BackgroundThe tibialis posterior has a important key role as an invertor of the rearfoot. Also providing dynamic support across the midfoot. The value of the tibialis posterior shown by biomechanical research conducted on patients with posterior tibialis tendon dysfunction. One method of assessing a muscle’s contribution to a specific movement pattern is via fatigue-inducing exercise of that muscle. Consequently, to realize the role of tibialis posterior fatigue on foot mechanics it seems prudent to use an exercise that more selectively activates this muscle (1,2).ObjectivesThe purpose of this study is to investigate dynamic and static foot parametres changed by tibialis posterior muscle fatique protocol.MethodsThirty patients were participated in this study. Socio-dermographic and descriptive characteristics of the participants were recorded. The changes on the dynamic and static parametres of foot were measured by pedobarography. The two exercises selected for the fatigue protocol are: 1-Unilateral heel raise 2-Close chain resisted foot adduction. Fatigue level was measured by Borg scale. Static and dynamic parameters obtained before and after fatigue protocol were compared.ResultsThe mean age of the patients was 24,88 ± 4,39 years, mean height was 171 ± 7,89 cm and mean weight was 68,7 ± 14,5 kg. We found significiant increase in the maximum pressure measurement of mid foot (p= 0,004). In the total contact area during the static position, there were no significant changes (p>0.05). Participants’ maximal pressure in the middle standing phase was changed from 19,78 ± 10,71 N/cm2 to 22.89 ± 13.03 N/cm2 after fatigue protocol in medial of middle foot (p=0.03).ConclusionAccording to the results, there was a correlation between the fatique of tibialis posterior and the static and dynamic parameters of foot. The increase in the middle foot peak pressure distributions after the fatigue protocol of the tibialis posterior muscle can be explained as the increase of the angular amount of pronation and prolongation of the time with the middle standing phase. Increase in pressure forces of the middle foot and increase in percentages of the area cause increase of the weight in the front foot during the gait cycle. Thus, fatigue protocol causes similar effects as tibialis posterior muscle dysfunction.References[1] Bubra, P. S., Keighley, G., Rateesh, S., & Carmody, D. (2015). Posterior tibial tendon dysfunction: an overlooked cause of foot deformity. Journal of family medicine and primary care, 4(1), 26.[2] Pohl, M. B., Rabbito, M., & Ferber, R. (2010). The role of tibialis posterior fatigue on foot kinematics during walking. Journal of foot and ankle research, 3(1), 6.Disclosure of InterestsNone declared

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Bu çalışmada torasik çıkış sendromlu hastalarda manuel tedavinin ağrı algısı ve solunum değişkenleri üzerine akut etkileri araştırıldı.Ça lış mapla nı:Çalışmaya torasik çıkış sendromlu 10 hasta (1 erkek, 9 kadın; ort. yaş 31.3±9.0 yıl; dağılım, 20-43 yıl) dahil edildi. Hastalar servikal omurga ve toraksı kapsayan tek bir manuel tedavi seansına alındı. Manuel tedavi programı olarak skalen, üst trapez, sternokleidomastoid, rektus abdominis, kalça fleksör kaslarına germe; birinci kaburga, servikal ve torakal omurga, sakroiliyak eklem ve toraks mobilizasyonu uygulandı. Üst kol ve boynun ağrı algısı görsel analog ölçeği ile değerlendirildi. Ölçümler 30 dakikalık manuel tedavi seansının öncesinde ve hemen sonrasında gerçekleştirildi. Pulmoner fonksiyon testi spirometre ile yapıldı. Solunum kas kuvveti (inspiratuar ve ekspiratuar kas kuvveti; sırasıyla maksimum inspiratuar basınç ve maksimum ekspiratuar basınç) ölçüldü. Solunum kas enduransı, maksimal inspiratuar basıncın %35'inde, sabit eşik yükü kullanılarak kaydedildi. Bul gu lar:Manuel tedavi girişimi sonrasında pulmoner fonksiyon değişkenleri ve maksimum ekspiratuar basınçta anlamlı değişim yoktu (p>0.05). Buna karşın, maksimum inspiratuar basınç ve solunum kas enduransı arttı (p<0.05). Üst kol ve boyundaki ağrı algıları tedavi sonrasında azaldı (p<0.05). So nuç:Torasik çıkış sendromlu hastalarda 30 dakikalık tek bir manuel tedavi seansı inspiratuar kas kuvvetini ve solunum kas enduransını artırırken pulmoner fonksiyon ve ekspiratuar kas kuvvetini artırmadı. Manuel tedavi hızlı ağrı azalması ile birlikte fonksiyonel solunumu ve primer solunum kaslarının daha etkili kullanımını kolaylaştırabilir. Cerrahi işlemlerden sonra düzenli manuel tedavinin solunum değişkenleri üzerine uzun dönem etkileri araştırılmalıdır.Anah tar söz cük ler: İnspiratuar kas kuvveti; manuel tedavi; torasik çıkış sendromu.

