Entrenamiento de la musculatura intrínseca del pie para la prevención de caídas en personas mayores / Effect of a program of intrinsic musculature exercises of the foot in the prevention of risk of fall on the elderly

OBJETIVO Las personas mayores y particularmente las mujeres, son propensas a sufrir traumatismo por caídas. El objetivo de esta investigación fue mejorar la estabilidad y funcionalidad de la pisada en personas mayores, implementando un programa de entrenamiento de musculatura intrínseca del pie, y determinar sus efectos en el riesgo de caída como método de prevención. MATERIALES Y METODOS Participaron 33 personas mayores, de género femenino y autovalentes. En las participantes se evaluó el equilibrio y la velocidad de la marcha con la prueba Time up and Go (TUG), y el equilibrio dinámico se evaluó con la Escala de Tinetti (ET). La intervención constó de enteramiento de tipo short-foot de forma diaria, durante 4 semanas. RESULTADOS los tiempos del TUG disminuyeron de manera progresiva al final de la intervención, lo que indica una optimización en la velocidad de la marcha, por lo que, el entrenamiento tuvo resultados beneficios para la transferencia de carga corporal de una posición sedente a bípedo y de bípedo a marcha. En cambio, para el equilibrio y marcha según ET no se detectó una diferencia significativa. CONCLUSIONES Este entrenamiento presenta una mejoría en el ámbito funcional de cambio de posición, pero no reemplaza el ajuste postural de base de sustentación para mantener el centro de masa en su posición central.

OBJETIVE Seniors, particularly women, are at risk for suffering traumatisms from falls. The objective of this study was to improve the balance and walking functionality of seniors by implementing a program to training the intrinsic muscles of the foot. The impacts of this training on preventing fall risk were assessed. MATERIALS AND METHODS A total of 33 self sufficient, female seniors participated. Balance and the speed of walking were measured using the Timed Up and Go (TUG) test, while balance and gait were measured using the Tinetti Balance and Gait Assessment Tool (TT). Intervention consisted in four weeks of daily short foot exercises. RESULTS The TUG test times decreases progressively from the start to the end of the intervention period, indicating an optimization in walking speed. This translates into beneficial results for the transfer of body load from a sedentary to standing to walking position. In contrast, balance and gait evidenced no significant changes per the TT. CONCLUSIONS The implemented training program improved the functional sphere of position change, but this did not replace the postural adjustments needed in the base of support (i.e. the feet) to maintain a well-positioned center of mass

Implementación de rehabilitación remota en artrosis bilateral de cadera / Implementation of Remote Rehabilitation in Bilateral Hip Osteoarthritis

Introducción: La pandemia causada por el COVID-19 obligó a cambiar la modalidad en la cual se llevan cabo los procesos de rehabilitación -de presencial a remoto- incluso la de aquellos tratamientos ya planificados. Objetivos: Implementar la telerehabilitación y documentar si el cambio de modalidad basada en el ejercicio terapéutico tiene efectos en los resultados de la intervención. Presentación del caso: Se presenta el caso de una paciente con osteoartritis bilateral de cadera cuya intervención de terapia física tuvo que ser modificada a una modalidad remota, debido a la pandemia por COVID-19. Conclusiones: La modalidad remota adoptada no afectó la recuperación funcional establecida en las primeras etapas. Se recomienda utilizar evaluaciones funcionales, así como considerar las condiciones en el hogar requeridas para la continuidad de las intervenciones(AU)

Introduction: The pandemic caused by COVID-19 forced to change the modality in the rehabilitation processes -from face-to-face to remote- including that of those already planned treatments. Objectives: To implement remote rehabilitation and to set down whether the change of modality based on therapeutic exercise impacts on the results of the intervention. Case report: The case of a patient with bilateral hip osteoarthritis is reported here. Her physical therapy intervention had to be modified to a remote modality, due to the COVID-19 pandemic. Conclusions: The remote modality adopted did not affect the functional recovery established in the early stages. It is recommended to use functional evaluations, as well as to consider the required conditions at home to continue the interventions(AU)

Rehabilitación física en pacientes con artropatía hemofílica: revisión sistemática y metaanálisis sobre dolor / Physical rehabilitation in haemophilic arthropathy: systematic review and pain-related meta-analysis

