The effects of adding a six-month Pilates exercise program to three months of traditional community-based pulmonary rehabilitation in individuals with COPD: a prospective cohort study.

Introduction: Pilates exercise may complement traditional pulmonary rehabilitation in individuals with chronic obstructive pulmonary disease (COPD). The objective was to analyze the effects of adding a six-month Pilates exercise program to a three-month pulmonary rehabilitation for individuals with COPD. Methods: Thirty-five participants with COPD (GOLD B) were assigned to the intervention (n=14) or control (n=21) group. Both groups received an initial three months of a pulmonary rehabilitation program. The intervention group further underwent six months of pilates. Participants were evaluated at baseline and at three, six, and nine months. Lung function and strength of respiratory muscles were defined as primary outcomes. Secondary outcomes included cardiac, physical function, and exacerbation episodes. Results: There were no consistent statistically significant differences between groups for the lung function outcomes (p\<0.05). Maximal inspiratory and expiratory pressure increased significantly at three months in both groups (p\<0.05). It was significantly superior in the intervention group at nine months for maximal inspiratory pressure (p=0.005) and six and nine months for maximal expiratory pressure (p=0.027 and p\<0.001, respectively). Changes in muscle strength (knee extension and handgrip) were comparable between groups (p>0.05), but exercise-induced fatigue and balance were significantly superior in the intervention group at the six- and nine-month follow-ups (p\<0.05). Discussion: Pilates exercise programs may be implemented to augment traditional pulmonary rehabilitation with the goal of improving the strength of respiratory muscles. Conclusion: Adding a Pilates exercise program to pulmonary rehabilitation resulted in superior strength of respiratory muscles, higher resistance to exercise-induced fatigue, and improved balance.

Individualized Anesthetic Management of a Patient With Pheochromocytoma and Concurrent Breast Cancer: A Case Report.

Pheochromocytomas are rare tumors that present a challenge for surgical and anesthetic management due to their ability to produce significant amounts of catecholamines. This case report highlights the successful management of a 49-year-old woman simultaneously diagnosed with neurofibromatosis type 1, pheochromocytoma, and breast cancer. A key decision by the multidisciplinary team involving endocrinology, general surgery, senology, intensive care, and anesthesiology was to prioritize breast cancer surgery over pheochromocytoma resection. This decision considered the potential for improved prognosis and the need to minimize chemotherapy dosage. The case emphasizes the importance of thorough perioperative preparation, including assessing end-organ damage and optimizing medical therapy. Intraoperative management effectively navigated periods prone to catecholamine release, and postoperative care was closely monitored. This case demonstrates that with meticulous planning, a multidisciplinary approach, and a precise anesthetic strategy, safe anesthesia is achievable for patients with pheochromocytoma undergoing major elective surgeries other than pheochromocytoma resection, adding valuable knowledge to a scarcely documented clinical area.

Fluid Leak From the Spinal-Epidural Puncture Site: Is That Cerebrospinal Fluid?

We present the case of a 30-year-old parturient who underwent a combined spinal-epidural for an elective cesarean section and subsequently experienced fluid leakage at the puncture site. The fluid analysis indicated a glucose level of 57 mg/dL, which initially raised suspicion of a cerebrospinal fluid fistula. However, an MRI revealed no significant abnormalities, and the patient remained asymptomatic. We aim to highlight that various fluids can emerge from a neuraxial puncture site, including cerebrospinal fluid, interstitial fluid due to edema, or residual local anesthetic. While glucose measurement has been used for diagnosing cerebrospinal fluid leakage, its reliability is questionable. More dependable diagnostic tests can be used such as the measurement of beta-trace protein or beta-2-transferrin or MRI.

Inadvertent Epidural and Intravenous Line Swap: A Case Report.

