. It seems that the effects of sports massage on the athletes’ performance are more due to its psychological effects rather than its clinical effects. The effects of sports massage on athletes’ performance have not yet been supported by scientific evidence.

Many scholars consider that the effects of sports massage are due to increasing blood flow, but there is insufficient scientific evidence. In treatment of tendonitis and muscle strains, there is insufficient evidence that sports massage can reduce pain and accelerate healing. It seems the therapeutic effects of sport massage are more psychological and less physiological.

Muscular atrophy is a condition derived from different diseases and aging. Molecular study of the disease condition can help in developing diagnostic methods and treatment approaches. In this study, protein interaction network was analyzed to understand molecular events at protein levels. In this experimental study, the network was constructed and analyzed using Cytoscape and its plug-in STRING. In addition, Network Analyzer and MCODE were applied to analyze the centrality and clustering, respectively. Bingo explored the gene ontology of the determined protein complexes. The findings showed five key genes in the network of atrophy including AKT1, ALB, DMD, SMN1, and SMN2. Furthermore, six clusters of proteins were obtained from which two significant ones were considered for gene ontology analysis. All the central proteins, AKT1, ALB, DMD, SMN1, and SMN2 are present in the clusters of our interests. It can be concluded that the panel of biomarkers introduced could be of great help in understanding the pathology of muscular atrophy.

The prevalence of heart failure is increasing. The effects of the second and third phases of cardiac rehabilitation in reducing symptoms and improving quality of life for ambulatory (discharged) heart patients has repeatedly been investigated. However, due to the threats to the survival of heart patients at hospitalization (and the possibility of a sharp decline in functional capacity of patients at this stage), the first phase of cardiac rehabilitation, especially for patients with heart failure, has rarely been studied. Meanwhile, the quality of life is becoming increasingly important in the health care system so that it is belived that the most important goal in interventions is to improve the quality of life, especially in chronic diseases. Thus, the aim of the present study was to evaluate the effect of the first phase of cardiac rehabilitation on the quality of life and functional capacity of patients with heart failure.
Methods and Materials: In the present one way blind clinical trial, 34 patients with moderate and severe heart failure (New York Heart Association functional classification basis) with left ventricular ejection fraction lower than 40 percent were included. The patients were randomly divided into two groups. Both groups received routine medical care during hospitalization and respiratory physiotherapy. In addition, patients in the intervention group care had aerobic exercise program using a stationary bicycle. In both groups, in addition to the usual parameters (such as heart rate, blood pressure and respiratory rate), the first and fifth day of hospitalization, quality of life (using the Persian version of the Seattle Angina Questionnaire) and functional capacity (6-minute walk test) were measured. Normality Shapiro-Wilk test was also performed. Then, dependent parameters in the two groups were tracked running multi-factor repeated measures analysis of variance.
In the beginning of the study, the two groups were not significantly different in terms of the variables related to disease severity and demographics. Then, functional capacity was increased in both groups from the first day to the fifth day, yet this improvement was not found to be significant. Also, the quality of life improved 53.84 percent in the intervention group and 29.62 percent in the control group, which is statistically significant (p Cardiac rehabilitation during the first five days of hospitalization can improve the quality of life (which is considered as a predictor of outcome in heart failure) as well as functional capacity in heart failure patients.

Studies show that ethanol can induce changes in proteomic profile of human fibroblast cells. Some of these proteins are important in promoting cancer. Thus, analyzing function and interaction networks of these proteins are essential for better understanding the carcinogenesis mechanism of ethanol.
In this study the protein-protein interaction network (PPI) of six significant down-regulated proteins in human fibroblast cells (HFFF2) treated with ethanol were analyzed by using Cytoscape software and its algorithms.
PPI network analysis showed that the constructed network consisted of 756 nodes and 1166 edges. Results indicated that Heterogeneous nuclear ribonucleoprotein A1 with degree = 528 and Betweenness Centrality = 0.74 is a hub protein that ethanol can alter its expression. In addition, module evaluation showed that the hub protein has a key role in different overlapped complexes. On the other hand, annotation studies by using DAVID program indicated that this protein is involved in different important biological processes in the cell.
The six down-regulated proteins treated with ethanol may become carcinogenic and can impose vast alterations in other vital biological processes of the cell. Among them, Heterogeneous nuclear ribonucleoprotein A1 is the most important one