RESUMEN Introducción: La artropatía hemofílica (AH) cursa con diferentes manifestaciones clínicas importantes, como son las hemorragias articulares, el dolor, la disminución de la amplitud del movimiento y las alteraciones funcionales que pueden causar secuelas en la funciona lidad y movilidad. El ejercicio físico adaptado a los pacientes con hemofilia puede ser una adecuada estrategia terapéutica, que repercuta positivamente sobre la calidad de vida de dichos sujetos. Objetivos: Evaluar la eficacia de la rehabilitación física en el tratamiento de la artropatía hemofílica. Materiales y métodos: Se ha realizado una revisión sistemática y metaánálisis de ensayos clí nicos (seleccionados según criterios de elegibilidad). Para ello, se han utilizado las siguientes bases de datos: PEDro, Pubmed, Scopus y Web of Science. Se empleó la escala «PEDro¼ para evaluar la calidad metodológica de los estudios. Resultados: Tras aplicar los criterios de inclusión y exclusión, en la revisión final fueron incluidos siete artículos, los cuales aportaron resultados favorables sobre la fuerza y el diá metro muscular, el rango de movilidad, el estado articular y la calidad de vida. De ellos, dos estudios aportaron datos para metaanálisis, con resultados favorables sobre la variable dolor [Diferencia de medias estandarizada (DME) = -2,64; IC 95%: (-4,26; 1,03)]. Conclusiones: Se encontró evidencia sobre la eficacia de la rehabilitación física en el trata miento de la artropatía hemofílica. El ejercicio terapéutico (ET) es el principal tratamiento realizado; con este se obtuvieron mejoras significativas en distintas variables físicas.

ABSTRACT Introduction: Haemophilic arthropathy presents with different important clinical disorders, such as joint disease, pain, decreased range of motion, and functional alterations that can produce limitations in functionality and mobility. The physical exercise adapted to patients with haemophilia can be an adequate therapeutic strategy, having a positive impact on the quality of life of these subjects. Objectives: To identify the published clinical trials that evaluate the efficacy of physical rehabilitation in the treatment of haemophilic arthropathy. Materials and methods: A systematic review and meta-analysis of clinical trials was con ducted (using pre-defined eligibility criteria). The literature search was performed in the databases: PEDro, Pubmed, Scopus, and Web of Science. The quality of the methods used in the studies was evaluated using the PEDro scale. Results: After applying the inclusion and exclusion criteria, 7 studies were included in this review, providing favourable results on muscle strength and circumference, range of motion, joint disease, and quality of life. Moreover, 2 articles contributed information to the meta-analysis, showing favourable results on pain [Standardised mean difference (SMD) = -2.64; 95% CI: (-4.26; 1.03)]. Conclusions: This systematic review found evidence on the efficacy of physical rehabilitation in the treatment for haemophilic arthropathy. Therapeutic exercise is the main treatment carried out, obtaining significant improvements in the different physical outcomes.

Effects of Aquatic Therapeutic Exercise on Motor Function and Activities for Children and Youth with Cerebral Palsy: A Systematic Review and Meta-Analysis / 中国康复理论与实践

Objective:To evaluate the intervention effects of aquatic therapeutic exercise on functioning and quality of life for children and youth with cerebral palsy within framework of World Health Organization Family International Classifications using systematic review. Methods:Literatures were retrieved and reviewed from the databases of Cochrane Library, PEDro, PubMed, EMBASE, Web of Knowledge, Web of Science, OVID, EBSCO, CMCI, CNKI, Wangfang and VIP until May, 2020. The randomized controlled trials (RCTs) about aquatic therapeutic exercise for children and youth with cerebral palsy for functioning were systematically reviewed. The data were analyzed with RevMan 5.3. Results:Nine RCTs were selected, including 162 children and youth. The score of Gross Motor Function Measure improved significantly after aquatic exercise (WMD = 6.31, 95 %CI 2.57 to 10.06, P < 0.001), as well as daily activities and quality of life. Conclusion:Aquatic therapeutic exercise can help improve the gross motor function of children and youth with cerebral palsy, and has positive effects on function of activity and quality of life.

