Evaluation of Abdominal Musculature Thickness, Pelvic Tilt, and Trunk Mobility in Women with Primary Dysmenorrhea: A Cross-Sectional Observational Study.

Background: This cross-sectional observational study aimed to investigate differences in abdominal musculature thickness, pelvic tilt, and trunk mobility between women with primary dysmenorrhea (PD) and a control group (CG). Methods: Participants included 44 women (22 with PD and 22 controls) aged over 18, nulliparous, and of reproductive age. Ultrasound imaging was used to measure the thickness of the transverse abdominis (TrA), internal oblique (IO), external oblique (EO), and rectus abdominis (RA) muscles at rest and during contraction. Additionally, anterior pelvic tilt was assessed using the Palpation Meter (PALM), and trunk flexion and extension were measured using an accelerometer (activForce2). Results: Significant differences (p < 0.05) were found in RA and EO muscle thickness, with lower values in the PD group compared to CG. However, there were no significant differences (p > 0.05) in TrA and IO muscle thickness, anterior pelvic tilt, or trunk mobility between groups. Conclusions: These findings contribute to understanding the musculoskeletal factors potentially involved in dysmenorrhea. Further research is needed to explore associations between PD and structural and alignment parameters.

Prevalence, diagnosis and management of musculoskeletal disorders in elite athletes: A mini-review.

Musculoskeletal injuries in elite sports are ones of the most impact issue because their remarkable impact on performance caused by drastic absence of training and competition and a progressive deterioration in physical health, emotional and social athletes' dimensions. Also, the prevalence of epidemiologic research found an incidence of musculoskeletal disorders vary within sports and in elite athletes which is even higher as a consequence of higher demand physical performance. This way, the loss of physical performance due to an sport injury impacts not only the individual economic sphere of the professional but also that ofsports entities, reaching, according to some studies, a loss estimated in the range of 74.7 million pounds. Thus, the purpose of this article is to review and to provide an overview of the most common musculoskeletal injuries in elite sports precipitating factors, clinical presentation, evidence-based diagnostic evaluation, and treatment recommendations with a view to preventing medical conditions or musculoskeletal injuries that may alter performance and general health in the elite athletes.

Effectiveness of a respiratory rehabilitation program including an inspiration training device versus traditional respiratory rehabilitation: a randomized controlled trial.

Background: In the context of COVID-19, respiratory training is vital for the care and recuperation of individuals. Both exercise-based and instrumental respiratory training have been employed as interventions to enhance respiratory function, providing relief from symptoms in those impacted by the virus. The aim of this study was to evaluate the efficacy of two different respiratory rehabilitation programs. Methods: A total of 200 participants affected with COVID-19 respiratory sequels were recruited, with a block randomization regarding sex to ensure equal and appropriate applicability of the results. An experimental controlled and randomized study was conducted, with participants engaging in a 31 days respiratory rehabilitation program, (a) experimental group, inspiratory training device combined with aerobic exercise and (b) traditional respiratory exercises combined with aerobic exercise. Results: Both groups improved in cardiorespiratory parameters, with a decrease in systolic and diastolic pressure, dyspnea and lower limbs fatigue, and increased oxygen saturation, 6 min walking distance, diaphragmatic thickness, forced vital capacity, forced expiratory volume during the first second, peak expiratory flow rate, forced inspiratory vital capacity and maximal inspiratory pressure. Comparison between groups showed statistically significant differences in all variables except for oxygen saturation, 6 min walking distance and diaphragmatic thickness. The results of this study support the use of specific inspiration training devices for respiratory rehabilitation in COVID-19 sequels.

Validity and Test-Retest Reliability of the Spanish Version of the International Hip Outcome Tool (iHOT-12Sv).

Objective: To develop a Spanish version of the international Hip Outcome Tool questionnaire (iHOT-12Sv) for assessing the psychometric characteristics (internal consistency, convergent validity, test−retest reliability, and floor and ceiling effects) of this version in physically active patients with hip pain. Methods: After conducting the translation and transcultural adaptation, a consecutive sample of patients with labral tear injury and/or femoroacetabular impingement (Pincer or Cam type) were recruited in a Spanish Hospital. Patients completed the iHOT-12Sv and the Spanish version of the iHOT-33 and the Hip Outcome Score (HOS). Internal consistency was calculated using Cronbach's alpha; convergent validity was evaluated using Spearman correlation coefficients (Rho) with iHOT-33 and HOS; test−retest reliability was examined using the intraclass correlation coefficient (ICC), standard error of measurement (SEM), and minimal detectable changes (MDC); and floor and ceiling effects were calculated as the percentage of patients who obtained the minimum and maximum score. Results: One hundred and fifty-three patients (64.7% males) participated in this study. Cronbach's alpha of 0.92 revealed the excellent internal consistency. In addition, the iHOT-12Sv demonstrated strong to very strong correlations with the HOS (Rho ranged from 0.741 to 0.827; p < 0.001) and the iHOT-33 (Rho = 0.932; p < 0.001), respectively; acceptable test-retest reliability (ICC = 0.86 to 0.94); SEM = 6.21 and MDC = 17.22; and no floor or ceiling effects were found. Conclusions: The iHOT-12Sv can be used as a valid and reliable tool for clinical evaluation of physically active patients with hip pathology. However, the full version is preferable for research purposes aiming to assess changes in hip function.

Test-Retest Reliability of Ultrasonographic Measurements from the Rectus Femoris Muscle 1-5 Years after Anterior Cruciate Ligament Reconstruction in the Ipsilateral and Contralateral Legs: An Observational, Case-Control Study.

