Perturbation-based Balance Training in Adults Aged Above 55 Years with Chronic Low Back Pain: A Comparison of Effects of Water versus Land Medium - A Preliminary Randomized Trial.

BACKGROUND: 'Rapid balance reaction' or 'perturbation' training is an emerging paradigm in elderly back pain rehabilitation due to its connection to postural stability. OBJECTIVE: This study aimed to inform the feasibility and practicality of perturbation-based balance training (PBT) using a stratification approach and to determine the effectiveness of land versus water-based PBT in elderly individuals with chronic low back pain (CLBP). METHODS: Elderly CLBP participants (n=24) received exercise interventions as per treatmentbased classification (TBC) and were randomly allotted into water-based perturbation exercises (WBPE, Mean age=63.0±2.6years, n=12) and land-based perturbation exercise group (LBPE, 62.3±2.6 years, n=12). Pain intensity, disability, scores of fear-avoidance beliefs, fall efficacy, and rate of perceived exertion (RPE) were assessed before and at the end of 6 weeks. RESULTS: WBPE group reported a significant reduction in pain score (median difference(MD)):2, p<0.03), fear avoidance behaviour for work (MD:9, p<0.01) and fear avoidance behaviour for physical activity (MD:10, p< 0.05), improved straight leg raise right (SLR) (MD:37.5°, p<0.05), and improved modified fall efficacy scores (MFES, MD:25, p<0.05) compared to the LBPE group at post-intervention. Within-group analysis in both groups revealed significant improvement in clinical outcomes except for fear-avoidance beliefs related to physical activity in the LBPE group. Subgroup analysis revealed that the high BMI elderly CLBP group of LBPE had significant improvements similar to the WBPE group except for scores of FABQ physical activity scores and SLR. CONCLUSION: Possible key factors for future research are discussed in the realms of perturbation exercise in the elderly with CLBP.

Effectiveness of neural mobilisation combined with postural correction exercises in a patient with lateral knee pain- A case report.

INTRODUCTION: Distinguishing intraarticular lesion from extraarticular lesion need a thorough clinical evaluation in case of atraumatic knee pain. The main objective of this case report was to describe about the clinical course of a patient with unrelenting symptoms with suspected lateral meniscus lesion. CASE DESCRIPTION: A 48-year old man was diagnosed with suspected lesion in the anterior horn of lateral meniscus for 9 months had received pharmacological and physiotherapy interventions. Yet the patient did not respond favourably to former symptomatic treatment. As the history and objective evaluation consistently matched with abnormal neurodynamics, in the similar line, the patient was treated with neural mobilization in a modified slump position, 15 repetitions per session for three consecutive days combined with postural correction exercises. RESULT: The outcomes were measured with numeric pain rating scale (NPRS) and knee society scale (KSS). The patient responded very well to neural mobilization combined with postural correction exercises. The NPRS (4 at rest; 7 on activity) before our intervention reduced to (0 at rest, 1 on activity) at the end of 3 rd consecutive day intervention and the KSS improved to 75 from 55 in pain score & 90 from 80 on function score. At 2-months follow-up, the patient completely recovered from pain and knee dysfunction. CONCLUSION: This case report signifies that abnormal neurodynamics can be a factor for lateral knee pain. Neural mobilization with postural correction exercises may be recommended as an appropriate treatment for patient with lateral-knee-pain due to abnormal neurodynamics.

Intramuscular Electrical Stimulation Combined with Therapeutic Exercises in Patients with Shoulder Adhesive Capsulitis: A Randomised Controlled Trial.

BACKGROUND: Myofascial trigger points (MTrPs) precipitate the shoulder pain severity and disability in patients with shoulder adhesive capsulitis (SAC). This study aims to compare the effectiveness of intramuscular electrical stimulation (IMES) combined with therapeutic exercises versus dry needling (DN) combined with therapeutic exercises in improving the clinical outcomes in patients with SAC. METHODS AND MATERIALS: In this randomized controlled trial, IMES (n = 45) and DN (43) groups had received respectively IMES, and DN twice weekly for three consecutive weeks. Both groups received therapeutic exercises 1520 minutes, five days in a week during the second and third week. Pain, disability, kinesiophobia, number of active and latent MTrPs, shoulder abduction and external rotation range of motion were assessed at baseline, week-1, week-2, week-3 and follow-up at 3 months. A repeated measures ANOVA performed to find out the significant differences in the clinical outcomes between the groups. RESULTS: The results of repeated measures of ANOVA shows that the post intervention timelines assessment scores of VAS, DASH, shoulder abduction and external rotation ROM, number of active and latent MTrPs and kinesiophobia were significantly (p. < 0.05) improved in both groups. However, IMES group had achieved a greater improvement over DN group (p. < 0.05) on the shoulder pain severity and disability, shoulder range of motion, number of active and latent MTrPs and kinesiophobia. Despite the significant statistical differences between the groups, IMES group did not achieve the minimal clinically important differences of 1.5cm and 11-points respectively for the VAS and DASH scores. No serious adverse effects occurred during the three weeks of treatment. CONCLUSION: IMES combined with therapeutic exercises is an effective treatment to reduce the shoulder pain severity and upper limb disability by deactivating the active and latent MTrPs and improving the shoulder abduction and external rotation range of motion in patients with SAC.