Programa de ejercicios físicos terapéuticos para pacientes amputados / Programa de exercícios físicos terapêuticos para pacientes amputados / Therapeutic physical exercises program for amputees

Resumen El proceso de rehabilitación para los pacientes amputados carece de un instrumento metodológico para el desarrollo de la fuerza muscular que les permitan alcanzar mejores niveles de marcha y equilibrio. Por tal motivo, se elaboró un programa de desarrollo de la fuerza muscular dirigido a alcanzar mejores niveles de marcha y equilibrio del paciente amputado. Se analizaron los fundamentos teóricos y metodológicos del tratamiento físico rehabilitador del paciente amputado para establecer el diagnóstico del tratamiento. Asimismo, se determinó la estructura, contenido y metodología del programa, el cual fue valorado por criterio de expertos. El estudio fue de corte descriptivo de naturaleza holística, con un diseño no experimental. La muestra fue de 19 especialistas, seis fisiatras con más de nueve años de experiencia, diez rehabilitadores con más de ocho años de experiencia, un ortopédico y un Doctor en Ciencia de la Cultura Física con más de seis años de experiencia, con una edad promedia de 45 años, presentando un alto dominio y nivel de conocimientos sobre el tema. Los métodos aplicados fueron teóricos y empíricos. Se estructuró el programa de ejercicios físico-terapéuticos para pacientes amputados. Los expertos valoraron de muy adecuado la pertinencia e implementación del programa de ejercicios físico-terapéuticos para pacientes amputados con una efectividad esperada fuerte. Resultó pertinente la confección del programa, ya que justifica la necesidad de orientar científica y metodológicamente a los rehabilitadores físicos.

Resumo O processo de reabilitação de pacientes amputados carece de um instrumento metodológico para o desenvolvimento da força muscular que lhes permita alcançar melhores níveis de marcha e equilíbrio. Por esta razão, foi desenvolvido um programa de desenvolvimento da força muscular para alcançar melhores níveis de marcha e equilíbrio para o paciente amputado. Os fundamentos teóricos e metodológicos do tratamento de reabilitação física do paciente amputado foram analisados para estabelecer o diagnóstico do tratamento. Do mesmo modo, a estrutura, conteúdo e metodologia do programa foram determinados e avaliados por critérios de peritos. O estudo foi descritivo e holístico por natureza, com um desenho não experimental. A amostra foi composta por 19 especialistas, 6 fisiatras com mais de 9 anos de experiência, 10 reabilitadores com mais de 8 anos de experiência, um ortopedista e um Doutor em Ciências da Cultura Física com mais de 6 anos de experiência, com uma idade média de 45 anos, apresentando um elevado nível de domínio e conhecimentos sobre o assunto. Os métodos aplicados eram teóricos e empíricos. O programa de exercícios físico-terapêuticos para pacientes amputados foi estruturado. Os peritos avaliaram a relevância e a implementação do programa de exercícios de fisioterapia para pacientes amputados com uma forte eficácia esperada. A preparação do programa foi pertinente, uma vez que justifica a necessidade de uma orientação científica e metodológica para os profissionais de reabilitação física.

Abstract The rehabilitation process for amputees lacks a methodological instrument for developing muscular strength that allows them to achieve better levels of walking and balance. For this reason, a muscle strength development program was designed to achieve better gait and balance levels for the amputee. The theoretical and methodological foundations of the rehabilitating physical treatment of the amputee patient were analyzed to establish the diagnosis of the treatment. The structure, content and methodology of the program were also determined. Which was valued by expert judgment. The study was descriptive in a holistic nature with a non-experimental design. The sample was of 19 specialists, six physiatrists with more than nine years of experience, ten rehabilitators with more than eight years of experience, an orthopedic and a Doctor of Science in Physical Culture with more than six years of experience, with an average age 45 years old, presenting a domain and level of knowledge on topic four obtained a medium and a high coefficient of 15. The applied methods were theoretical and empirical. The physical-therapeutic exercise program for amputated was structured. The experts rated the relevance and implementation of the physical-therapeutic exercise program for amputees with a strong expected effectiveness as very adequate. The preparation of the program was pertinent, since it justifies the need to guide the physical rehabilitators scientifically and methodologically. Conclusions and recommendations were reached.