Administration of medication via the wrong administration route has the potential for serious morbidity and mortality. Regrettably, because of the ethical implications in such situations, most of our knowledge comes from case reports. This paper reports on the accidental misconnection of intravenous acetaminophen to an epidural line and of the patient-controlled epidural analgesia (PCEA) pump to intravenous access, as a result of patient error. A male patient aged 60-65 years, 80 kg, American Society of Anesthesiologists (ASA) physical status III presented for unilateral total knee arthroplasty under a combined spinal-epidural anaesthesia technique. For postoperative analgesia, a multimodal analgesia regimen including acetaminophen, in combination with a PCEA pump, was selected. During the night, the patient disconnected and reconnected the drug administration lines, resulting in an epidural/intravenous misconnection. After six unsupervised hours, a total of 114 mg of ropivacaine was administered intravenously and the acetaminophen vial, at this time connected to the epidural catheter, was found empty. A full physical examination by the on-call anaesthesiologist showed no abnormal findings and the nursing staff and patient were instructed on signs to look out for and how to monitor for complications. This case highlights the risks associated with intravenous/epidural line misconnection, as well as the impactful variable the patient represents when admitted to a lower vigilance infirmary. This makes it evident that more safety developments are needed to ensure the utmost quality of care is provided to all patients.

Kinesiology tape increases muscle tone, stiffness, and elasticity: Effects of the direction of tape application.

The claim that the effects of kinesiology tape are different depending on the direction of tape application needs to be clearly ascertained. This study aimed to determine the immediate effects of two forearm kinesiology tape applications on muscle tone, stiffness, and elasticity of young individuals. Thirty-nine participants (15 men and 24 women) were randomized (1:1:1) to: the facilitatory group, receiving kinesiology tape applied from origin to insertion; the inhibitory group, receiving kinesiology tape applied from insertion to origin; or, a control group, without any intervention. The mechanical properties - tone, elasticity, and stiffness - of the forearm muscles were measured with a handheld mechanical impulse-based myotonometric device before and 30 min after the kinesiology tape application. Only the application of kinesiology tape from origin to insertion significantly increased muscle tone [16.6 (2.5) to 17.4 (3.5) Hz, p = 0.036], stiffness [318.3 (52) to 355.0 (87) N/m, p = 0.004], and elasticity [0.98 (0.1) to 1.10 (0.1), p = 0.023]. No changes were observed in both inhibitory kinesiology tape and the control group. In conclusion, kinesiology tape application has different effects depending on the direction of the taping application. The facilitatory tapping increased muscle tone, elasticity, and stiffness.

Community-Based Pulmonary Rehabilitation Programs in Individuals With COPD.

BACKGROUND: Community-based pulmonary rehabilitation (PR) programs can be offered to patients with COPD, but the literature on its effects is still not well summarized. Our purpose was to investigate the health-, physical-, and respiratory-related effects of community-based PR in individuals with COPD as compared to control groups. METHODS: The PubMed and Embase databases were searched up to May 17, 2021. We included randomized control trials that compared the effects of community-based PR as compared to control groups in individuals with COPD. The risk of bias was judged using the Cochrane Risk of Bias 2 (RoB2). Meta-analysis was performed using a random-effects model to estimate the standardized mean difference (SMD) with 95% CI of the mean changes from baseline between groups. The Grading of Recommendations Assessment, Development, and Evaluation was used to interpret certainty of results. RESULTS: We included 10 randomized control studies comprising a total of 9,350 participants with weighted mean age of 62.3 ± 2.38 y. The community-based interventions were based on exercise programs (resistance and/or endurance). All studies were judged as high risk and/or some concerns in one or more domains the risk of bias. All meta-analyses displayed very low certainty of evidence. The community-based PR interventions were significantly superior to control interventions in improving the St. George Respiratory Questionnaire Activity subscore (-0.40 [95% CI -0.72 to -0.08]; k = 5, n = 382) and total score (-0.73 [95% CI -1.29 to -0.18]; k = 4, n = 268) and the Chronic Respiratory Disease Questionnaire dyspnea subscore (0.36 [95% CI 0.03-0.69]; k = 6, n = 550). The mean changes from baseline were not different between the groups for all other outcomes. CONCLUSIONS: Community-based PR tended to result in superior health-related quality of life and symptoms than control interventions, but the findings were inconsistent across outcomes and with very low certainty of evidence. Further studies are warranted for stronger conclusions.