The main cause of Myofascial pain syndrome is trigger point. The purpose of this study was to compare muscle energy technique (MET) with dry needling (DN) on latent trigger point of upper trapezius.
Fourty females, with diagnosis of latent trigger point of upper trapezius after adopting the inclusion and exclusion criteria were equally and randomly allocated into either the muscle energy technique or dry needling groups. Each patient received one treatment to the upper trapezius muscle. Outcome measures (visual analogue scale (VAS), pressure pain threshold (PPT), and range of active contra lateral flexion (CLF) measured before and 48 hours after treatment.
Two techniques which used in this study were effective for treating latent trigger point of upper trapezius (P0/05).
This study demonstrated that muscle energy technique was as effective as dry needling in improvement of VAS, PPT and ROM in subjects with latent trigger point of upper trapezius muscle. But since muscle energy technique is safe and non-invasive method, therefore, if you want to select one of these two techniques, muscle energy technique is recommended.

An important part of examination in patients with cervical disorders is measuring active range of motion of the cervical, particularly in evaluation of the effectiveness of interventions. Goniometer is a common instrument in measuring range of motion. Easy working, easy carrying, and custom benefits make this instrument popular and common. This study was set out to determine the intra-examiner reliability of goniometer for all active movements of cervical. A total of 15 asymptomatic young women, aged 18-30 years old, volunteered for the present study. Voluntaries evaluated for all active cervical movements in three trials and 5 minutes rest time between the trials. Intraclass correlation coefficient (ICC) and Standard Error of Measurements (SEM) were used to quantify intra-examiner reliability. Intraclass correlation coefficients (ICC) for intra-examiner reliability of the gonameter were estimated to be 0.93 for flexion, 0.94 for extension, 0.92 for left lateral flexion, 0.90 for right lateral flexion, 0.88 for right rotation, and 0.89 for left rotation, respectively. Goniometer has accurate intra-examiner reliability for measurement of cervical range of motion of flexion, extension, right, and left lateral flexion, and right and left rotation movements.

Anterior cruciate ligament injury is a common knee problem that could affect balance. The purpose of this study was to investigate whether the additional sensory information could improve dynamic balance in individuals with anterior cruciate ligament (ACL) injury in comparison with healthy adults. 15 young patients with unilateral anterior cruciate ligament injury (mean age 28.9±4.7, male) and 15 healthy volunteers (mean age 26.1±3.8, male) participated in this study. Participants were completed the star excursion balance test under two sensory conditions: with and without using light touch. The force sensor that was placed on the light touch device transferred the sensory informations from index finger to the microprocessor and proper feedback was produced. The results showed significant differences after using light touch in anterior cruciate ligament deficiency patients in compared with control group in these directions: medial, posterior, lateral, anterolateral, Posterolateral and posteromedial (P=0.001).There was also significant differences between the patients and healthy controls in posterior (P=0.005),lateral(P=0.004) and medial(P=0.003) directions. Based on these results, we suggest that the reduction in dynamic test in patients with anterior cruciate ligament deficiency would be due to the reduction of sensory information provided by this ligament, but when sensory information is enhanced, dynamic performance improves. The results have implications for a new method to improve stability in these patients.