Efecto de la técnica "contracciones repetidas" sobre la fuerza del músculo dorsal ancho / Effect of the "repeated contractions" technique on the strength of latissimus dorsi muscle

La Facilitación Neuromuscular Propioceptiva es un enfoque de la rehabilitación comúnmente usado por el fisioterapeuta. Sin embargo, no existen estudios que evalúen el efecto de las técnicas de FNP dirigidas al agonista, como por ejemplo las contracciones repetidas de la forma más avanzada, a pesar de existir mecanismos neurofisiológicos que sustentan su aplicación. Objetivo: Describir el efecto de la Técnica de Facilitación Neuromuscular Propioceptiva­ Contracciones Repetidas de la forma más avanzada sobre la fuerza del músculo dorsal ancho en mujeres universitarias sanas. Método: Se incluyeron 10 mujeres sanas entre 18-25 años de edad con notas musculares de 3 o 3+ en el examen muscular manual del músculo dorsal ancho. Se realizó el entrenamiento de la fuerza con la Técnica de Facilitación Neuromuscular Propioceptiva ­ Contracciones repetidas de la forma más avanzada (3 series de 8 repeticiones, 3 veces a la semana durante 8 semanas) en el miembro superior no dominante. Para el análisis se aplicaron la prueba Shapiro-Wilk, Levene y t-Student pareada (p<0.05). Resultados: Hubo un aumento significativo en la fuerza del músculo dorsal ancho después de la intervención (p=0,002418) en el miembro superior entrenado. Se observó un aumento no significativo en la fuerza del músculo dorsal ancho que no fue intervenido. Discusión: Se discute sobre varias de las características del entrenamiento tales como duración, componente en diagonal, movimiento voluntario repetido, y las implicaciones de estas sobre los resultados en la fuerza se comprenden a la luz de la evidencia disponible.

Proprioceptive Neuromuscular Facilitation (PNF) techniques are a rehabilitation approach commonly used by physiotherapists. However, there are no studies that evaluate the effect of PNF techniques such as repeated contractions (RC) in the most advanced form, despite the existence of neurophysiological mechanisms that support its application. Objective: To describe the effect of PNF RC Technique in the most advanced form on the strength of latissimus dorsi muscle in healthy university women. Method: Ten healthy women (18-25 years) with muscle notes of 3 or 3+ in the manual muscle examination of the latissimus dorsi muscle, and who did not perform physical exercise during the intervention, were included. Training was performed with the PNF RC Technique in the most advanced form (3 sets of 8 repetitions, 3 times a week for 8 weeks) in the non-dominant upper limb. The normality and homogeneity of the data were evaluated with the Shapiro-Wilk and Levene test, the difference pre and post-intervention in the muscle strength was analyzed by the paired t-Student test (p <0.05). Results: There was a significant increase in the strength of the latissimus dorsi muscle after the intervention (p = 0.002418) in the trained upper limb. There was increase in non-intervened latissimus dorsi muscle strength (p = 0.121). Discussion: Several training characteristics such as duration, diagonal component and repeated voluntary movement are discussed. The implications of these on strength results are understood using the available evidence.

Therapeutic Exercises for Strengthening Suprahyoid Muscles / 대한연하장애학회지

Suprahyoid muscles play an important role in normal swallowing by providing muscle contractions involved in airway protection and upper esophageal sphincter opening. However, these muscles can be weakened by neurological disease or aging, which can result in pharyngeal dysphagia. Therefore, strengthening of the suprahyoid muscles is a clinically important treatment. In addition, it is important to know exactly how and which method is optimal. Many therapeutic exercise methods have been reported to strengthen the suprahyoid muscles, and new methods related to this have recently been reported. Therefore, this study will briefly summarize the representative traditional methods and the recently reported, relatively new methods for strengthening the suprahyoid muscles.

Programa de ejercicios físico-terapéuticos en el síndrome de hipermovilidad articular y Ehlers-Danlos hiperlaxo / Program of physical-therapeutic exercises with syndrome of hypermobility to articulate and hypermobile Ehlers-Danlos syndrome

Se desconoce en el país la existencia de un programa para la rehabilitación física integral en pacientes adolescentes con Síndrome de Hipermovilidad Articular y Síndrome Ehlers-Danlos Hiperlaxo. Por tal motivo se diseñó un programa de ejercicios físico-terapéuticos para contribuir al alivio de las dolencias del sistema osteomioarticular para que los afectados puedan tener una mayor participación en las diferentes actividades escolares y de la vida diaria. Se analizaron los fundamentos teóricos y metodológicos del tratamiento físico rehabilitador en los adolescentes para establecer el diagnóstico del tratamiento. Asimismo fue determinado la estructura, contenido y metodología del programa. El cual fue valorado por criterio de especialistas. El estudio fue de corte descriptivo de naturaleza holística con un diseño no experimental. La muestra estuvo conformada de 21 especialistas, siete médicos especialistas en primer y segundo grado en Medicina Física y Rehabilitación, seis médicos especialistas en segundo grado de Reumatología, tres rehabilitadores (dos Licenciado en Cultura Física y un Especialista en Medicina Física y Rehabilitación), tres médicos especialistas en primero y segundo grado de Genética, dos Doctores en Ciencias Biológicas (Profesores en Fisiología) con una edad promedio de 42 años. Los métodos aplicados fueron teóricos y empíricos. Los especialistas valoraron de muy adecuado la implementación del programa con una Efectividad Esperada Fuerte. Resultó pertinente la confección del programa de ejercicios físico-terapéuticos dirigidos a estos síndromes y a las enfermedades asociadas, ya que justifica la necesidad de orientar científica y metodológicamente a los rehabilitadores físicos. Se arribaron a conclusiones y recomendaciones

