فهرست مطالب gholamreza olyaei

Carpal tunnel syndrome (CTS) is a common peripheral entrapment neuropathy with squeezing of the median nerve and the patient is unable to function properly. There are different physiotherapy interventions for the management of these patients and recently, shock wave therapy and low-power laser (LPL) have been widely used, but there is no strong evidence comparing the effect of shock wave therapy and LLLT. Therefore, this trial was designed to compare the effect of extracorporeal shock wave therapy (ESWT), LPL, and routine interventions on clinical outcomes and electrophysiological parameters in patients with moderate CTS.

Fifty-four patients were randomly assigned to the control (routine interventions), ESWT, and LPL therapy groups. All participants received transcutaneous electrical nerve stimulation (TENS) therapeutic ultrasound, hot pack, mobilization, and stretching for ten sessions over two weeks. Additionally, the ESWT group received radial ESWT in four sessions, and the LPL therapy group received laser in ten sessions. The primary outcomes were pain (assessed by the visual analog scale), function (assessed using the Boston questionnaire (BQ)), hand grip, and finger pinch strength. Secondary outcomes were electrophysiological parameters (distal motor and sensory latency and nerve conduction velocity (NCV) of the median nerve. 

Time group interactions were significant for pain, the symptom severity subscale of BQ, finger pinch, and hand grip strength (p<0.001). Significant improvements were seen in clinical and sensory latency and motor NCV of the median nerve (p<0.05). The ESWT group experienced significant improvements with a large effect size in pain, function, and finger pinch strength compared to the control group (p<0.01). Additionally, the LPL therapy group showed significant changes in the function and finger pinch and hand grip strength compared to the control group. There were no significant differences between the LPL therapy and ESWT groups except for pain in favor of the ESWT group. No significant differences were found among the three groups in electrophysiological parameters (p>0.05).

Although laser therapy increased the efficacy of routine interventions, it seems adding ESWT to the routine treatment may be superior for the management of moderate CTS patients.

Many studies have investigated ankle sprain injury and it has been reported that in 80% of cases, ankle sprains lead to functional ankle instability (FAI). The conventional exercises for FAI rehabilitation neglect the associated neurocognitive dysfunction.

This study aims to evaluate the effect of Wii Fit Plus as a virtual reality training on neurocognitive function in athletes with FAI compared to athletes without FAI.

In this matched randomized clinical trial study, 25 athletes with unilateral FAI and 25 athletes without FAI were assigned to two groups randomly: 1) the intervention group, subjects performed the Wii training including balance and strengthening games three times a week for 12 sessions and 2) subjects in the control group received no intervention. Before and after the training, the neurocognitive function was assessed through the computerized-reaction time test based on the detection or identification of ‘X’ mark on a computer monitor. Between-groups and within-group comparisons were done by the independent T-test and paired T-test, respectively.

A significant difference was observed in mean differences of neurocognitive function between athletes with and without FAI. Comprising before and after training was significant in the intervention group. 

Based on the results, the information-processing speed of athletes with FAI increased after the training, utilized for rehabilitation protocols.

Functional ankle instability (FAI) is a common injury. Traditional training improved the reported balance impairment and subjective sense of instability in athletes with FAI.

This study aims to compare the effects of traditional and virtual reality training on a subjective sense of instability and balance in athlete with FAI.

In this single-blinded matched randomized clinical trial design, Fifty-four basketball players were randomly assigned in the virtual reality (n=27) or control (n=27) groups. All athletes performed 12 sessions Wii exercises or traditional training in the virtual reality and the control group, respectively, for three days a week. To assess the subjective-sense of instability and balance, we used Cumberland Ankle Instability Tool (CAIT) and Star Excursion Balance Test (SEBT), respectively. Measures were taken at pre- and post-test and one month after training as a follow-up. The between-group comparisons were done by the analysis of Covariance.

At the pre-test, the CAIT score was 22.37, 22.04 in the control and virtual reality groups, respectively and at the post-test, these scores increased to 26.63, 27.26. The involved limb showed significant differences in posteromedial and posterior directions of the SEBT and CAIT score in the post-test and in the posterior direction and CAIT score in the follow-up. The virtual reality group had better performance than the control group but the effect size is small (cohen’s d<0.2). 

