Investigating the Combined Effects of Fascial Distortion Model Manual Therapy and Balance-Strength Training in Individuals with Chronic Ankle Instability.

BACKGROUND: The Fascial Distortion Model (FDM) is a relatively new manual therapy approach in the field of musculoskeletal physical therapy, and its potential effectiveness in treating chronic ankle instability (CAI) remains unexplored. METHODS: A randomized controlled trial with 23 participants was conducted. Patients were randomly assigned to either the FDM + balance-strength training (BST) group (n = 8), receiving extra FDM sessions weekly in addition to two sessions of BST, or the BST group (n = 7). Healthy controls (n = 8) did not receive any treatment and participated only in pre- and post-test measurements. Objective measurements including Y-Balance Test Lower Quarter (YBT-LQ), Flamingo Balance Test (FBT), Weight-Bearing Lunge Test (WBLT), ankle joint range of motion (ROM), and Cumberland Ankle Instability Tool (CAIT) were recorded at baseline and the end of the intervention. The results demonstrated significant differences between the FDM + BST and BST groups for supination ROM (p = 0.008) and similarly for WBLT (p = 0.041), FBT (p = 0.40), YBT-LQ (p = 0.023), and CAIT score (p = 0.008). Moreover, while both groups demonstrated significant improvement at the post-test compared with their pre-test for plantarflexion and pronation ROM, WBLT, and CAIT score, the FDM + BST group demonstrated significant improvements in supination ROM, FBT, and YBT-LQ. CONCLUSION: Our study suggests that the addition of FDM concepts to a BST may lead to enhanced improvements in ankle ROM, static and dynamic balance, and self-reported outcomes in individuals with CAI compared to BST.

Effects of Leg-Press Training With Moderate Vibration on Muscle Strength, Pain, and Function After Total Knee Arthroplasty: A Randomized Controlled Trial.

OBJECTIVES: To examine the effects of a time-saving leg-press training program with moderate vibration on strength parameters, pain, and functional outcomes of patients after total knee arthroplasty (TKA) in comparison with functional physiotherapy. DESIGN: Randomized controlled trial. SETTING: Outpatient rehabilitation department at a university teaching hospital. PARTICIPANTS: Patients (N=55) with TKA were randomly allocated into 2 rehabilitation groups. INTERVENTIONS: Six weeks after TKA, participants either underwent isokinetic leg-press training combined with moderate vibration (n=26) of 15 minutes per session or functional physiotherapy (n=29) of 30 minutes per session. Both groups received therapy twice a week for a period of 6 weeks. Participants were evaluated at baseline (6wk after TKA) and after the 6-week rehabilitation program. MAIN OUTCOME MEASURES: The main outcome measure was maximal voluntary contraction (MVC) of the involved leg. Secondary outcome measures were pain assessed with a visual analog scale (VAS), range of motion, stair test, timed Up and Go test, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). RESULTS: Both groups showed statistically significant improvements in MVC of knee extensors measured on the knee dynamometer (leg-press group: from 0.8±.06 to 1±.09Nm/kg body weight [BW], physiotherapy group: from 0.7±.06 to 0.9±.06Nm/kg BW; P<.05) and in closed kinetic chain on the leg press (leg-press group: from 8.9±.77 to 10.3±1.06N/kg BW, physiotherapy group: from 6.7±.54 to 9.1±.70N/kg BW; P<.05) and in pain at rest (leg-press group: from 2±.36 to 1.3±.36 on the VAS, physiotherapy group: from 1.2±.28 to 1.1±.31; P<.05), WOMAC scores, and functional measurements after 6 weeks of training. There was no significant difference between the 2 groups concerning strength, pain, and functional outcomes after training (P>.05). CONCLUSIONS: Isokinetic leg-press training with moderate vibration and functional physiotherapy are both effective in regaining muscle strength and function after TKA; however, isokinetic leg-press training is considerably less time consuming.

Atrophy/hypertrophy cell signaling in muscles of young athletes trained with vibrational-proprioceptive stimulation.

OBJECTIVE: To compare the effects of isokinetic (ISO-K) and vibrational-proprioceptive (VIB) trainings on muscle mass and strength. METHODS: In 29 ISO-K- or VIB-trained young athletes we evaluated: force, muscle fiber morphometry, and gene expression of muscle atrophy/hypertrophy cell signaling. RESULTS: VIB training increased the maximal isometric unilateral leg extension force by 48·1%. ISO-K training improved the force by 24·8%. Both improvements were statistically significant (Pâ©¿0·01). The more functional effectiveness of the VIB training in comparison with the ISO-K training was shown by the statistical significance changes only in VIB group in: rate of force development in time segment 0-50 ms (P<0·001), squat jump (P<0·05) and 30-m acceleration running test (P<0·05). VIB training induced a highly significant increase of mean diameter of fast fiber (+9%, P<0·001), but not of slow muscle fibers (-3%, not significant). No neural cell adhesion molecule-positive (N-CAM(+)) and embryonic myosin heavy chain-positive (MHC-emb(+)) myofibers were detected. VIB induced a significant twofold increase (P<0·05) of the skeletal muscle isoform insulin-like growth factor-1 (IGF-1) Ec mRNA. Atrogin-1 and muscle ring finger-1 (MuRF-1) did not change, but myostatin was strongly downregulated after VIB training (P<0·001). Peroxisome proliferator-activated receptor γ coactivator-1α (PGC-1α) expression increased in post-training groups, but only in VIB reached statistical significance (+228%, P<0·05). DISCUSSION: We demonstrated that both trainings are effective and do not induce muscle damage. Only VIB-trained group showed statistical significance increase of hypertrophy cell signaling pathways (IGF-1Ec and PGC-1α upregulation, and myostatin downregulation) leading to hypertrophy of fast twitch muscle fibers.

Training program and additional electric muscle stimulation for patellofemoral pain syndrome: a pilot study.

OBJECTIVES: To evaluate the beneficial effect of training in patients with patellofemoral pain syndrome (PFPS) and influence of additional electric muscle stimulation (EMS) of the knee extensor muscles. DESIGN: A randomized clinical trial. SETTING: Supervised physiotherapy (PT) training and home-based EMS. PARTICIPANTS: Patients (N=38; 14 men, 24 women) with bilateral PFPS. INTERVENTIONS: One group (PT) received supervised PT training for 12 weeks. The other received PT and EMS. The stimulation protocol was applied to the knee extensors for 20 minutes, 2 times daily, 5 times a week for 12 weeks at 40 Hz, with a pulse duration of .2 6ms, at 5 seconds on and 10 seconds off. Maximal tolerable stimulation intensity was up to 80 mA. MAIN OUTCOME MEASURES: Patellofemoral pain assessment with visual analog scale during activities of daily life, Kujala patellofemoral score, and isometric strength measurement before and after 12 weeks treatment as well as after 1 year. RESULTS: Thirty-six patients completed the 12-week follow-up. There was a statistically significant reduction of pain in both groups (PT group, P=.003; PT and EMS group, P<.001) and significant improvement of the Kujala score in both groups (PT group, P<.001; PT and EMS group, P<.001) after 12 weeks of treatment with improvement of function and reduction of pain at the 1-year follow-up. The difference between the 2 treatment groups was statistically not significant. We could not measure any significant change in isometric knee extensor strength in either group. CONCLUSIONS: A supervised PT program can reduce pain and improve function in patients with PFPS. We did not detect a significant additional effect of EMS with the protocol described previously.