The existence of a program for comprehensive physical rehabilitation in adolescent patients with Syndrome of Hypermobility to Articulate and Hypermobile Ehlers-Danlos Syndrome is unknown. For this reason a program of physical-therapeutic exercises was designed to contribute to the relief of bone muscle articulate System ailments so that the affected ones can have a greater participation in the different school activities and of the daily life. We analyzed the theoretical and methodological foundations of physical rehabilitation treatment in adolescents to establish the diagnosis of the treatment. The structure, content and methodology of the program were also determined. This was judged by specialists. The study was descriptive of a holistic nature with a non-experimental design. The sample consisted of 21 specialists, 7 first and second grade physicians in Physical Medicine and Rehabilitation, 6 medical specialists in the second degree of Rheumatology, 3 rehabilitators (2 Graduate in Physical Culture and 1 Specialist in Physical Medicine and Rehabilitation), 3 doctors specialized in first and second degree of Genetics, 2 Doctors in Biological Sciences (Professors in Physiology) with an average age of 42 years. The methods applied were theoretical and empirical. The specialists considered the implementation of the program with a Strong Expected Effectiveness very appropriate. The preparation of the program of physical-therapeutic exercises aimed at these syndromes and associated diseases were pertinent, since it justifies the need to provide scientific and methodological guidance to physical rehabilitators. Conclusions and recommendations were reached

Ejercicio terapéutico: Pautas para la acción en fisioterapia / Therapeutic exercise: guildenes for physiotherapy action

Los programas de ejercicio terapéutico son una modalidad de intervención propuestas por orga-nismos internacionales y nacionales. Le permiten al fisioterapeuta manejar conceptos básicos del ejercicio dirigidos a nivel individual o colectivo para intervenir limitaciones funcionales o restric-ciones en los roles de los individuos. El profesional debe conocer los aspectos básicos a tener en cuenta para elegir y diseñar programas de ejercicio acordes a los objetivos terapéuticos derivados de su evaluación. En este artículo se revisaron las pautas generales sobre la óptima prescripción del ejercicio terapéutico, partiendo de los conceptos esenciales, hasta la elaboración de progra-mas de tratamiento con los elementos a tener en cuenta al momento de escoger, plantear y su-pervisar ejercicios para individuos y comunidades con patologías que presenten compromisos del movimiento corporal humano, buscando intervenciones costo efectivas dirigidas a mejorar la capacidad funcional y calidad de vida de los pacientes/clientes a quienes se dirigen

Therapeutic exercise programs are a form of intervention proposed by international and national bodies, which allows the therapist to handle basic exercise concepts of targeted individually or co-llectively to intervene functional limitations or restrictions on the individual's roles. To do, this pro-fessional must know the basics for choosing and designing exercise programs chords to therapeutic targets derived from its evaluation. The following paper seeks to review the general guidelines on the optimal prescription of therapeutic exercise, based on the essential concepts to the development of treatment programs with elements to consider when choosing, raising and monitoring exercises for individuals and communities with pathologies that submit commitments of human body mo-vement, looking for cost-effective interventions to improve functional capacity and quality of life of patients / clients to whom they are addressed

Effect of the Press Tack Needle on Recovery from Muscle Fatigue by Randomized Controlled Trial-sham controlled study- / 全日本鍼灸学会雑誌