Based on our results, both training protocols were effective in reducing the subjective-sense of instability and improved balance in athletes with FAI. Moreover, virtual reality training was very attractive for the participants.

Although carpal tunnel syndrome (CTS) is an incident entrapment neuropathy disorder, there has been inadequate evidence about the effect evaluation of adding low-level laser therapy to ultrasound (US) plus median nerve glide exercises in these patients. Hence, this research investigated the trace of US plus median nerve glide exercises with and without low-level laser therapy (LLLT).

Thirty-six patients with moderate CTS in two groups of intervention were assessed. One group received 10 sessions of adding LLLT to median nerve glide exercises plus US and the other group received median nerve glide exercises plus US without LLLT. Outcome measures were hand grip strength (HGS), visual analogue scale (VAS), Boston questionnaire (BQ), and cross-sectional area (CSA) of the median nerve.

Baseline analysis revealed similarities between the two groups in all parameters. Statistical analysis indicated significant improvement of HGS, VAS, BQ, and CSA of the median nerve in two groups of intervention.

In patients with CTS, US and median nerve glide exercises with and without LLLT significantly improved without the superiority of adding LLLT to mentioned treatment.

The purpose of this work was to explore cervical position sense and electromyographic (EMG) responses of cervical muscles during head repositioning movements in students with and without upper trapezius muscle trigger points.

Forty-six right-handed men and women subjects without upper extremity disorders participated in this study. The maximal voluntary contraction (MVC) was measured three time before the fatigue test. A force gauge was used to measure force while recording with a monitor. Measurement was initiated with a MVC force before and after fatigue pain and head positioning were measured. When the protocol was accomplished, the subjects showed signs of exhaustion; however, they were not subjectively evaluated for fatigue. As the protocol aimed at assessing muscle fatigue, a force level of 80% MVC was induced.

These findings support the argument that the precision of the neck position sense can be reduced by the fatigue of the neck muscle. Fatigue impaired balance in the trapezius muscles. After removing vision this resulted in an increased center of pressure excursions on a force platform. Motor control did not change significantly in this study.

Fatigue had a more significant effect on cervical kinematics in the healthy subjects, probably due to the fact that altered neck motor control in volunteers implied that these individuals were not completely able to make up for fatigue of the neck muscle. Significant pain and head positioning changes were identified following fatigue applied to the pre-determined myofascial trigger points, but the changes were insignificant in the sham control group.

This study aimed to assess the test-retest intra-rater reliability and convergent validity of digital photography (DP) in detecting the postural orientation of children with cerebral palsy (CP).

The study recruited children with various types of CP with the Gross Motor Function Classification System level I or II and spasticity < 2 on the Ashworth Scale, without any visual or cognitive impairments. Children who had undergone any surgical intervention or received a botulinum toxin injection within the previous six months were excluded. A digital camera was fixed at 1.5 meters from the participants at the height of 90 cm. Non-reflective markers were attached to eight anatomical landmarks to localize the upper and lower center of mass on both sides. The same examiner took three digital photos to detect intra-rater reliability using the intraclass correlation coefficient (ICC). Pearson's correlation and linear regression analysis were used to assess the convergent validity of the DP method compared with the Pediatric Balance Scale (PBS) scores.

Thirty children (7.44 ± 2.38 years) were assessed to test the reliability of DP, and 55 others (8.06 ± 2.19 years) participated in the convergent validity study. Intra-rater reliability was found to be perfect (ICC > 0.995) and there was a strong significant negative correlation between DP measures and PBS scores (Pearson's correlation > 0.75) with high adjusted R2 (R2 > 0.567), indicating goodness of fit between the measures.

Digital photography (DP) is a reliable and valid method for assessing postural orientation in children with various types of CP.

Until now, a variety of techniques have been introduced to address the adverse effects of NS-CLBP, including spinal manipulation technique (SMT) and muscle energy technique (MET). However, most of these techniques have focused on pain assessment and disability. In other words, the intermuscular synchronization between the co-contracting muscles was not considered, and hence, the effectiveness of these techniques on the corticospinal tract function was not studied.

This study aimed to compare the effects of SMT and MET on corticospinal tract function during four phases of standing, flexion, relaxation, and extension in flexion-extension task (F-ET) in NS-CLBP using pair-wise coherence of Beta-band intermuscular coherence (Bb-IMC).