BackgroundPresentation of the most common changes in the thoracic outlet syndrome causing functional disorders of the upper limb (1). The majority of the studies published on TOS highlight physiotherapy strengthening exercises and postural reducational drills as being the mainstay of any conservative management programme for TOS (2). However, in the literature, the effect of emotional state on progression in treatment programs has not been investigated. Alexithymia, which refers to deficiencies in the self-awareness of emotional states, has been reported to be associated with poor ability in various aspects of social cognition (3). The ability of TOS patients to express themselves and their emotions will affect the success of the treatment.ObjectivesThe aim of this study was to investigate the effect of alexithymia on upper extremity functions, symptoms, pain level, depression and anxiety in patient with Thoracic Outlet Syndrome.MethodsForty-three TOS patients (36.67±13.99 years; 38 women, 5 men) were enrolled to the study. Alexithymia was assessed with Toronto Alexithymia Scale (TAS-20). The patients were divided into two groups as non-alexithymia group and alexithymia group according to 51 points TAS -20 cut-off score. Pain levels at rest and activity were assessed with visual analogue scale; upper extremity function was assessed with Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and upper extremity symptom was assessed with using Servical Brachial Symptom Questionnaire. Mann-Whitney U test was used for data analyses.ResultsActivity pain level and depression in alexithymia group was higher than the non-alexithymia group, p=0,008 and p=0,007, respectively. Also, functional level and symptoms were worst in alexithymia paitents, p=0,041 and p=0,05, respectively. No difference was found between groups in anxiety and resting pain level (p>0,05).ConclusionThoracic outlet syndrome patients who have alexithymia show worse pain, symptoms, function, and depression. Emotion should be considered in physiotherapy programs. Because the progression of alexithmia patients are worst than non-alexithmia patients.References[1] Laulan, J., Fouquet, B., Rodaix, C., Jauffret, P., Roquelaure, Y., & Descatha, A. (2011). Thoracic outlet syndrome: definition, aetiological factors, diagnosis, management and occupational impact. Journal of occupational rehabilitation, 21(3), 366-373.[2] Watson, L. A., Pizzari, T.,Balster, S. (2010). Thoracic outlet syndrome part 2: conservative management of thoracic outlet. Manual therapy, 15(4), 305-314. [3] Moriguchi, Y., Ohnishi, T., Decety, J., Hirakata, M., Maeda, M., Matsuda, H., & Komaki, G. (2009). The human mirror neuron system in a population with deficient self-awareness: An fMRI study in alexithymia. Human brain mapping, 30(7), 2063-2076.Disclosure of InterestsNone declared

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Physiotherapy and rehabilitation is always the first choice in the management of Thoracic Outlet Syndrome (TOS). Due to difficulty to make objective diagnosis or making the diagnosis behind time despite obvious clinical features, physiotherapy approaches should include causative factors and protective approaches than symptomatic treatments.Creating approaches oriented causative factors for TOS is more important while postural modifications, patient education, strengthening and stretching exercises seem as basic approaches. The basic aim in conservative management is to remove extrinsic compression with decreasing the irritation of peripheral nerves. Moreover, to offer methods to treat TOS as well as decreasing compression in the neurovascular structures.Assessment should include sensory and motor symptoms which induced by neural and vascular compressions. Posture assessment, muscle imbalance, muscle shortness and flexibility, respiratory assessment and pain assessments are performed in this manner.Conservative treatment approaches can be ranged to gain the diaphragmatic breathing pattern, to decrease inflammation, to relieve the soft tissues with tension, to provide muscle balance, to maintain neural excursion, to improve posture and body mechanics and to provide the spinal stabilization. In accordance with these basic aims, physiotherapy and rehabilitation can be planned as 3 stages: Preventative phase, restorative phase and rehabilitation phase.

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