[Purpose]The purpose of this paper is to examine whether or not the Press Tack Needle (PTN) treatment enhances the recovery process from muscle fatigue which assists in the therapeutic exercise rehabilitation process. By using the PTN, this paper investigates the recovery effect of the fatigued muscle. Randomized controlled trials were used to compare outcomes. <BR>[Method]Twenty-nine healthy male adults were chosen as subjects. However, crossover study was used to compare the PTN group and the sham group. After two sets of arm curl exercises with isotonic contraction at 10%weight of maximum voluntary contraction, the decrease percentage of exercise repetition was calculated. A PTN or sham was inserted at the posterior cervical region using the double masking method. After the intervention of the PTN or sham needle, the subjects were asked which intervention was inserted into them. A Kappa statistics value was used to evaluate the validity of the sham group and a Visual Analog Scale (VAS) was used to determine the upper arm fatigue. <BR>[Result]The Kappa statistic value was 0.17. The decrease percentage of the exercise repetition of the PTN group was 35.4±20.1%, and of the sham group was 45.1±11.1%. The PTN group indicated a significantly smaller percentage than the sham group (p<0.01). Both groups showed no difference in Upper arm fatigue. <BR>[Conclusion]The PTN seems to help in recovery from muscle fatigue. It is thought that by inserting the PTN, somato-automomic reflex was induced to promote the increase of blood flow in to the muscle. Faster recovery of physical function of the patient can be possible as well as the improvement of QOL. In conclusion, this investigation showed that the PTN treatment method can be useful in assisting in therapeutic exercise rehabilitation.

Pain Managements and Therapeutic Exercises of Lumbar Disc Herniations

Most people experience episodes of low back pain that are usually brief, resolve spontaneously, and recur infrequently. The successful management of persistent low back pain requires that the treatment be directed to the pain-producing structures in the human body. The treatment of low back pain ranges from very simple and straight forward managements to very complex and intricate ones. Treatments for lumbar disc herniations can be conservative (75~90% of patients), invasive (5~10% of patients), or surgical (5% of patients). Resolution of the first lumbar disc herniation takes place in approximately 75% of patients over a period of 3 months. With recurrent herniations, the chance of spontaneous relief of symptoms decreases. In a very acute stage, the patients may require hospitalization to control the level of pain. Bed rest should be limited for 2 days with the most comfortable position of the knee and the hip flexion at about 80~90 degrees. A few days of bed rest, adequate analgesics, and muscle relaxants to reduce muscle spasm are usually required. Physical therapeutic modalities (including traction, heat, ultrasound, and electrical stimulation), mobilization, manipulation, back school, spinal supports, therapeutic exercise and proper position should be used and educated. If the low back pain is not controlled after these treatments, invasive procedures such as trigger point injection, facet or sacroiliac joint injection, epidural steroid injection, selective nerve root injection with high frequency heat therapy, or intradiscal injection may be implemented to alleviate the symptoms rapidly. Every patient should attend a class for spine education as part of the comprehensive management. Instructions should be given for low back care, especially as related to the activities of daily living. Participants will learn correct postures, pelvic tilting, knee-to-chest exercise, and exercises to strengthen abdominal and paraspinal muscles. Individual instructions are given to each patient, detailing the nature of the patient's particular problem and how he or she can make the best of the treatment.

Pain Managements and Therapeutic Exercises of Lumbar Disc Herniations

Most people experience episodes of low back pain that are usually brief, resolve spontaneously, and recur infrequently. The successful management of persistent low back pain requires that the treatment be directed to the pain-producing structures in the human body. The treatment of low back pain ranges from very simple and straight forward managements to very complex and intricate ones. Treatments for lumbar disc herniations can be conservative (75~90% of patients), invasive (5~10% of patients), or surgical (5% of patients). Resolution of the first lumbar disc herniation takes place in approximately 75% of patients over a period of 3 months. With recurrent herniations, the chance of spontaneous relief of symptoms decreases. In a very acute stage, the patients may require hospitalization to control the level of pain. Bed rest should be limited for 2 days with the most comfortable position of the knee and the hip flexion at about 80~90 degrees. A few days of bed rest, adequate analgesics, and muscle relaxants to reduce muscle spasm are usually required. Physical therapeutic modalities (including traction, heat, ultrasound, and electrical stimulation), mobilization, manipulation, back school, spinal supports, therapeutic exercise and proper position should be used and educated. If the low back pain is not controlled after these treatments, invasive procedures such as trigger point injection, facet or sacroiliac joint injection, epidural steroid injection, selective nerve root injection with high frequency heat therapy, or intradiscal injection may be implemented to alleviate the symptoms rapidly. Every patient should attend a class for spine education as part of the comprehensive management. Instructions should be given for low back care, especially as related to the activities of daily living. Participants will learn correct postures, pelvic tilting, knee-to-chest exercise, and exercises to strengthen abdominal and paraspinal muscles. Individual instructions are given to each patient, detailing the nature of the patient's particular problem and how he or she can make the best of the treatment.