Twenty volunteer healthymale subjects and twenty-fourmale subjects with NS-CLBP (20 - 45 years of age) participated in this work. The patients had continuous or recurrent symptoms for three months or more without any referral pain to the lower extremities. The patients were randomly assigned to two equal intervention groups (SMT and MET), and the techniques were applied as described by Greenman. Surface electromyography (sEMGs) from lumbopelvic muscles was recorded for all participants (i.e., healthy group and the patient groups), while they performed three trials of F-ET, and the pair-wise coherence for all muscles was calculated using Bb-IMC analysis. Besides, in the patient’s groups, sEMGs from the muscles were recorded before and after the interventional techniques (i.e., SMT and MET), while they performed three trials of F-ET, and the pair-wise coherence was calculated. Multivariate analysis of variance test was used to compare the healthy subjects and patient groups before the interventions in A and B muscle cross at different phases of F-ET task. Furthermore, in the NS-CLBP patients, comparisons were made before and after the interventions in each group (i.e., SMT and MET groups) as well as between the two groups in A and B muscle cross at different phases of the F-ET task.

In the standing phase of F-ET, there were no significant differences in the SMT and MET group before and after the intervention in PWC of A muscle cross and B muscle cross (P < 0.05). Considering the flexion phase, there were significant differences in the SMT group in all pair muscles as PWC (M1-M4), PWE (M1-M6), PWC (M4-M6) (P < 0.05), whereas there was one significantly in PWC (M4-M6) in the MET group (P < 0.05). In the relaxation phase, the SMT had significantly in PWC (M2-M5), whereas there was one significantly in PWC (M4-M6) in MET group (P < 0.05). In the extension phase, although the SMT was not significant (P < 0.05) in the MET intervention group, there were significant differences in the PWC (M2-M3) and PWC muscles (M2-M5).

This study provided some pieces of evidence about the effects of one of the common manual therapy techniques on the primary motor cortex and corticospinal drive in the NS-CLBP patients. The results showed that, by increasing the pair-wise coherence in all phases of FE-T, SMT intervention was more effective than MET intervention. Therefore, the pair-wise coherence of Bb-IMC can be considered an approach for clinicians when designing the rehabilitation protocol to ensure optimal treatment.

The aim of the study was to investigate the reliability and agreement of the Beta-band intermuscular coherence (Bb-IMC) as a clinical assessment tool for Non-Specific Chronic Low back pain (NS-CLBP) patients and healthy subjects by studying four phases of flexion-extension task; standing, flexion, relaxation and extension phases (F-ET).

Twenty-four men with NS-CLBP and 20 healthy subjects voluntarily participated in this study. All those subjects performed three trials of F-ET while the sEMG was recorded from the lumbar erector spinal, gluteus maximus and hamstring muscles of both sides. Beta-band intermuscular coherence analysis was used to calculate the pool coherence and the pairwise coherence for all mentioned muscles. Afterward, the intra-class correlation coefficient (ICC), standard error of measurement (SEM), and minimal detectable change (MDC) for four phases of F-ET were also used to analyze the intrarater reliability and agreement of the measurements.

The investigation of ICC, SEM and MDC showed that the reliability was moderate to a high level of reliability for pool and pairwise coherence of Bb-IMC in all mentioned muscles for four phases of flexion-extension task in NS-CLBP patients and healthy subjects. Yet, the agreement was low because the measurement error was relatively large.

Up until now, no studies have used the Bb-IMC method to study Low back pain which are carried out in our study to check the reliability of this new method. Our findings revealed that pool and pairwise coherence obtained during F-ET are moderate to a high level of reliability for using Bb-IMC and could be considered as a tool for the NS-CLBP patients’ assessment. Although the small sample size investigated, in clinical practice the using this measure to conclude the interaction of corticospinal in NS-CLBP and healthy subjects should help to improve the analysis. This requires including larger sample sizes in addition to studying other circumstances and functional movements such as lifting weight. Furthermore, more research appears to be warranted by the observed effectiveness of a particular intervention in modulation mechanisms of corticospinal tract function by Bb-IMC in NS-CLBP.