The effectiveness of low-level laser therapy combined with facial expression exercises in patients with moderate-to-severe Bell's palsy: A study protocol for a randomised controlled trial.

BACKGROUND: Even though corticosteroid therapy and facial expression exercises were found to be effective, still 30% of participants with bell's palsy achieve incomplete recovery from the facial paralysis. The study objective was to evaluate the effectiveness of low-level laser therapy (LLLT) combined with progressive facial expression exercises in participants with moderate to severe bell's palsy. METHODOLOGY: A total of 120 participants with idiopathic bell's palsy to be equally allocated in three groups. LLLT, electrical stimulation and corticosteroid/antiviral therapy will be performed respectively in the group I, group II and Group III and facial expression exercises as a common intervention. First two groups to be treated with respective interventions weekly 3 days for 6 consecutive weeks and third group will receive prescribed doses of medications and facial expression exercise for 6 weeks. The functional recovery will be assessed at baseline, 3 weeks, 6 weeks, and 12 weeks using the Facial Disability Index and House-Brackmann Scale. The overall within and between group differences in the clinical outcomes to be reported based on the Friedman Repeated Measures ANOVA and Kruskal-Wallis test. Whereas Wilcoxon Signed Rank and Mann-Whitney-U tests will be performed to report the within and between groups timeline differences. DISCUSSION: Based on the dearth of evidence for the effective treatment of moderate to severe bell's palsy, we framed a most appropriate LLLT dosage along with facial expression exercises. Our study's intervention protocol designed with equal duration and number of interventions for all three groups. Even the comparator groups such as electrical muscle stimulation and Corticosteroids therapy will be receiving similar facial expression exercises. We believe that this intervention protocol would benefit by promoting the complete facial function recovery in patients with moderate to severe bell's palsy. DISSEMINATION: We plan to publish this review in a peer-reviewed journal. We may also present this review at local and/or national conferences.

Immediate Effects of Paraspinal Dry Needling in Patients with Acute Facet Joint Lock Induced Wry Neck.

INTRODUCTION: Acute facet joint lock induced wry neck (AFJL-WN) is common among adult population and it is primarily managed by medications and physiotherapy. However, the immediate recovery from pain and movements restriction caused by AFJL-WN is not documented in favour of existing interventions. AIM: To evaluate the immediate effects of paraspinal dry needling (PSDN) on acute neck pain and movement deficit in patients with AFJL-WN. MATERIALS AND METHODS: A total of 21 patients with AFJL-WN were treated with single session of PSDN for 12-15 minutes. The Visual Analog Scale (0-100mm) and Hand Held Goniometer were used to assess the immediate, 24 hours and 1 week follow-up neck pain and cervical spine's range of motion respectively. The mean and standard deviation was used to make inferences. RESULTS: Immediately after PSDN the pain score was reduced and cervical spine range of motion have improved. The 24 hours and 1 week follow-up pain and range of motion scores have shown the sustained improvement without deteriorations. CONCLUSION: PSDN is effective method to achieve pain free neck movements in patients with AFJL-WN.

Effects of Intramuscular Electrical Stimulation Using Inversely Placed Electrodes on Myofascial Pain Syndrome in the Shoulder: A Case Series.

Myofascial pain syndrome (MPS) is one of the common musculoskeletal conditions of the shoulder which may develop sensory-motor and autonomic dysfunctions at the various level of the neuromuscular system. The pain and dysfunction caused by MPS were primarily treated with physical therapy and pharmacological agents in order to achieve painfree movements. However, in recent years intramuscular electrical stimulation (IMES) with conventional electrode placement was used by researchers to maximise therapeutic values. But, in this study an inverse electrode placement was used to deliver electrical impulses intramuscularly to achieve neuro-modulation at the various level of the nervous system. Nine patients with MPS were treated with intramuscular electrode stimulation using inversely placed electrodes for a period of three weeks. All nine subjects recovered from their shoulder pain and disability within the few weeks of intervention. So, this inverse electrode placement may be more appropriate for chronic pain management.