THERAPEUTIC THERA-BAND EXERCISE ON OSTEOARTHRITIS OF THE KNEE-EFFECTS OF SIMULTANEOUS EXERCISE OF KNEE EXTENSORS AND FLEXORS- / 体力科学

Purpose : We examined the effect of therapeutic exercise on osteoarthritis (OA) of the knee. Objects and Method : We evaluated seven women with bilateral OA of the knees of over Grade I on the Kellgren and Lawrence scale. The patients were instructed in therapeutic exercise for both knees. The exercise was to tie a Thera-Band <SUP>®</SUP> around the leg just above both ankles in the 8 figure, and then, in a sitting position, extend one leg while simultaneously retracting the other, repeating alternatively every 5 seconds. One set consisted of repeating this motion 10 times, and 2 sets were performed per day. Before exercise, 1 month, and 3 months after exercise, we evaluated the effect of this therapy by the JOA score, isokinetic muscle strength of knee extensors and flexors, and surface EMG signals recorded from rectos femoris (RF), vastus medialis (VM), vastus lateralis (VL), and biceps lemons (BF) . The integrated signal, the root mean square (RMS), and the mean power frequency (MPF) parameters were extracted.<BR>Result : The parameters of the JOA score, muscle strength of knee flexors, integrated EMG from RF, VM, VL, and RMS from VM, VL were significantly increased at 3 months after exercise. MPF from VM at 3 months after exercise decreased significantly.<BR>Conclusion : We thought a proper balance of knee extensors and flexors are related to the improvement of symptoms of OA of the knee. The decrease of MPF might suggest the possibility of muscle fiber type change. It is also possible that pain reduction results from the improvement of balance between knee extensors and flexors as well as from the increase of knee joint stability. Therapeutic exercise with the Thera-Band R is extremely easy and is effective in promoting con-tinuous exercise.

Effect of Therapeutic Exercise according to Degree of Injury in Sciatic Nerve Damaged Rat

OBJECTIVE: To investigate the effects of treadmill running and swimming exercise for the functional and electrophysiological recovery in rats with sciatic nerve damage, and to evaluate the patterns of recovery according to various degree of intensity and duration of injury. METHOD: Sixty male Sprague-Dawley rats (200~250 g) were used, and divided into the control and the experimental groups. Crushing injuries to the sciatic nerve at the sciatic notch was manipulated using a hemostatic forcep, treadmill and swimming exercise programs were performed for 30 minutes on a daily basis, 5 days a week during the 4 week period. The experimental group was divided into 2 sub-groups in correlation with the intensity of injury, and into 5 and 30 seconds group in correlation with the duration of injury. The test results were analysed by sciatic nerve functional index (SFI) that was obtained through walking tract analysis, and by the amplitude of compound muscle action potentials in calf muscles through the sciatic motor nerve conduction study. RESULTS: 1) After 4 weeks following sciatic nerve injuries, the SFI were -21.8+/- 10.8, -23.1+/- 7.0, -32.5+/- 9.1 in treadmill, swimming, and control groups, respectively. Treadmill and swimming groups showed markedly improved function compared to the control group. Amplitudes of sciatic nerve compound muscle action potentials in calf muscle were 21.2+/- 6.5, 15.9+/- 5.8, 12.5+/- 2.0 mV in treadmill, swimming, and control groups respectively, and revealed marked electrophysiological improvement in treadmill group. 2) The results concerning the intensity and the duration of injury, nerve recovery patterns showed the most significant improvement in the first degree-5 seconds group in both treadmill and swimming exercise programs. CONCLUSION: These findings suggest that the treadmill and swimming exercises have significantly better effect in the regeneration of damaged sciatic nerve than that of control, and the intensity of injury was a more important factor in the recovery of nerves compared to the duration of injury.