Cross-cultural Adaptation and Validation of the European Portuguese Version of the Western Ontario Shoulder Instability Index (WOSI).

INTRODUCTION: The Western Ontario Shoulder Instability Index (WOSI) is a self-administered questionnaire specifically used to determine the impact of shoulder instability on quality of life. The aim of this study was to translate the WOSI into European Portuguese and analyze its validity and reliability in a population with shoulder instability. MATERIAL AND METHODS: The WOSI was translated and culturally adapted from its original version into European Portuguese (WOSIPT). Internal consistency and test-retest analyses were conducted to determine the level of reliability of the scale. WOSI-PT, Quick-DASH, and SF-12 questionnaires were applied to 81 patients with symptomatic shoulder instability to assess validity, and reliability was tested by randomly selecting 50 patients within 72 hours using a test-retest design. RESULTS: The reliability of the WOSI-PT was very high, with Cronbach´s alpha equal to 0.97 and an intraclass correlation coefficient of 0.98. Regarding the construct validity, the correlation between the WOSI-PT and QuickDASH was high and negative (-0.79). The correlations between WOSI-PT and SF-12 were positive, respectively, moderate with physical (0.66) and low with mental (0.34) health. CONCLUSION: WOSI-PT is a reliable and valid instrument for assessing the functional impact of shoulder joint instability on quality of life.

Introdução: O Western Ontario Shoulder Instability Index (WOSI) é um questionário de autopreenchimento utilizado especificamente para determinar o impacto da instabilidade do ombro na qualidade de vida. O objetivo deste estudo foi traduzir o WOSI para português e analisar a sua validade e fiabilidade para a população portuguesa com instabilidade do ombro. Material e Métodos: O WOSI foi traduzido e adaptado culturalmente da sua versão original para Português (WOSI-PT). Foram efetuadas as análises de consistência interna e teste-reteste para determinar o seu nível de fiabilidade. Os questionários WOSI-PT, QuickDASH, and SF-12 foram aplicados a 81 pacientes com sintomas de instabilidade para avaliar a validade, enquanto a fiabilidade foi testada usando 50 desses pacientes selecionados de modo aleatório, num estudo do tipo teste-reteste com 72 horas de intervalo. Resultados: A fiabilidade do WOSI-PT foi excelente com alfa de Cronbach de 0,97 e um ICC (intraclass correlation coeficiente) de 0.98. Relativamente à validade de constructo, a correlação entre o WOSI-PT e a QuickDASH foi alta e negativa (-0,79). A correlação entre o WOSI-PT e o SF-12 foi positiva e moderada para a componente física (0,66) e positiva e baixa para a componente de saúde mental (0,34). Conclusão: O WOSI-PT é um instrumento fiável e valido para avaliar o impacto da instabilidade do ombro na qualidade de vida.

The Acute Effects of Manual and Instrument-Assisted Cervical Spine Manipulation on Pressure Pain Threshold, Pressure Pain Perception, and Muscle-Related Variables in Asymptomatic Subjects: A Randomized Controlled Trial.

OBJECTIVE: The purpose of this study was to compare the immediate effects in asymptomatic participants of manual and instrument-assisted cervical manipulation on pressure pain thresholds, pressure pain perception, and muscle mechanical properties (tone, stiffness, and elasticity) over muscles anatomically related and unrelated to the manipulated level. METHODS: Fifty-nine asymptomatic participants (34 women and 25 men; age [mean ± standard deviation] = 21.1 ± 1.6 years) were randomly assigned to 4 groups in a double-blind, randomized, placebo-controlled trial. Two groups received cervical (C3/C4) manipulation, 1 manual and the other instrument-assisted; the third group received a sham manipulation; and the fourth group served as the control. Bilateral pressure pain threshold, pressure pain perception, muscle tone, stiffness, and elasticity in the upper trapezius and biceps brachii were evaluated before and immediately after the interventions. RESULTS: At baseline, there were no differences among the groups on any variable. After the interventions, a significant increase in pressure pain threshold was observed with both manual and instrument-assisted manipulation at local and distal sites (P < .05), whereas no changes were observed in either the control or the placebo group. The perception of pain pressure did not change significantly in any group. The interventions did not promote any statistically significant differences in muscle tone, elasticity, or stiffness at any site (local or distal). CONCLUSION: Cervical (C3/C4) manual and instrument-assisted manipulations produced an increase in pressure pain threshold bilaterally and over muscles related and unrelated to the vertebral segment, but had no effect on muscle tone, elasticity, or stiffness.

