Modalities in Physical Therapy

Despite the high prevalence of carpal tunnel syndrome and cubital tunnel syndrome, the quality of clinical practice guidelines is poor and non-invasive treatment modalities are often poorly documented. The aim of this cadaveric biomechanical study was to measure longitudinal excursion and strain in the median and ulnar nerve at the wrist and proximal to the elbow during different types of nerve gliding exercises. The results confirmed the clinical assumption that 'sliding techniques' result in a substantially larger excursion of the nerve than 'tensioning techniques' (e...

BACKGROUND: With the increased popularity of foam rolling as a recovery tool, it is important to explore possible mechanisms of action toward mitigating soreness and restoring athletic performance. PURPOSE: The purpose of the present experiment was to assess the influence of foam rolling on gross measures of physical performance and indices of autonomic function following exercise-induced muscle damage (EIMD). METHOD: In a between-group design, 40 participants performed a session of 40x15 meter sprints, inducing muscle damage...

OBJECTIVES: The effects of trigger point dry needling (TDN) on myofascial trigger points (MTP) in Achilles tendinopathy (AT) are unknown. We conducted a study to test the feasibility of a large randomized controlled trial (RCT) to compare the effects of TDN to MT and exercise in a patient population with AT. METHODS: Twenty-two subjects were randomly assigned to a control (MT+Ex) or experimental group (TDN+MT+Ex) and completed eight treatment sessions over 4 weeks with follow up at 3 months...

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CONTEXT: When using an ice bag, previous researchers recommended cooling times based on the amount of subcutaneous tissue. Unfortunately, many clinicians are unaware of these recommendations or whether they can be applied to other muscles. OBJECTIVE: To examine if muscles of the lower extremity cool similarly based on recommended cooling times. DESIGN: Crossover study. SETTING: Athletic training laboratory. PATIENTS OR OTHER PARTICIPANTS: Fourteen healthy participants volunteered (8 men, 6 women; age = 21...

Myofascial pain syndrome is a pain condition characterized by the presence of trigger points. Current evidence, mostly experimental studies, clearly supports a role of trigger points on peripheral and central sensitization since they are able to contribute to sensitization of peripheral nociceptors, spinal dorsal horn neurons, and the brainstem. Several interventions are proposed for treating trigger points, dry needling being one of the most commonly used by clinicians. There is no consensus on the clinical application of trigger point dry needling: some authors propose that local twitch responses should be elicited during the needling intervention to be effective, whereas others do not...

OBJECTIVE: Examine the comfort and pain experienced with blow flow restriction resistance training (BFR-RT) compared to standard care heavy load resistance training (HL-RT) during anterior cruciate ligament reconstruction (ACLR) patient rehabilitation. DESIGN: Randomised controlled trial. SETTING: United Kingdom National Health Service. PARTICIPANTS: Twenty eight patients undergoing unilateral ACLR surgery with hamstring autograft were recruited...

CONTEXT: Neuromuscular electrical stimulation (NMES) is widely used to induce muscular strength increase, however, no study has compared Russian current (RC) with Pulsed current (PC) effects after a training program. OBJECTIVES: We studied the effects of different neuromuscular electrical stimulation (NMES) currents, Russian current (RC) and Pulsed current (PC) on the neuromuscular system after a six-week training period. DESIGN: Blinded randomized controlled trial...

UNLABELLED: Instrument assisted soft-tissue mobilization (IASTM) has become a popular myofascial intervention for sports medicine professionals. Despite the widespread use and emerging research, a consensus on clinical standards, such as a describing the intervention, indications, precautions, contraindications, tool hygiene, safe treatment, and assessment, does not exist. There is a need to develop best practice standards for IASTM through a universal consensus on these variables. The purpose of this commentary is to discuss proposed clinical standards and to encourage other sports medicine professionals and researchers to contribute their expertise to the development of such guidelines...

OBJECTIVE: This study was conducted to measure and to determine differences in tissue depth in the upper back for two prone positions and to stratify the results by body composition and sex of the patient. In addition, muscle thickness changes with positioning were assessed. This information is important for clinicians who dry needle in the thorax area, cognizant of the dangers of inadvertently piercing the pleura or lung tissue. DESIGN: Descriptive cross-sectional...

BACKGROUND: Electrotherapy provides a wide range of treatment alternatives for musculoskeletal pathologies. However, for the electrical stimulation to exert a significant therapeutic effect, the induced current must often penetrate deep inside the target tissue. OBJECTIVE: The objective was to systematically compare the penetration efficiency of 3 electrotherapeutic stimulation modalities: transcutaneous electrical nerve stimulation (TENS), interferential (IF) stimulation, and combined therapy with pulsed ultrasound and IF current (CTPI)...