Under-water Therapeutic Exercise in a Temperature-adjusted Pool on Patients with Rheumatoid Arthritis / 日本温泉気候物理医学会雑誌

We performed electromyographic observations of M. deltoideus, M. biceps, M. triceps brachii, and extensor and flexor muscles of the right forearms of four healthy males (22.3 years old average) during various exercises of the right upper extremity on ground and in water. All electromyographic activities were examined through integral analysis. During exercise in water, the proximal part of the upper arm showed a significantly lower electric discharge than that for the exercises on the ground (p<0.05). Furthermore, forearm muscles showed significantly higher electrical discharge than that for the same exercise on the ground (p<0.05). We investigated the effects of therapeutic exercises in water in a temperature-adjusted pool on 15 female patients with rheumatoid arthritis (average 48.0 years old, Stage 2.3, and Class 1.9). The respiratory function, dorsal muscle power, power around a knee, grasping power, elasticity of the trunk and lower extremities, Lansbury index, and Japan Orthopedic Association's judgment score for rheumatoid arthritic knees were improved significantly (p<0.05) after an eight-week course of therapeutic exercises in water (two session a week). The result of a psychological test showed that their mental conditions were significantly improved (p<0.01) by therapeutic exercises in water. No aggravation of inflammatory reactions was observed in serological examinations before and after the exercise. We concluded that therapeutic exercise in water was an effective treatment method for patients with rheumatoid arthritis.

Clinical Effect of the Ogi-Kenchu-To and Therapeutic Exercise for a Patient with Spinocerebellar Degeneration. Electrophysiological Study / 日本東洋医学雑誌

To investigate the effects of Kampo and a rehabilitation approach on patients with spinocerebellar degeneration (SCD), a 65-year-old female patient with SCD was treated with Ogi-kenchu-to and therapeutic exercise based on the Bobath concept.<br>She had a gait disturbance (unable to walk) with slightly increased muscle tonus and deep sensory disturbance in the left leg before therapy. In Kampo confirmations, there was a generalized cold feeling and fatigue due to decreased physical fitness. In the electrophysiological study, the amplitude of Auditory Brainstem Responses (ABR) and Somatosensory Evoked Potentials (SEP) in the left side showed a greater decrease than those in the right side. The amplitude of the F-wave in the left side showed a greater increase than that of the right side.<br>After two months of this therapy, the patient was able to walk unassisted. Improvement in the neurological and general findings, along with normalization of the ABR, SEP and F-wave were also observed.<br>It was suggested that Kampo therapy using Ogi-kenchu-to and therapeutic exercise based on the Bobath concept were effective in the treatment of this patient with SCD.

Effects of Under-Water Therapeutic Exercise with Hydropower System on Middle-Aged Lumbago Patients / 日本温泉気候物理医学会雑誌

We subjected six male lumbago patients (average age of 58.2 years) to underwater therapeutic exercise with and without a hydropower system (Flow Machine (FM)) twice a week for 4 weeks (a total of 10 hours) at an interval of 10 weeks between the two therapeutic sessions. The FM produced running water (average speed of 0.9meter/second) in a temperature-controlled pool. The water temperature was kept to about 30°C, The subjects received a total of four examinations before and after these two therapeutic sessions. We compared the results of these two therapeutic sessions (under-water therapeutic exercise with FM and without FM) and obtained the conclusions described below.<br>Improvements of obesity, anaerobic power, power around knee, vital capacity and total score in lumbago treatment (results of Japanese Orthopaedic Association) were observed more significantly (p<0.05) and rapidly with the use of FM than without FM. Further, increased HDL-cholesterol and decreased free fatty acid in blood were observed significantly (p<0.05) only for FM use.<br>It was suggested that the resistance of running water, vibratile massage effect, and heat action of produced supersonic waves promoted the above improvements. We concluded that the hydropower system was useful in underwater therapeutic exercise on lumbago patients.

Effects of Acupuncture on Spondylosis Deformans of Lumbar Spine / 全日本鍼灸学会雑誌

The patients with the spondylosis deformans of the lumbar spine are often treated by acupuncture therapy. Forty patients (male 28, female 12, mean age 61.2 years old) with spondylosis deformans of lumbar spine were treated by the acupuncture therapy with therapeutic exercise and silver spike point (SSP) therapy in Meiji College of Oriental Medicine Hospital. The purpose of this study is to evaluate the clinical effect of our therapy using our painscale score. In our therapy, acupuncture points (Dachangshu-BL25, Shenshu-BL23, Ciliao-BL32, Baohuang-BL53 etc.) and SSP points on erector spinae muscle and gluteal muscle were used. As the result of this study, 22.5 % had excellent effect and 55.0 % had good effect by our therapy. It was concluded that our therapy is one of considerably effective therapy for the spondylosis deformans of the lumbar spine.