Cold-Water Immersion Has No Effect on Muscle Stiffness After Exercise-Induced Muscle Damage.

OBJECTIVE: To analyze the effect of cryotherapy on muscle stiffness after exercise-induced muscle damage. DESIGN: A leg-to-leg comparison model. SETTING: University research laboratory. PARTICIPANTS: Thirty (30) untrained men (21.1 ± 1.6 years, 177.6 ± 6.4 cm, 75.9 ± 10.0 kg, and 15.9 ± 2.9% fat mass) with no history of lower-limb injury and no experience in resistance training. INTERVENTION: All participants underwent a plyometric exercise program to induce muscle damage; however, randomly, one leg was assigned to a treatment condition and subjected twice to cold-water immersion of the lower limb at 10°C (±1°C) for 10 minutes, while the other leg was assigned to control. MAIN OUTCOMES MEASURES: Longitudinal stiffness and passive transverse stiffness were evaluated on the soleus and gastrocnemius muscles at 4 moments: pre-exercise, immediately after exercise, 24 hours, and 72 hours after the damage protocol. Furthermore, pressure pain threshold (PPT) and maximal voluntary isometric contraction (MVIC) were also assessed in the same periods. RESULTS: No significant differences between control and cryotherapy were observed in regard to MVIC (P = 0.529), passive longitudinal stiffness (P = 0.315), and passive transverse stiffness (P = 0.218). Only a significant decrease was observed in PPT on the soleus muscle in the cryotherapy compared with the control leg immediately after exercise (P = 0.040). CONCLUSIONS: The results show that cryotherapy had no influence on muscle stiffness. However, cryotherapy had a positive effect on PPT immediately after exercise.

Non-Pharmacological and Non-Surgical Interventions for Knee Osteoarthritis: A Systematic Review and Meta-Analysis.

OBJECTIVE: The aim of the present systematic review and meta-analysis is to know, based on the available randomized controlled trials, if the non-surgical and non-pharmacological interventions commonly used for knee osteoarthritis (OA) patients are effective and which are the most effective ones. MATERIAL AND METHODS: RCTs were identified through electronic databases respecting the following terms to guide the search strategy: PICO (Patients - Humans with knee OA; Intervention - Non-surgical and non-pharmacological interventions; Comparison - Pharmacological, surgical, placebo, no intervention, or other non-pharmacological/non-surgical interventions; Outcomes - Pain, physical function and patient global assessment). The methodological quality of the selected publications was evaluated using the PEDro and GRADE scales. Additionally, a meta-analysis was performed using the RevMan. Only studies with similar control group, population characteristics, outcomes, instruments and follow-up, were compared in each analysis. RESULTS: Initially, 52 RCTs emerge however, after methodological analysis, only 39 had sufficient quality to be included. From those, only 5 studies meet the meta-analysis criteria. Exercise (especially resistance training) had the best positive effects on knee OA patients. Pulsed Electromagnetic Fields and Moxibustion showed to be the most promising interventions from the others. Balance Training, Diet, Diathermy, Hydrotherapy, High Level Laser Therapy, Interferential Current, Mudpack, Neuromuscular Electrical Stimulation, Musculoskeletal Manipulations, Shock Wave Therapy, Focal Muscle Vibration, stood out, however more studies are needed to fully recommend their use. Other interventions did not show to be effective or the results obtained were heterogeneous. CONCLUSIONS: Exercise is the best intervention for knee OA patients. Pulsed Electromagnetic Fields and Moxibustion showed to be the most promising interventions from the others options available.