Carpal tunnel syndrome is common among handicapped people using wheelchair, and repeated wrist movements increase the risk of incidence of this syndrome. In present study, performance, pain and range of motion of wrist were compared between the athletes and non-athlete handicapped people suffering from carpal tunnel syndrome. In this descriptive study, all members of handicapped basketball team in Tehran (35 persons) and 33 wheelchair-bound non-athlete handicapped persons residing in Tehran sanitariums were studied (similar with respect to age, weight, height, years of using wheelchair and level of disability).In this study, Clinical Questionnaire and Nerve Conduction Study were used for diagnosing carpal tunnel syndrome, VAS Scale for measuring pain, Goniometer for measuring range of motion of wrist, and Self-Administered Questionnaire for investigating severity of symptoms and performance. The finings of this study indicated that there was no significant difference between two athlete and non-athlete handicapped groups with carpal tunnel syndrome in prevalence of carpal tunnel syndrome, severity of pain, performance and range of motion of wrist (p>0.05). Among 35 athletes, 6 persons (mean age: 36±3.11, mean weight: 68±4.74 and mean height: 172±7) and among 33 non-athletes, 5 persons (mean age: 41±7.1, mean weight: 73±3 and mean height: 173±5) had carpal tunnel syndrome. Unlike what is supposed, repeated movements of wrist is not the only factor predisposing the athlete handicapped people to carpal tunnel syndrome, So other influencing factors should be considered.

Chronic obstructive pulmonary disease (COPD) causes shallow breathing, low oxygen, muscular weakness and reduced mobility. The most common symptoms of COPD is shortness of breath and a chronic cough with sputum. Despite the high prevalence of this disease and effective role of physical therapy, there is a noticeable lack of research in this area. Therefore, the purpose of this study was to compare the degree of thoracic kyphosis and diaphragm muscle thickness between females with COPD and healthy women. In this study, 20 women with COPD (stages 2 and 3) and 20 healthy women were examined regarding some biomechanical and physiological parameters. Diaphragm thickness was determined using ultrasound and kyphosis angle was measured by flexible ruler. Kyphosis in healthy subject was less than healthy individuals (p<0.05). The diaphragm muscle thickness was not significantly difference between the two groups. But the diaphragm thickness changes in healthy individuals was about 2 times more than patients with COPD (p<0.05). The resean for lower kyphosis angle in COPD patients could be due to their shape of chest. It also increases the percentage of diaphragm thickness change in healthy individuals (as compared to COPD) that shows their better diaphragm performance. Perhaps, short deep breath and intervals of breathing in patients are the result of this effect. These results can be considered for description of the treatment protocol of physiotherapy in patients with COPD.

The objective of this study was to investigate the amount of medical society's knowledge about the role of physiotherapy in treating and improving the confined patients. A questionnaire has prepared with five clinical questions by multiple choice items. The volunteers have one or more items to choice. These questionnaires have randomly completed by the medical students of the Medical Universities around Iran. Our results have shown that only 47.5% of physicians are familiar with the role of physiotherapy for treating and improving restricted patients, on the other hand 18.6% prescribed unsuitable,expensive, and even harmful techniques for curing these patients. The results of our study emphasis on the limited knowledge and information of the medical society about physiotherapy. Even in some cases that the role of physiotherapy has proven, they are not familiar with it. It may reflect the lack of medical training program and their educational syllabus.

Anal fistula is the most common cause of severeanal pain during rectal surgery. Patients experience pain and discomfort duringthe immediate post-operative period and some specialties e.g., physiotherapycould be taken into account for mitigating pain and improving the scar healing.Although no researches have performed concerning the post rectal surgeryphysiotherapy, it leads to surgeons uncaring to this apparently important point.Therefore, the current study aimed to prepare a new physiotherapy protocol afterrectal surgery and to investigate its effectiveness in one patient. This study carried out on a 45 year-old male. He wassuffering from pain and bleeding in the rectal area and on medical examinationand colonoscopy, he was diagnosed with external hemorrhoid and anal fistula.After hemorroidectomy and fistulectomy, physiotherapy protocol was performedin five phases. The results showed that the pain medication needed just for 4 days and the patient returned to work within 3 days. In addition, the intensity of pain,difficulty in bowel movement, difficulty in mobility, and stress from bowel movement (measured by VAS) removed within 5th days. This result in comparison with previous studies showed the faster improvement of the pain and scar healing and complete recovery took about 4 weeks. The beneficial effects of physiotherapy protocol were demonstrated, especially in aged patients with background diseases.