Muscle energy technique (MET) is one of the alternatives for the treatment of joint dysfunctions. Previous studies investigated this technique without considering the kind of dysfunctions. Therefore, the aim of this study was to evaluate the therapeutic effects of MET by considering the type of dysfunction and the direction of the corrective maneuver in women with iliosacral joint dysfunctions.

This randomized controlled clinical trial included 60 women with anterior innominate or posterior innominate dysfunctions and were randomly divided into the treatment group (n=30) receiving a session of MET and the control group (n=30). The range of flexion and extension of the lumbar, visual analogue scale (VAS), active straight leg raising (ASLR), and pressure pain threshold (PPT) at five points were measured before, after, and 24 hours after MET.

Before, after, and 24 hours after the intervention, the mean change of the range of lumbar flexion and extension showed an increase. However, the mean change of the level of VAS and ASLR decreased significantly (P<0.05) in the treatment group with corresponding 95% confidence intervals.

According to the results of this study, using MET by considering the kind of dysfunction may more efficiently improve a patient’s symptoms.

 Sacroiliac Joint Dysfunction (SIJD) is considered an origin of low-back pain. It can change the motor control strategy and postural control (PC).

 We aimed to find any probable differences in PC between subjects with and without SIJD and determine the effects of the pelvic belt (PB) on PC.

 Thirty-eight subjects were assigned into two equal groups with and without SIJD. They started to walk from the place marked on a force plate for 10 seconds after hearing an auditory signal and performed three attempts for each foot. They repeated six more ones with PB. Raw data were imported to an excel software (version 2007) spreadsheet to calculate the reaction time (RT) and anticipatory postural adjustment (APA) as the components of PC.

 Our results showed a significant difference in RT between the SIJD-affected and non-affected sides (P = 0.035), but there was no significant difference in APA (P = 0.057). There were significant differences in RT and APAs between the control and SIJD-affected side groups (P = 0.001 and P = 0.010, respectively). The PB application showed a significant difference in RT and APAs of the SIJD-affected side (P = 0.001 and P = 0.047, respectively).

 It seems pain could lead to the postural sway into instability and change the motor control strategy. The proprioception signals from the neuromuscular system of SIJ improved after PB. Therefore, PB, as a feasible tool, can be recommended for PC improvement.

 The current study aimed to compare between the chronic non-specific low back pain (CNSLBP) and healthy subjects during four phases of the trunk flexion-extension task (standing, flexion, relaxation, and extension phases) by using pool coherence as well as pairwise coherence of Beta band Intermuscular coherence (Bb-IMC) and flexion relaxation phenomena.

 Twenty-four men with CNSLBP and 20 healthy men voluntarily participated in this study. All subjects performed three tests of Flexion-extension task (F-ET) while the surface electromyography (sEMGs) were recorded from the right erector spinal muscle of the lumbar region “1”, left erector spinal muscle of the lumbar region “2”, right gluteus maximus muscle”3”, left gluteus maximus muscle”4”, right hamstring muscle”5” and left hamstring muscle”6”. Accordingly, group A contains muscles 1, 4, and 6 and group B consists of muscles 2, 3, and 5. The pool coherence (PC) and the pairwise coherence (PWC) for all the above-mentioned muscles were calculated using Beta-band intermuscular coherence analysis. Thereafter, the mean pool coherence (mPC) was considered for group A and group B for four phases of F-ET in three groups as following: CNSLBP patients group, healthy subjects group and the third group included all subjects that participated in this study, whether patients or healthy and it was called the general group. Moreover, the mean pairwise coherence (mPWC) among each pair of group A and B muscles was calculated for four phases of F-ET using Bb-IMC in CNSLBP patients and healthy subjects.

 These results indicated a high value of A mPC in the general group and healthy subjects in the flexion phase, whereas the same A mPC in CNSLBP patients was high in all phases of F-ET. On the other hand, while B mPC was high in the general group and healthy subjects in the extension phase; it was high in all phases of F-ET in CNSLBP patients; B mPC in CNSLBP patients was high in extension, standing, and flexion phases. A mPWC and B mPWC were not significantly different between CNSLBP patients and healthy subjects in all phases of F-ET. However, only A mPWC “1 - 4” and the A mPWC “4 - 6” were significantly smaller in CNSLBP patients compared to the healthy subjects in the relaxation and flexion phases, respectively. Hence, we suggest pool coherence of Bb-IMC, not pairwise coherence of Bb-IMC, to compare CNSLBP patients and healthy subjects.

