SST did not show a consistent high reliability. The diagnostic accuracy of the LSST was low, which questions the clinical importance of the tests outcomes.
Objectives The objective of this study was to assess the short-term effects of dry needling on spasticity, gait, and muscle architecture of patients with chronic stroke. Methods A case series study was designed; and six chronic stroke patients with ankle spasticity and gait impairment received a single session of dry needling for gastrocnemius medialis, lateralis, and soleus muscles. The main outcome measures were the Modified Modified Ashworth Scale (MMAS), and Timed Up and Go test (TUG). In addition, ultrasonography measurements (e.g. thickness, pennation angle, and fascicle length) were performed for gastrocnemius medialis at baseline (T0), immediately after intervention (T1) and 30 min after intervention (T2), while the MMAS and TUG Test were only measured at T0 and T2. Results Based on the TUG test, there was a significant improvement in gait function (p = 0.023). Furthermore, the MMAS results (p = 0.014) showed a decrease in resistance to passive movements from plantar flexor muscles. Furthermore, a significant decrease in pennation angle (p = 0.014) and muscle thickness (p = 0.001), and also a significant increase in fascicle length of gastrocnemius medialis (p = 0.001) were observed after dry needling. Discussion & conclusions Based on the outcomes of this study, dry needling application seems to have short term effects in terms of reducing spasticity, improving gait, and muscle architecture of gastrocnemius medialis in patients with chronic stroke. The changes of muscle architecture may be interpreted as the positive effects of dry needling on the physical properties of hypertonic muscles.
Background It is unknown how diaphragm training combined with electrical stimulation affects pain, function, static stability, and balance in athletes with chronic low back pain (CLBP). This study aimed to explore the effects of combining diaphragm training with electrical stimulation on pain, function, static stability, and dynamic balance in athletes with nonspecific CLBP. Methods The design was a randomized clinical trial. A total of 24 amateur athletes (12 women, 12 men, mean age: 35.2 ± 9.8) with nonspecific CLBP were randomly allocated into two groups. The experimental group (n = 12) received diaphragm training plus Transcutaneous Electrical Nerve Stimulation (TENS), while the control group (n = 12) received TENS alone. Both groups underwent 12 sessions over a four-week period. Static stability, dynamic balance, pain, and function were measured pre- and post-intervention. Results Analysis of variance 2 × 2 revealed greater improvements in pain (p < 0.001), static stability (p < 0.001), and dynamic balance (p < 0.01) in the experimental group compared to the control group. Function was improved in both groups following the interventions (p < 0.001), and there was a trend of a larger improvement in the experimental group than the control group (p = 0.09). Fisher’s exact test showed that the experimental group reported ≥50% improvement only in the pain score, not function, compared to the group that received TENS alone (p = 0.005). Conclusions Pain, function, static stability, and dynamic balance were improved in both groups following 12 intervention sessions. However, pain, static stability, and dynamic balance were improved to a greater extent in diaphragm training plus TENS than TENS alone in amateur athletes with CLBP. Therefore, it seems beneficial to add diaphragm training to the rehabilitation program for athletes with nonspecific CLBP. Trial registration The trial was retrospectively registered in the Iranian Registry of Clinical Trials (www.irct.ir) on September 10, 2020 as IRCT20090228001719N8.
BackgroundUltrasound imaging has been suggested for studying the structure and function of nerves and muscles; however, reliability studies are limited to support the usage. The main aim of this study was to explore the intrarater within-session reliability of evaluating the sciatic nerve and some related muscles morphology by ultrasound imaging.MethodsThree B-mode images from two scans (transverse and longitudinal) were acquired from the multifidus, biceps femoris, soleus and medial gastrocnemius muscles bilaterally from 15 participants with sciatica and 15 controls in one session, 1-h apart. The data were collected from March to July 2017. Contraction ratio was measured only by longitudinal scan, while the echo intensity was measured using maximum rectangular region of interest in two scans (transverse and longitudinal) for all muscles. Cross-sectional area, direct (tracing) and indirect (ellipsoid formula) methods were used to measure the sciatic nerve. Intraclass correlation coefficient (ICC 3,1), standard error of measurement and minimal detectable change were calculated.ResultsGood to high ICCs (0.80–0.96) were found for muscle contraction ratio in the longitudinal scans in all the muscles in both sciatica and control groups. For echo intensity measurements ICCs ranged from moderate to high, with higher ICCs seen with the maximum region of interest in the transverse scans. The minimal detectable change values ranged between 0.11 and 0.53 cm for contraction ratio.ConclusionsUltrasound imaging has high intrarater within-session reliability for assessing the sciatic nerve Cross-sectional area and muscle contraction ratios. Transverse scans with the maximum region of interest result in higher reliability. The sciatic Cross-sectional area is most accurately measured utilizing the direct tracing method rather than the indirect ellipsoid method.