To investigate the effect of the light touch, vision and dual task interference on the surface electromyography (sEMG) activity of ankle musclesParticipants: Thirty persons (12 male, 18 Female), right hand without any neuro-musculo-skeletal disorder and in healthy condition, participated in this study.Methods and Materials: Participants stood in upright and semi tandem position. There was a high sensitivity sensor on the right side in direction of femur greater trochanter. They should press the sensor less than 50 gr. Also we examined the rate of activity in 3 muscles (Tibialis Anterior, Proneus Longuse, Soleuse) on both lower limbs by Biometrix sEMG device. 4 positions were experimented in semi tandem standing: No Touch, No Counting; No Touch, Counting; Light Touch, No Counting; Light Touch, Counting. Each of the above positions was tested in 2 conditions: Eyes Open, Eyes Closed. Our findings detect that light touch contact especially during vision, resulted in reducing the rate of sEMG activity in the leg postural muscles. No touch and closed eyes, raise the rate of sEMG activity to maximum. On basis of findings, it seems that following skin receptors stimulation, some complicated mechanisms will be begun and in order to the orders of Central Nervous System (CNS), these muscles will make the hole body, stable. So it can reduce the entered pressure on leg postural muscles. Therefore we can see the lesser rate in sEMG activity of leg postural muscles.

The objective of this study was to investigate the endotracheal tube cuff (ETT) pressure in the intensive care unit (ICU) patients, who had been intubated. Meterials and All patients were placed in ICU during the last three month 2008. The endotracheal tube cuff (ETT) pressure in 308 cases was measured at twice by an expert. A standard manometer was used to measure the cuff pressure and it was calibrated before and after the measurement. The results show indicated that 50% of cases 1 suffered from brain injuries and 63.6% of them were intubated as a result of brain problem. The value of cuff pressure was not standard in 31 cases at both times. In addition, the cuff pressure in 49% of cases was not standard at first, but after correction it decreased to 18.5%.This emphasizes the effectiveness of having supervision over cuff pressure in acceptable regular intervals by treatment team. It is suggested that along with recording the vital signs of the patieut, ETT cuff pressure beingrecorded at appropriate intervals as well.

The strength of a group of muscles can be measured by muscle strength test, employing a force measuring instrument. In order to monitor the effectiveness of a therapeutic or training programs we need a reliable technique which is also accurate in repeated measurements. The purpose of this study was to examine the reliability of an isometric neck muscle force measurement device. Thirty seven healthy non athlete subjects (18 males and 19 females, aged 18-25) participated in this analytical study. The maximal isometric contractions of the neck extensor and flexor muscles were measured in different times and different days and by two different testers. A new sensitive “load cell” was applied to our previously designed neck muscle force measurement apparatus. The results of the inter-trail, test retest, and inter rater reliability (0.86 < ICC < 0.98, 2.2< Sw <5.1 N) indicated that the neck muscle force measurements were highly repeatable and less variable between measurements. There were no statistically significant differences in neck muscle force measurements, between times, between days and between retsters. Maximum isometric contractions were significantly higher in males than in the females (p < 0.001). Women’s neck muscle strengths were 30.8% and 46.1% of men in cervical extension and cervical flexion. In this study we used a new model (Isometer 2) of our previous apparatus (Isometer). The isometric strength of neck flexor and extensor muscles which was measured by Isometer 2 appeared to be a reliable and useful method for measuring the force of the neck extensor and flexor muscles.