 According to the present findings, we suggest using the pool coherence of Bb-IMC in the clinical examination for CNSLBP patients and studying the probable cortical effects and the effectiveness of various treatments on corticospinal tract function in CNSLBP.

The stability and mobility function of dominant and non-dominant limbs are different. Considering the lack of any previous investigation in this regard, this study aimed to investigate the effect of limb dominancy on anticipatory postural adjustments and reaction time (RT) during gait initiation in healthy people.

Twenty healthy people with the right limb dominant participated in the study. The two stimuli of warning and response were used within a 2-second interstimulus interval. In addition, the participants were instructed to get ready to initiate walking as soon as they hear the warning stimulus and initiate gait immediately after hearing the response stimulus, followed by measuring the RT and duration of the anticipatory postural adjustment phase.

The RT was slower when a person initiated gait with the dominant limb as compared with the non-dominant limb and no significant differences were observed in anticipatory postural adjustment phase duration between the two limbs.

In general, our findings demonstrated that information processing capacity for perception, motor planning, and selection of proper motor responses for movement initiation is affected by limb dominance

Kinesio taping (KT) is recently used as a therapeutic tool for the treatment of chronic low back pain (CLBP). However, the effectiveness of different types of lumbar KT is still unclear when not combing with other therapeutic methods. This review aimed to summarize the results of studies investigating the effect of various methods of lumbar KT alone on pain and functional disability in patients with CLBP.

A search was performed on the electronic databases PubMed, ProQuest, Science Direct, Thomson, OVID, Google Scholar, Scopus, MEDLINE, and PEDro, from 1990 to January 31, 2020, using the following keywords: Kinesiology Taping, Kinesio Taping, chronic low back pain. In total, seven studies met the inclusion criteria using three different methods of KT and corresponded to the aim of this review.

The methods consisted of I shape, Y shape, and star shape of KT. The studies suggested that all three KT methods can reduce pain and disability in CLBP patients. Based on the included studies, it seems that KT might reduce pain and disability.

Three methods of lumbar KT, including I shape, Y shape, and star shape, may reduce pain and disability in patients with CLBP, possibly by improving pain, circulation, muscle tone, and proprioception. However, owing to limited studies, they cannot be compared, and the best method is unclear, which should be investigated by future high-quality studies.

This study aimed to evaluate the effect of Kinesio Taping (KT) on low back/pelvis pain, disability, and trunk Range of Motion (ROM) in individuals with nonspecific chronic low back pain (CLBP) after 72 h.

Eighteen patients with nonspecific CLBP participated in this study. Pain intensity, Oswestry low back pain disability questionnaire, and lumbar ROM were evaluated once before the intervention (KT with 50% tension) and then 72 h after. For statistical analysis, we used the paired sample t-test.

Pain intensity was significantly reduced (P<0.01). But KT did not improve disability and lumbar ROM (P>0.05).

Based on the results, 72 h KT over the lumbopelvic area did not improve disability and lumbar ROM in people with nonspecific CLBP while there was a significant reduction in pain intensity. The proposed mechanism of the KT effects is inconsistent with these results.

Ankle sprain is a common sports injury that can cause Functional Ankle Instability (FAI). Neurocognitive function impairment had been reported in subjects with musculoskeletal injuries. Consequently, information processing deficits might be associated with FAI. This study aimed to compare information processing speed and accuracy in athletes with and without FAI.

Eighteen control healthy male basketball players and 18 male basketball players with FAI voluntarily participated in the study. They were matched according to age, height, weight, duration of physical activity, and upper-limb dominance. The neurocognitive function of subjects was assessed with the computerized neurocognitive test. The computerized neurocognitive assessment is based on the presentation of ‘X’ on a computer monitor and includes detection (i.e. simple reaction time [SRT]) or identification (i.e. Choice Reaction Time [CRT]).

Significant differences were observed between study groups in the SRT, CRT, and the number of errors (P<0.001). Subjects in the control group had a shorter reaction time and fewer errors.

Athletes with FAI had significantly slower reaction times. FAI affects processing speed and accuracy, which may be modifiable through the performance of exercises designed to accelerate neurocognitive processing of visual input.