Splenic Artery Pseudoaneurysm.

Splenic artery pseudoaneurysm is an extremely rare entity, although it is the most frequent location of visceral pseudoaneurysms. Trauma or previous pancreatitis (where the proteolytic pancreatic enzymes lead to the formation of pseudoaneurysm, as a result of enzymatic injury to the splenic artery wall) (Amico and Alves in Pancreatology 14: 144-145, 2014) is the most frequent causes. A high degree of suspicion is required for the accurate diagnosis. The authors present a case of splenic artery pseudoaneurysm in a middle-aged man who came to the emergency department with several days of abdominal pain.

Impact of Patellar Tendinopathy on Knee Proprioception: A Cross-Sectional Study.

OBJECTIVE: To determine whether high-level athletes with patellar tendinopathy have diminished knee proprioceptive acuity. DESIGN: Cross-sectional study. SETTING: University research laboratory (institutional). PARTICIPANTS: Twenty-one basketball and volleyball players with patellar tendinopathy (13 men and 8 women; mean age 24.5 ± 3.6; body mass index = 22.5 ± 2.0 kg/m) and an equal number of athletes without symptoms of patellar tendinopathy injury were included in this study. ASSESSMENTS: Participants underwent knee proprioception assessments on a single day. Furthermore, age, sex, height, weight, VISA-P (Victorian Institute of Sport Assessment) questionnaire sports participation, medical history, knee injuries, previous treatment, and medication were obtained. MAIN OUTCOME MEASURES: Knee proprioception was evaluated by assessing sense of resistance, using a weight discrimination protocol, and joint position sense (JPS). RESULTS: No significant differences were observed in JPS at 30 and 60 degrees of knee flexion between groups (P = 0.165 and 0.481, respectively). In regard to the ability to discriminate weight, significant differences between the 2 groups were found with the tendinopathy group showing a higher percentage of error (P = 0.009), namely when the set of incremental weights varied by 10% from the standard weight. CONCLUSIONS: Athletes with patellar tendinopathy have a diminished perception of force signals required for weight discrimination, whereas JPS remains unaffected in these athletes.

The Acute Effect of Cryotherapy on Muscle Strength and Shoulder Proprioception.

CONTEXT: Cryotherapy, a common intervention used by clinicians, poses several benefits in managing acute injuries. However, cooling muscle tissue can interfere with muscular properties and the sensory-motor system. OBJECTIVE: The aim of this study was to analyze the influence of cryotherapy with a crushed-ice pack on shoulder proprioception concerning joint position sense, force sense, the threshold for detecting passive movement, and maximal force production. DESIGN: A randomized, double-blind controlled trial. PARTICIPANTS: 48 healthy women aged 22.6 ± 0.4 y with a mean body mass index of 22.8 ±0.37 kg/m2 and a percentage of body fat of 15.4 ± 1.5%. METHODS: In the experimental group, a crushed-ice pack was applied to the shoulder for 15 min, whereas participants in the control group applied a sandbag at skin temperature, also for 15 min. An isokinetic dynamometer was used to assess maximal voluntary contraction, force sense, joint position sense, and the threshold for detecting passive movement. RESULTS: Paired sample t tests revealed that maximal voluntary isometric contraction decreased significantly after cryotherapy (P ≤ .001), or approximately 10% of the reduction found in both muscular groups assessed. Shoulder position sense (P < .001) and the threshold for detecting passive movement (P = .01 and P = .01 for lateral and medial shoulder rotator muscles, respectively) also suffered significant impairment. Nevertheless, no significant differences emerged in force sense at 20% and 50% of maximal force reproduction (P = .41 and P = .10 for lateral rotator muscles at 20% and 50%, respectively; and P = .20 and P = .09 for medial rotator muscles at 20% and 50%, respectively). CONCLUSION: Applying a crushed-ice pack to the shoulder for 15 min negatively affected muscle strength and impaired shoulder proprioception by decreasing joint position sense and the threshold for detecting passive movement.