The aim of this study was to determine the efficacy of three common remedial exercises and then compare them in severity of pain and disability in patients with chronic low back pain. 25 patients with same as level of physical activity and history of mechanical low back pain during 6-12 months ago invited to participate to this clinical trial. After routine physical exam, severity of pain and disability due to low back pain was evaluated with visual analog scale (VAS) and Oswestry Questionnaire (OSWQ) respectively. Patients distribute to three subgroups (stabilization exercise=10pateints, Williams exercise=8patients, McKenzie exercise=7patients). Means difference of pain score and OSWQ (disability index) in all groups wasnt significant. Patients had done exercises according to name of their group during 12 weeks. At first all groups performed a complete set of exercises every day in 6 weeks. Then second 6 weeks exercises had done every other day (3 days per week). After testing the repeat ability of the parameters, reassessment of parameters was performed at the end of every 3 weeks. Data analysis was done with SPSS software. Friedman and Willcoxon tests were used for determination and analysis of data in three groups and then Kruskal-Wallis test and Mann-Whitney was done for determination of differences between three groups. Data showed that all exercise regimens can decrease pain and disability index (P<0.000l). Though decrease of pain and OSWQ in stabilization group was faster than the other groups (P<0.05). All exercise regimens due to their strengthening properties and special affects on muscles and joints of lumbopelvic region can decrease severity of pain even acute pain. But according to the effect of pain chronocity to surrounding tissues and receptors of lumbopelvic region and also central effect of pain (reorganization of motor cortex), which exercise can more effect than the other to this parameters that can more and more affect the surrounding tissues and receptors of lumbopelvic region so in the long time stabilization exercise according to activate inhibited local stabilizing muscles and then global muscle in stable position and unstable position can more effective than the other exercise regimens.

Spinal cord injuries are among the most common problems originated in human societies. In our country this problem takes into account more seriously when considering the devotees of 8-year imposed war.

After filling the questionnaire and receiving necessary educations, paraplegic patients walked on a course like "figure of 8" with preferred speed for 5 minutes. Heart rate, blood pressure, and RPE were measured. Tests were achieved in three stages, each time with a different crutch. Axillary crutch, elbow crutch, and walker were used randomly. Energy cost was assessed using two novel indices PCI (Physiological Cost Index) and RPE.

10 paraplegic patients with mean age of 34±4.99 yrs, height of 167cm, and weight of 64.6kg had entered this study. All of them had spinal cord injuries, averagely occurred for 3.8±3.3yrs. Mean of PCI was measured 1.94, 1.58, and 1.65 beats/min for axillary crutch, elbow crutch, and walker, respectively. Mean of walking speed was higher with elbow crutch. Regarding the RPE, results have revealed that when patient has little balance, walker is the preferred device but in case of good balancing then elbow crutch is the device of choice. Patients with complete spinal cord injuries have shown lower PCI comparing with those who had incomplete injuries. This was proved in other studies, too. Meanwhile, walking speed in patients with complete injuries was 1.4 times as likely as those who had incomplete injuries.

Using crutches and exercising could lead to higher cardiovascular readiness that would be accompanied by lower PCI. Employing walking-aid devices in rehabilitation centers seeks more attention.

Lower back pain is most prevalent during our young and middle adult lives. Eighty percent of the population will experience an episode of pain during their lifetime. Recently some exercises are prescribed by physical therapists based on the patient's lordosis. Therefore, the aim of this study is to investigate the relationship between LBP and lumbar lordosis in the students (21±2.3 years old). Lumbar lordosis with adjustable ruler, pelvic tilt with tilt-meter and scoliosis, flat foot and shoulder drop with clinical examination have been studied. For determining the reproducibility, each test has been repeated after 5 minutes. The results have been shown that there were 21.5% scoliosis, 34% shoulder drop, 25% flat foot and 12.5% lateral pelvic tilt. Also, 15.6% of subjects have been suffering from LBP. In addition, correlation between lumbar lordosis and pelvic tilt was 43% that supported the results of previous studies. The results of this study have not shown any significant differences of lumbar lordosis between normal and LBP subjects. On the other hand, mean of lumber lordosis in subjects with scoliosis was more than able-bodied subjects. Otherwise, in back pain subjects with shoulder drop and flat foot, hypolordosis has seen. Therefore, we concluded that to describe the exercise program based on lumbar lordosis needs more study.