Lumbar stiffness is a common complaint of patients with low back pain. The Muscle Energy Technique (MET) is a common intervention to treat the spine and sacroiliac joint dysfunctions and their resulting disability in daily activities. This research aimed to evaluate the effects of MET on pain, functional disability, and lumbar stiffness of patients with sacroiliac joint dysfunctions by considering the type of dysfunction and the orientation of the correcting maneuver.

Fifty women with ant innominate or post innominate dysfunctions were recruited for the research and randomly divided into two groups (n=25). One group received one session of MET, and the other group received the sham position. Visual Analogue Scale (VAS), lumbar Stiffness Disability Index (SDI) and Oswestry Disability Index (ODI) were used for the evaluation of the participants before, 24 hours after and one week after the intervention.

According to the results, MET significantly decreased the mean range of VAS and ODI, 24 hours, and a week after the intervention (P<0.01). We did not see any significant difference in SDI values before, 24 hours, and one week after MET in the patients (P>0.01).

Applying MET regarding the kind of dysfunction may reduce the patient’s pain and disability.

Latent Myofascial Trigger Points (LMTrPs) are defined as certain pain-free hyperirritable spots in a taut band of muscle, which lead to alternation in muscle activation pattern in both loaded and unloaded conditions. Fatigue can alter the stability of the cervical spine because of transferring loads to the passive connective tissues and also increasing muscle activity. Few studies have investigated the effects of fatigue on the parameters of the upper trapezius muscle as a more common muscle to MTrPs. This study attempts to examine the electromyographic activity of the upper trapezius muscle fatigue during shoulder elevation.

Thirty-six right-handed subjects without upper extremity disorders took part in this study. The highest measured force level was assumed to be the Maximal Voluntary Contraction (MVC) of the trapezius. A sustained submaximal contraction of the trapezius was performed. The subjects were asked to sustain a unilateral (80%) MVC isometric shoulder elevation until the force gauge monitor showed (50%) of MVC in at least three minutes.

The Root Mean Square (RMS norm) of the sustained trapezius contractions showed differences between the groups. The Myocardial Depressant Factor (MDF) parameters of the left and right sides of both healthy subjects and patients were significantly different (P<0.001).

The increase in RMS is related to the recruitment of additional motor units and also an increased firing rate. These are necessary to compensate for the loss of force. This accumulation also inhibits the excitability of the muscle membrane, thereby causing a decrease in the firing rate and, consequently, a decrease in Median Frequency (MF).

Osteoarthritis (OA) is one of the common causes of disabilities in adults. The prevalence of Knee Osteoarthritis (KOA) is approximately 4.9% among people over 26, 16.7% among people over 45, and 12.1% among people over 60 years old. This study aims to determine the effects of Low-Level Laser Therapy (LLLT) and laser acupuncture in decreasing pain and increasing functional activity in patients with subacute and chronic KOA. In this randomized, single-blind, controlled study, the patients with grades 2 and 3 primary KOA were assigned into two experimental groups (active low-level laser and acupuncture laser) and one control group (infrared & exercise). The patients in the experimental group I (n=23) were under low-level Ga-Al–As diode laser, 830-nm continuous waves, and received laser irradiation of 30 mW/cm2 power density, 3 mW output power, 0.1 cm2 spot size, with a total dose of 18 J and for 10 minutes on 6 acupuncture points (SP10, ST34, ST35, GB34, Xiyan, SP9) around the knee in each session. The patients in the experimental group II (n=23) received 3 J power irradiation in each cm2 in a gridding technique over a triangle-like surface of 15 cm2 over the medial, lateral, and anterior sides of the knee with a total energy density of 45 J/15 cm2 for each session. Laser therapy was applied 5 times per week for a period of two weeks (10 sessions in total). The patients in the control group (group III) were under conventional physiotherapy (superficial heat therapy and isometric knee exercises for 15 minutes every day for a similar period (10 sessions in 2 weeks). The outcome study measures were pain level at rest rated by Numeric Rating Scale (NRS), Western Ontario and McMaster Universities Osteoarthritis index (WOMAC), and Short Form of McGill Pain Questionnaire (SF-MPQ). In addition, active knee flexion and extension Range of Motions (ROMs) were measured too. These variables were evaluated at the baseline time, before the intervention, and after the intervention, on the final day of the intervention. Based on statistical outcomes, a significant pain reduction by NRS and McGill, an increase in functional activity by WOMAC as well as an increase in the Range of Motion of the knee were observed in three study groups after 10 sessions. However, the result of ANOVA test showed significant difference in pain reduction among three groups and the post hoc Least Significant Difference (LSD) test showed the significant difference between laser acupuncture and conventional laser groups with the control group; the largest improvement was found in Group I. In terms of functional activity, the post hoc LSD test showed the significant difference between conventional laser and laser acupuncture groups with the control group; the largest improvement was found in Group II. No significant difference was observed among the three groups with regard to the mean values of active knee flexion and extension. Laser acupuncture and conventional laser are more effective in reducing pain and increasing functional activity in patients with KOA compared to conventional treatment. Clinically, laser acupuncture would appear to be superior in pain reduction.

