Background: The muscle imbalances between upper and lower trapezius muscle activity are related to abnormal scapular motion in patients with frozen shoulder. This explains the importance of rehabilitation of the lower trapezius muscle in addition to common stretching and mobilizing treatment protocols for patients with frozen shoulder. Purpose: This study aims to investigate the effect of additional strengthening exercises of lower fibers of trapezius muscle on the scapular tipping in patients with Diabetic Frozen Shoulder (DFS). Subjects and methods: Thirty patients with DFS were randomly assigned into two equal groups A and B. Both groups received a traditional physical therapy program, however group B additionally received strengthening exercises for lower fibers of trapezius. Baseline and post-treatment assessment for the scapular tipping were evaluated by using (A-T) distance test. Results: After treatment; mixed design MANOVA revealed significant improvement in scapular tipping (A-T) distance from supine position, supine position with scapula retraction, standing position, and standing position with scapula retraction, for group B more than group A (P<0.05). There were significant improvements in scapular tipping when comparing the post-treatment mean value with pretreatment in group B only (P<0.05). Conclusion: Strengthening of the lower trapezius fibers plus traditional physical therapy program yields improvement in scapular tipping in patients with DFS more than traditional physical therapy alone.

El objetivo de este estudio fue examinar el resultado de la terapia de ondas de choque extracorpóreas (TOCH) en mujeres con dolor en la articulación sacroilíaca posparto. Cuarenta mujeres primigrávidas (seis semanas después del parto) con dolor sacroilíaco participaron en este estudio. Fueron asignadas al azar a los grupos A y B. El grupo A fue tratado mediante TOCH, además de ejercicios de corrección postural y ejercicios de inclinación pélvica posterior. El grupo B fue tratado únicamente con el mismo programa de ejercicios. Ambos grupos recibieron dos sesiones por semana durante cuatro semanas. Las variables estudiadas fueron el dolor sacroilíaco y el nivel de función, las cuales se midieron mediante la escala visual analógica (EVA) y la escala funcional de dolor de espalda (EFDE), respectivamente. Todas las mediciones se evaluaron antes y después de las cuatro semanas de intervención. El análisis dentro de los grupos mostró una mejora significativa en la EVA y un aumento significativo en la EFDE en ambos grupos después del tratamiento en comparación con el valor inicial. Con respecto a los análisis entre grupos, hubo una mejora significativa en la EVA y un aumento significativo en la EFDE en el grupo A en comparación al grupo B. En conclusión, tanto la TOCH como el programa de ejercicios son efectivos para disminuir el dolor y mejorar la función en mujeres con dolor sacroilíaco posparto. Sin embargo, al agregar TOCH a los ejercicios en el programa de tratamiento, los resultados son mejores, por lo que esta combinación se recomienda en el tratamiento de mujeres con dolor sacroilíaco posparto. Examining the outcome of the extracorporeal shock wave therapy (ESWT) on females with postpartum sacroiliac joint pain was the aim of this study. Forty primigravida (six weeks postpartum) females with sacroiliac pain was the sample in this study. The subjects equally randomly allocated in group A and B. Group A was treated by ESWT in addition to postural correction and posterior pelvic tilting exercises. Group B was treated by the same exercise program only. Two sessions every week for four weeks were received by both groups. The measurement variables were sacroiliac pain and function level that were measured by visual analogue scale (VAS) and the back pain functional scale (BPFS), respectively. All measurements were evaluated pre and post four weeks of intervention. The within groups analysis showed a significant improvement in VAS and a significant increase in BPFS in both groups after treatment compared with baseline. Regarding between groups analyses there was a significant improvement in VAS and a significant increase in BPFS in group A compared with group B. In conclusion, both ESWT and exercise program are effective in decreasing the pain and improving the function in females with postpartum sacroiliac pain. However, by adding ESWT to exercises in the treatment program the results are better, so this combination is recommended in treatment of females with postpartum sacroiliac pain.

Purpose. The study was to assess the effectiveness of strain-counterstrain (SCS) techniques, after treatment and after a 6-week follow-up, on pain, range of motion (ROM), and disability in patients with acute nonspecific low back pain with mobility deficits. Methods. Overall, 84 patients diagnosed with nonspecific low back pain with mobility deficits were divided into 2 groups; 42 received SCS techniques (group A) and 42 (group B, control group) were advised to be active. The pressure pain threshold (PPT), lumbar flexion ROM, and Oswestry Disability Index (ODI) were used for assessment. All patients were assessed before treatment, after treatment, and after a 6-week follow-up. The treatment program was applied for 2 weeks, 2 sessions per week. Results. Statistical analysis revealed that there were significant increases in PPT on both sides of L5 and lumbar flexion ROM. In addition, a significant reduction in ODI scores was observed (p < 0.05) in the pre-vs. post-treatment evaluation, in the pre-treatment vs. post-6-week evaluation, and in the post-treatment vs. post-6-week evaluation with regard to both groups. As for between-group effects, multiple pairwise comparisons revealed significant increases in PPT on both sides of L5 and lumbar flexion ROM, in addition to a significant reduction in ODI scores (p < 0.05) in favour of group A as compared with group B after treatment and after the 6-week follow-up. Conclusions. SCS is preferable to be advised in the treatment of acute nonspecific low back pain with mobility deficits.

Aim. to assess the impact of a 6-weeks high-intensity interval exercise (HIIE) regimen on pain, disability, as well as autonomic balance in women with nonspecific chronic low back pain (NSCLBP). Materials and methods. Eighty females with mild to moderate NSCLBP, with ages of 18-65 years, were recruited from the physiotherapy department at King Fahd University Hospital, AlKhobar. They were assigned randomly into the control group (n = 40), which received standard regular physiotherapy, or the experimental group (n = 40), which received HIIE as well as conventional regular physiotherapy. Pre- and post-intervention (after 6 weeks) assessments included pain intensity via Numerical Rating Scale (NRS), disability via Oswestry Disability Index (ODI), as well as autonomic balance via heart rate variability (HRV) parameters & baroreceptor sensitivity (BRS) Both at rest and in reaction to an orthostatic challenge. Results. Both groups experienced significant improvements in pain and disability, with the HIIE group experiencing a higher improvement in both variables. For the HRV parameters after 6 weeks of intervention, the control group had a statistically significant reduction in high frequency (HF), and in response to the orthostatic challenge, a significantly higher rise in the normalized low frequency (LFnu) compared to the baseline. BRS showed a significant reduction and heart rate recovery was significantly faster post-intervention in the HIIE group in the 2nd and 3rd minutes, compared to the baseline values. Conclusions. HIIE can be a valuable addition to NSCLBP patients’ exercise routines in practice, since adding HIIE to standard physiotherapy resulted in more reduction in pain, disability compared to conventional physiotherapy alone, with enhanced autonomic regulation after six weeks of treatment.