Background:Little is known about the neuromuscular morphometric characteristics in patients with sciatica.Objective: To evaluate the possible changes of nerve and muscle structures in patients with low back pain with unilateral radiculopathy due to lumbar disc herniation by ultrasound imaging. Design:A case-control observational study.Methods: Forty individuals were divided into case (n=20; low back pain with unilateral radiculopathy due to disc herniation), and healthy control groups (n=20). The thickness of lumbar multifidus at L5 level, and of lower limb muscles (i.e., biceps femoris, medial gastrocnemius, and soleus) was measured during both rest and full contraction to calculate the rest/contraction ratio of these muscles. Additionally, the sciatic nerve cross-sectional area and the echogenicity of the nerve and muscles were measured based on ultrasound imaging.The association between severity of low back pain radiculopathy (i.e., pain and patients' perceived disability) and rest/contraction ratio was assessed.Results: Patients with sciatica showed sciatic nerve enlargement, and different contraction ratios for multifidus (at L5) / ankle plantar flexors compared to the controls. The rest/contraction ratio for biceps femoris was similar between the two groups. Conclusion:According to these findings, ultrasound imaging can be considered a useful tool to detect changes in the sciatic nerve and muscles due to disc herniation. Furthermore, regarding the observation of significant changes in muscle rest/contraction ratio in the multifidus and gastrosoleus, one might attribute these changes to the nerve root compression.
Purpose:To investigate the effect of single session Extracorporeal Shock Wave Therapy (ESWT) over the ankle plantar flexor muscles on the spasticity, muscle architecture, and gait in chronic stroke patients. Methods:This quasi-experimental, single group study had a repeated measures design. A total of 17 post-stroke patients were selected by convenience sampling method, and received 2000 shots of ESWT on the ankle plantar flexor muscles of the affected side in one session. Outcome measures consisted of Modified Modified Ashworth Scale (MMAS), bilateral leg circumference, and muscle architecture parameters (pennation angle, fascicle length, and muscle thickness) of the medial head of the gastrocnemius muscle, timed up and go (TUG) test, self-reported visual analog scale (VAS) of spasticity, and ankle passive Range of Motion (pROM). All outcomes were measured at 2 times: before the intervention and 30 minutes after the intervention. The muscle architecture parameters and leg circumference were also measured immediately after the intervention. Statistical analysis was done using SPSS 18.0. Repeated measures analysis of variance (ANOVA) was performed to evaluate the effects of intervention in time.Results: Wilcoxon test revealed significant improvement in MMAS. Significant improvement in VAS, pROM, and TUG test results is also noted by means of the paired t test. ANOVA showed significant time×side interaction for the pennation angle and leg circumference. Significant effect of time was also shown by ANOVA for leg circumference. Post hoc analyses showed a significant difference for the leg circumference before the intervention and 30 minutes after it. ANOVA showed no significant change in fascicle length and muscle thickness. Spearman's rho revealed significant positive correlation between the changes of the ankle pROM and improvement of the fascicle length. Conclusion:According to the results single session of ESWT over the spastic plantar flexors muscle can improve clinical measures of muscle spasticity and motor function. More studies are needed to clarify the underlying mechanisms for the antispastic effect of ESWT.
[Purpose] The purpose of this study was to determine the effect of dry needling on tendon-pulley architecture, pain and hand function in patients with trigger finger. [Participants and Methods] A randomized controlled trial was conducted. Fifty eight patients having trigger finger were randomly assigned as either an experimental group that received a single session of dry needling over pulleyA1 and flexor tendon or a control group that received no intervention. Thickness of tendon-pulley, and pain-hand function (by disability arm-shoulder questionnaire score and pinch grip strength) were measured by a blinded assessor before and one week after intervention. [Results] The two way mixed ANOVA in the experimental group showed that the thickness of pulley-tendon decreased, pinch grip power increased and DASH questionnaire score was decreased in comparison to the control group. [Conclusion] This study results suggest that a single session of Dry Needling (DN) was effective in decreasing pain, DASH score, pulley-tendon thickness and improving pinch grip power in patients with trigger finger.
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