The effect of kinesiology tape on knee proprioception in healthy subjects.

BACKGROUND: Kinesiology tape can improve athletic performance; however, due to cutaneous stimulation its application can have an influence on proprioception. OBJECTIVES: To determine the effects of kinesiology tape on knee proprioception applied to quadriceps, namely in the joint position sense (JPS) and in the threshold to detect passive movement (TTDPM), both immediately after and 24 h after its application. METHODS: Thirty young healthy participants were randomly divided into experimental and control group. In the experimental group, a kinesiology tape on the quadriceps muscle was applied. The JPS and the TTDPM of the knee was assessed before, immediately after and 24 h after the kinesiology tape intervention. RESULTS: No significant differences were found in the assessment made before intervention. The Friedman Test showed that kinesiology tape had no influence on JPS in either group over time (p > 0.05). However, the TTDPM decreased significantly immediately after and 24 h after its application (p < 0.05).

Kinesiology taping does not change fibularis longus latency time and postural sway.

BACKGROUND: Kinesiology tape seems to improve muscle force, although little is known regarding its effect on latency time and postural sway. OBJECTIVES: To examine the effects of kinesiology taping on fibularis longus latency time and postural sway in healthy subjects. METHODS: Thirty participants were equally randomized into three groups, two experimental groups receiving kinesiology tape (EG1, from origin to insertion; EG2, from insertion to origin) and a control group. Before and 20-min after the intervention, postural sway was assessed on a force platform and fibularis longus latency time was recorded with surface electromyography during a sudden inversion perturbation. RESULTS: At baseline, no differences were found between groups regarding age, anthropometrics variables, postural sway and fibularis longus latency time. In both experimental groups, the application of tape did not change postural sway and fibularis longus latency time (EG1: 93.7 ± 15.0 to 89.9 ± 15.6 ms; EG2, 81.24 ± 14.21 to 81.57 ± 16.64, p < 0.05). Also, no changes were observed in the control group. CONCLUSION: Kinesiology tape seems not to enhance fibularis longus reaction time and postural sway in young healthy subjects.

Effect of single bout versus repeated bouts of stretching on muscle recovery following eccentric exercise.

OBJECTIVES: To analyze the effects of a single bout and repeated bouts of stretching on indirect markers of exercise-induced muscle damage. DESIGN: A randomized controlled clinical trial at a university human research laboratory was conducted. METHODS: Fifty-six untrained males were randomly divided into four groups. (I) a single stretching group underwent a single bout of stretching on the quadriceps muscle; (II) an eccentric exercised group underwent eccentric quadriceps muscle contractions until exhaustion; (III) an eccentric exercise group followed by a single bout of stretching; (IV) an eccentric exercised group submitted to repeated bouts of stretching performed immediately and 24, 48, and 72 h post-exercise. Muscle stiffness, muscle soreness, maximal concentric peak torque, and plasma creatine kinase activity were assessed before exercise and 1, 24, 48, 72, and 96 h post-exercise. RESULTS: All exercised groups showed significant reduction in maximal concentric peak torque and significant increases in muscle soreness, muscle stiffness, and plasma creatine kinase. There were no differences between these groups in all assessed variables, with the exception of markers of muscle stiffness, which were significantly lower in the eccentric exercise group followed by single or repeated bouts. The single stretching group showed no change in any assessed variables during the measurement period. CONCLUSIONS: Muscle stretching performed after exercise, either as single bout or as repeated bouts, does not influence the levels of the main markers of exercise-induced muscle damage; however, repeated bouts of stretching performed during the days following exercise may have favorable effects on muscle stiffness.

Exercise-related quality of life in subjects with asthma: a systematic review.