The origin of the Patellofemoral Pain Syndrome (PFPS) is not still completely clear and may have a biomechanical or biochemical cause. Motor control dysfunction may have a role in this condition. Voluntary Response Index (VRI) is able to show changes in the central nervous system motor output that occur with intervention, recovery, or progression of the disorder. Therefore, the outcomes may contribute to offer another tool for PFPS motor control evaluation. The aim of the present study, therefore, was to assess the changes in the quadriceps and hamstring reciprocal coactivation patterns that may be observed in individuals with PFPS using the VRI.

Methods and Materials: 

A total of 24 female participants, 12 with sound knees and 12 with PFPS participated in the present study. The study was accomplished in the Biomechanics Laboratory at Rehabilitation School of Tehran University of Medical Sciences in 2015. The participants sat on a Biodex dynamometer. They were asked to perform 10 continuous knee extension and flexion motions with maximal strength at 45˚/s and 300˚/s, distinctly. Simultaneously, electromyographic activities of the vastus medialis (VM), vastus lateralis (VL), rectus femoris (RF), and biceps femoris (BF) were recorded and VRI was calculated. A two-way analysis of variance was run to assess the effect of group and velocity on the VRI (similarity index and magnitude).

There was no velocity or group main effect observed for the VRI (P>0.05). In addition, no significant velocity × group interaction was found for the VRI (P>0.05).

PFPS may not be linked to altered quadriceps and hamstring reciprocal co-activation patterns during isokinetic exercise. In addition, angular velocity may not be an important parameter in voluntary motor control assessment during isokinetic exercise.

Ankle sprain occurs often late in sport competitions consisting of many lateral ankle movements, jumping or landing, where peroneal muscles are fatigued. Changes in Ground Reaction Force (GRF) parameters may also be related to this injury. The present study aimed to assess the effects of peroneal muscles fatigue on GRF profile during lateral hop landing. Twenty-five recreationally active healthy males performed a lateral hop on a force plate before and after a fatigue intervention by a Biodex dynamometer using an isometric eversion at 40% of maximal voluntary isometric contraction until eversion torque decreased to 50% of its initial value. A force plate and an EMG system were used to collect data during lateral hop landing. Fatigue was confirmed by a significant fall in median frequency (P<0.05). Mean of the normalized peak GRF in the vertical direction, mean of the normalized impulse of the GRF in the vertical direction, and means of the time to peak GRF in the vertical and mediolateral directions decreased significantly after fatigue (P<0.05). If the peroneal muscles are fatigued, a much more load may transfer to the vertical direction during landing, although the vulnerable part of the ankle is situated on the mediolateral direction.

Muscle fatigue is tiredness, in other words, loss of productive capacity of power in response to the activity. The development of fatigue during prolonged exercise may be evaluated by repeated assessments of maximal voluntary force. This study aimed to determine the effect of muscle fatigue on trans-tibial stump level in knee extensor muscles (vastus lateralis, vastus medialis, and rectus femoris) at 30 and 45 degree knee flexions by using surface electromyography.
Forty male amputees with trans-tibial amputation, aged between 18-50 years were assigned randomly in three groups; performed three isometric contractions with extended knee at 80% of the maximal voluntary contraction. Median Frequency (MDF) and Root Mean Square (RMS) values were obtained by surface electromyography from the knee extensor muscles at 30 and 45 degree knee flexions. Force values in stump and sound sides during knee flexion at 30 and 45 degree were also compared.
Median frequency on sound side showed more fatigue and MDF-RMS between stump levels was short, medium, and long for knee extensor muscles at 30 and 45 degree, before and after the fatigue. No significant effect between stump and sound side was found. Vastus lateralis muscle showed more power than vastus medialis and rectus femoris muscles before fatigue. But after fatigue, rectus femoris muscle showed more power than vastus medialis and vastus lateralis.
Results have confirmed that trans-tibial amputees with good functional ability showed more fatigability on the sound side while stump side showed more power. Vastus lateralis muscle had maximum power on both sides. Vastus medialis and rectus femoris of long stump levels and vastus lateralis muscle of short levels were more powerful.