BACKGROUND: Devices for applying transcutaneous electrical nerve stimulation (TENS) use numerous frequency modulation patterns for decreasing habituation to currents. However, there is no evidence supporting the use of an optimal pattern instead of the others, or even modulated frequencies instead of a fixed frequency. OBJECTIVE: The objectives of this study were to determine the effects of 3 TENS patterns (fixed frequency, random modulation, and 6-second-6-second [6s-6s] modulation) on habituation, to examine the subjective perception of habituation and comfort, and to determine their effects on the mechanical pain threshold (MPT)...

BACKGROUND: Despite best practice, quadriceps strength deficits often persist for years after anterior cruciate ligament reconstruction. Blood flow restriction training (BFRT) is a possible new intervention that applies a pressurized cuff to the proximal thigh that partially occludes blood flow as the patient exercises, which enables patients to train at reduced loads. This training is believed to result in the same benefits as if the patients were training under high loads. OBJECTIVE: The objective is to evaluate the effect of BFRT on quadriceps strength and knee biomechanics and to identify the potential mechanism(s) of action of BFRT at the cellular and morphological levels of the quadriceps...

CONTEXT: Patellofemoral pain (PFP) is a chronic condition that presents with lower extremity muscle weakness, decreased flexibility, subjective functional limitations, pain, and decreased physical activity. Patterned electrical neuromuscular stimulation (PENS) has been shown to affect muscle activation and pain after a single treatment, but its use has not been studied in a rehabilitation trial. OBJECTIVE: To determine the effects of a 4-week impairment-based rehabilitation program using PENS on subjective function, pain, strength, range of motion, and physical activity in individuals with PFP...

Blood flow restriction (BFR) therapy is becoming increasingly popular in musculoskeletal injury rehabilitation. In particular, this form of therapy is being utilized more often in the postoperative setting following knee surgery, including anterior cruciate ligament reconstruction. BFR therapy provides patients and clinicians an alternative treatment option to standard muscle strengthening and hypertrophy guidelines in the setting of postoperative pain, weakness, and postoperative activity restrictions that contribute to muscle atrophy...

Cryotherapy is the use of the anti-inflammatory and analgesic properties of ice to facilitate healing. Cryotherapy mediates these salutatory effects by reducing blood flow to the site of injury, down-regulating the production of inflammatory and pain-inducing prostaglandins, and diminishing the conductive ability of nerve endings. It is commonly used postoperatively in orthopedics to decrease analgesic requirements and blood loss as well as to increase range of motion, despite limited literature on its ability to produce such therapeutic effects in clinical practice...

Introduction: Dry needling has been reported to decrease pain in subjects having myofascial trigger points, as well as pain in muscle and connective tissue. Objective: The purpose of the study was to compare the effects on the ability to perform a two-legged vertical jump between a group who received one bout of dry needling and a group who received one bout of a sham treatment. Methods: Thirty-five healthy students (19 males, 16 females) were recruited to participate in this study (mean age 22...

Background: In addition to established interventions, dry needling may reduce impairments leading to greater functional abilities for individuals following ankle sprain. Hypothesis/Purpose: The purpose of this study was to compare effects of spinal and peripheral dry needling (DN) with peripheral DN alone on impairments and functional performance among individuals with a history of lateral ankle sprain. Study Design: Randomized controlled trial...

OBJECTIVE: No studies comparing the effects of platelet-rich plasma (PRP) injection and placebo injection in bilateral knee osteoarthritis in the same patient, or discussing muscle strength after PRP injection, have been published. DESIGN: Twenty patients with bilateral knee osteoarthritis were eligible, and 40 knees were randomized into two groups: PRP (knees [right or left by a coin toss] receiving a single intra-articular PRP injection) and saline group (the contralateral knee of the same patient, into which single 4-mL intra-articular injection of normal saline was administered)...

PURPOSE: The primary aim of the study was to examine stability and alignment after total knee arthroplasty (TKA) using patient-specific instrumentation (PSI) and conventional instrumentation (CI). The hypothesis was that stability and alignment would be better using PSI than CI, 12 months postoperatively. The secondary aim included the evaluation of clinical outcomes after TKA. METHODS: In this prospective randomized controlled trial, 42 patients with knee osteoarthritis received a Genesis II PS prosthesis with either PSI or CI...