OBJECTIVE: The purpose of this review was to analyze, based on a review of the current literature, the effects of physical activity on the quality of life (QoL) of subjects with asthma. METHODS: The authors conducted a search of randomized controlled trials (RCTs) between January 2000 and August 2010 in a group of major databases of health sciences (Academic Search Complete, Directory of Open Access Journals, Elsevier--Science Direct, Highwire Press, PubMed, Scielo Global, Scirus, Scopus, SpringerLink, Taylor & Francis, and Wiley Interscience) with the keywords asthma, QoL, physical activity, exercise, training, and program in all possible combinations. Citations and references of each study selected were also examined. RESULTS: Of the 1075 studies identified, only 11 were included. Five of these studies were performed in children between the ages of 7 and 15 and the remaining studies were performed on adults. Intervention programs were divided into aerobic training programs and breathing exercises programs. All aerobic training programs showed improvements in QoL, demonstrating a positive influence of aerobic training on asthma. CONCLUSIONS: There is a noticeable trend in the benefit of aerobic training programs in the QoL for individuals with asthma. The breathing exercises programs were few and heterogeneous, making it difficult to reach a positive conclusion on whether it could be recommended for the improvement of QoL in this pathology. There is a great need for more RCTs with methodological rigor.

Evidence of the physiotherapeutic interventions used currently after exercise-induced muscle damage: systematic review and meta-analysis.

INTRODUCTION: Exhaustive and/or unaccustomed exercise, mainly involving eccentric muscle actions, induces temporary muscle damage, evidenced by delayed onset muscle soreness (DOMS) and decreased muscle function. Different strategies to recover from its signs and symptoms have been studied and, as a result, a significant number of articles on this issue have been published. OBJECTIVE: To assess whether some modalities currently used in physiotherapy such as massage, cryotherapy, stretching and low-intensity exercise are effective for treating the signs and symptoms of exercise-induced muscle damage. METHODS: Randomized controlled trials (RCTs), written in English or Portuguese, that included physiotherapeutic interventions [i.e., massage, cryotherapy, stretching and low-intensity exercise, on adult human subjects (18-60 years old) of both gender] were searched on electronic databases including MEDLINE, CINHAL, EMBASE, PEDro and SPORTDiscus. MAIN OUTCOME MEASURES: "Muscle soreness" and "muscle strength" were the outcome measures included in the meta-analysis. RESULTS: Thirty-five studies were included; nine analysed the effects of massage, 10 examined the effects of cryotherapy, nine investigated the effects of stretching and seven focused on low-intensity exercise intervention. Massage was the only intervention with positive effects, reducing soreness at 24 h, on average, 0.33 on 10 cm visual analog scale (95 percent CI: -0.59, -0.07) and increasing muscle recovery by 1.87 percent (95 percent CI: 0.30, 3.44). Additionally, there is inconclusive evidence to support the use of cryotherapy, while there is little evidence to prove the efficacy of stretching and low-intensity exercise. CONCLUSION: Massage proved slightly effective in the relief of symptoms and signs of exercise-induced muscle damage. Therefore, its mean effect was too small to be of clinical relevance. There is a lack of evidence to support the use of cryotherapy, stretching and low-intensity exercise.

An Acute Bout of Quadriceps Muscle Stretching has no Influence on Knee Joint Proprioception.

The main objective of this study was to determine if an acute bout of static stretching of the quadriceps muscle affects the sense of joint position, the threshold to detect passive movement, and the sense of force. Thirty young, healthy men (age : 22.1 ± 2.7 years) were randomly divided into two groups. The Stretching Group (n=15) underwent stretching of the dominant quadriceps muscle, which comprised ten passive stretches lasting 30 seconds each, while the Control Group (n=15) remained seated for the same length of time. A repeated-measures analysis of variance was used to establish intragroup differences over time, and an independent sample t-test was used to compare the dependent variables between groups at each moment. None of the measurements revealed any significant change between both groups in each assessment moment or between moments within groups (p>0.05). This study demonstrated that static quadriceps muscle stretching has no effect on the sense of knee joint position, threshold to detect passive movement, and force sense, suggesting that stretching does not have appreciable effect on the spindle firing characteristics and tendon organs activation.