Stroke patients often experience falls with potentially serious consequences. Associated factors with falling in stroke patients have already been identified. The present study was conducted to find a better assessment tool for measuring the risk of falling, Fear of Falling (FOF), and balance between Falls Efficacy Scale-International (FES-I) and Berg Balance Scale (BBS).
One hundred stroke patients were recruited from the physiotherapy clinics affiliated to Tehran University of Medical Sciences (TUMS) based on inclusive criteria to administer two predictive scales; FES-I and BBS. In 16-item FES-I, face to face interview provide information on FOF in daily life activities. BBS is used to measure the FOF during sitting, standing, and postural changes (reaching, balancing on one limb and transferring). Data were analyzed on the basis of age, post stroke duration, history of falling since disease onset and in the last 6 months as well as risk of falling.
Based on FES-I scale, the majority (69.8%) of old patients (50-64 years) showed low risk of falls and according to BBS, the majority of the stroke patients older than 64 years had high concern for falling. Both genders showed low concern for falling on FES-I and BBS scales and the results were not significant. On BBS, the falling concern was more among those who had one falling during the last 6 months.
BBS is more relevant to predict the risk of falls among Iranian stroke patients and is also easy to administer at the stroke centers with minimum equipment.

Chronic Low Back Pain (CLBP) may be associated with impaired proprioception which can result in joint instability and balance deficit. However, wearing a lumbosacral belt may be helpful in this situation. This study aimed to identify postural control impairments in patients with CLBP and determine the effect of lumbosacral support on postural control strategies in these patients.
A total of 16 patients with CLBP and 16 healthy subjects participated in this study. Center of Pressure (COP) data were recorded for 30 seconds while wearing or not wearing a belt in four standing positions; double leg with open eyes, double leg with closed eyes, single leg with open eyes, single leg with closed eyes. Postural control was assessed using range, area and total mean velocity for each experimental condition.
Patients with CLBP showed significantly larger mean COP range and mean area compared to the healthy controls in single leg stance with closed eyes (P Individuals with CLBP had poorer postural control compared to the healthy controls as determined by changes in COP. Lumbosacral belt can improve postural control during challenging tasks.

Tennis elbow (Lateral Epicondylitis) is one the most common elbow and arm musculoskeletal disorders. About 1% to 3% of active population in modern societies suffer from tennis elbow. Tennis elbow is usually caused by repetitive activities of hand and wrist, especially wrist extension and forearm supination. This research aimed to study high and also medium power gallium arsenide (Ga-As) laser irradiation on improving pain and grip strength (functional mobility) in patients with tennis elbow.
Material and Thirty female [Mean(SD) age: 49(2.3) y] patients with acute tennis elbow were recruited for this study. The patients were randomly divided into two groups based on random allocation table. Group A (15 patients) had been received 10 J/cm2 under a 0.5 W beam medium power Ga-As laser irradiation of 980 nm wave length. Group B (15 patients) had been received same energy density under 2 W beam high Ga-As laser irradiation with the same wavelength. Laser irradiation was performed on a 9 cm2 surface of lateral elbow epicondyle based on Grid laser application technique. The patients were under treatment for 10 sessions every other day. The outcome measures of pain at rest and ring finger extension against loading, grip strength and hand function were recorded and analyzed in a pre- and post-setting. The pain severity was measured by VAS (Visual Analog Scale) and McGill questionnaire and upper extremity function was measured by DASH questionnaire.
Significant pain reduction was observed in resting position and ring finger extension against loading after application of both high and medium power (980 nm, 0.5-2 W) laser therapy (P High and low power Ga-As laser irradiation may improve pain and grip strength in patients with acute tennis elbow.