The purpose of this study was to determine the effects of ultrasound and phonophoresis using an anti-inflammatory-analgesic cream (trolamine salicylate) on delayed-onset muscle soreness (DOMS). Repeated eccentric contractions were used to induce DOMS in the elbow flexors of 40 college-aged women. Subjects were then assigned randomly to one of four groups: (1) group 1 (n = 10) received sham ultrasound using placebo cream, (2) group 2 (n = 10) received sham ultrasound using trolamine salicylate cream, (3) group 3 (n = 10) received ultrasound using placebo cream, and (4) group 4 (n = 10) received ultrasound using trolamine salicylate cream. Subjects were treated on 3 consecutive days. Muscle soreness and active elbow range of motion were assessed daily prior to each treatment. The subjects in group 3 experienced an increase in DOMS, whereas no increase in soreness was observed in the subjects in group 4. The authors concluded that ultrasound enhanced the development of DOMS but that this enhancement was offset by the anti-inflammatory-analgesic action of salicylate phonophoresis. These findings suggest that salicylate phonophoresis may be useful in clinical situations in which it is desirable to administer ultrasound without increasing inflammation.

Study design: Randomized clinical trial. Objectives: To investigate the immediate effects of soft tissue mobilization (STM) versus therapeutic ultrasound (US) in patients with neck and arm pain who demonstrate neural mechanical sensitivity. Background: While experts have suggested that individuals with neck and arm pain associated with neural tissue mechanical sensitivity may benefit from STM, there has been little research to investigate this hypothesis. Methods: Twenty-three patients with neck and arm pain and a positive upper limb neurodynamic test (ULNT) were randomly assigned to receive STM or therapeutic US during a single session. Outcome measures were collected immediately before and after treatment, and at 2-4 day follow-up. Primary outcomes were the Global Rating of Change (GROC), range of motion (ROM) during the ULNT, and pain rating during the ULNT. Secondary measures included the Neck Disability Index (NDI), Patient-Specific Functional Scale (PSFS), Numeric Pain Rating Scale (NPRS), and active range of shoulder abduction motion combined with the wrist neutral or wrist extension. Results: A greater proportion of patients in the STM group reported a significant improvement on the GROC immediately after treatment (P50.003, STM575%, US59%), and at 2-4 day follow-up (P50.027, STM558%, US59%). Patients who received STM demonstrated greater improvements in ROM during ULNT (P50.026), PSFS (P50.007), and shoulder active ROM combined with wrist extension (P50.028). Improvements in Numeric Pain Rating Scale and pain during the ULNT were observed only in the STM group. There was no difference between groups for the NDI or shoulder abduction ROM with wrist neutral. Conclusion: Patients with neck and arm pain demonstrated greater improvements in ULNT ROM, GROC, and PSFS, and pain following STM than after receiving therapeutic US. Level of evidence: Therapy, level 1b.

Eight children, who needed walkers to ambulate and who were able to use either anterior or posterior walkers, were selected for a comparative study of both types of walker. Data for gait analysis, using high-speed cinematography, were collected to determine stride length, time in double support and velocity. Trunk, hip and knee angles were also measured during four phases of the gait cycle. The results demonstrated significant improvements in both postural alignment and gait

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Pharmacokinetics involves the factors that influence drug absorption, distribution, and elimination. Pharmacokinetic variables determine how a specific dose of a drug will eventually reach target tissues and exert a response. Various factors can influence normal pharmacokinetics, including exercise, application of physical agents, and massage. These interventions produce hemodynamic and other physiologic changes that can potentially alter drug disposition within the body. The magnitude and specific type of pharmacokinetic changes, however, are highly variable depending on the specific intervention and the drug in question. Physical therapy interventions seem to have the greatest potential to affect absorption and distribution of drugs that are administered by transdermal techniques or by subcutaneous and intramuscular injections. Research is needed to determine exactly how physical therapy interventions can affect the pharmacokinetics of various medications, and how the clinical effects of these medications are affected by altered drug disposition.