About 40% of traumatic injuries in sports are related to the knee. Of these, 33% require arthroscopic surgery. The rehabilitative ultrasound imaging technique is a simple method to obtain objective real-time results on the state and measurement of the musculoskeletal tissue and its use can represent an important change in the process of functional diagnosis and recovery of these injuries. The aim was to quantify the differences in the thickness, muscle contraction time, and muscle relaxation time of the rectus femoris muscle between individuals with knee arthroscopy and healthy individuals and to verify the reliability of the inter-examiner measurements in these ultrasound variables. An observational case-control study with individuals (18−60 years aged) who underwent surgery for anterior cruciate ligament through knee arthroscopy a year or more before. A total of 38 subjects were divided into 2 groups, case and control. Ultrasound measurements were taken of the following outcomes: thickness at rest and contraction, muscle contraction time, and muscle relaxation time of the rectus femoris muscle. Excellent inter-examiner reliability was obtained for all ultrasound measurements (ICC3.3 > 0.90). No significant changes were found in the rate of contraction or rest of the rectus femoris muscle. On the other hand, if significant changes in the thickness of the rectus femoris muscle were found between control and case group. Arthroscopic surgery for anterior cruciate ligament reconstruction does not appear to modify function but does modify the thickness of the rectus femoris muscle on ultrasound examination. Ultrasound appears to be a reliable tool for the study of these measurements in the rectus femoris muscle.

Current understanding of the diagnosis and management of the tendinopathy: An update from the lab to the clinical practice.

Tendinopathy is labeled by many authors as a troublesome, common pathology, present in up to 30% medical care consultations involving musculoskeletal conditions. Despite the lasting interest for addressing tendon pathology, current researchers agree that even the exact definition of the term tendinopathy is unclear. Tendinopathy is currently diagnosed as a clinical hypothesis based on the patient symptoms and physical context. One of the main goals of current clinical management is to personalize treatment approaches to adapt them to the many different needs of the population. Tendons are complex structures that unite muscles and bones with two main objectives: to transmit forces and storage and release energy. Regarding the tensile properties of the tendons, several authors argued that tendons have higher tensile strength compared with muscles, however, are considered less flexible. Tendinopathy is an accepted term which is used to indicated a variety of tissue conditions that appear in injured tendons and describes a non-rupture damage in the tendon or paratendon, which is intensified with mechanical loading Even when the pathoetiology of tendinopathy is unclear, there is a wide array of treatments available to treat and manage tendinopathy. Although tendinitis usually debuts with an inflammatory response, the majority of chronic tendinopathies do not present inflammation and so the choosing of treatment should vary depending on severity, compliance, pain and duration of symptoms. The purpose of this article is to review and provide an overview about the currently research of the tendon diagnosis, management and etiology.

Quantitative Ultrasound Changes in Echotexture and Functional Parameters after a Multicomponent Training Program in Pre-Frailty Individuals: A Pilot Randomized Clinical Trial.

Objective: Currently, ultrasound imaging (USI) is considered a feasible tool in the evaluation of structural and textural muscle differences due to aging. The main aim of this study was to evaluate sonographic changes in muscular structure and function after a 12-week multicomponent training program in pre-frailty individuals. Design: A prospective, randomized, clinical trial was carried out. Participants: Thirty-two pre-frailty subjects were recruited and randomly divided into a multicomponent training program group (n = 16; Multicomponent group) and a conventional care group (n = 14; Control group) with a 12-week follow up. Main outcome measures: Rectus femoris thickness, cross-sectional area (CSA), echointensity, echovariation and vastus lateralis pennation angle tests were carried out to assess the structure and echotexture, and the force-velocity (F-V) profile for muscle power and muscle strength was employed to assess the functional parameters. Results: Statistically significant differences (p < 0.05) were shown for the left rectus femoris echointensity and in the functional parameter of muscle power after a 12-week program for the multicomponent training group compared to the conventional care group. Conclusions: Pre-frailty elderly subjects showed a decrease in rectus femoris echointensity (RF-EI) and an increase in the functional parameter of muscle power after a 12-week multicomponent training program compared to the control group.

Current advances and novel research on minimal invasive techniques for musculoskeletal disorders.

The present review summarized the current advances and novel research on minimal invasive techniques for musculoskeletal disorders. Different invasive approaches were proposed in the physical therapy field for the management of musculoskeletal disorders, such as ultrasound-guided percutaneous needle electrolysis, dry needling, acupuncture and other invasive therapy techniques, discussing about their worldwide status, safety and interventional ultrasound imaging. Indeed, dry needling may be one of the most useful and studies invasive physical therapy applications in musculoskeletal disorders of different body regions, such as back, upper limb, shoulder, arm, hand, pelvis, lower limb, neck, head, or temporomandibular joint, and multiple soreness location disorders, such as fibromyalgia. In addition, the assessment and treatment by acupuncture or electro-acupuncture was considered and detailed for different conditions such as plantar fasciitis, osteoarthritis, spasticity, myofascial pain syndrome, osteoporosis and rheumatoid arthritis. As an increasing technique in physical therapy, the use of ultrasound-guided percutaneous needle electrolysis was discussed in injuries of the musculoskeletal system and entrapment neuropathies. Also, ultrasound-guided percutaneous neuromodulation was established as a rising technique combined with ultrasound evaluation of the peripheral nerve system with different clinical applications which need further studies to detail their effectiveness in different musculoskeletal conditions. Thus, invasive physical therapy may be considered as a promising approach with different novel applications in several musculoskeletal disorders and a rising use in the physiotherapy field.

Current advances and research in ultrasound imaging to the assessment and management of musculoskeletal disorders.

Currently evidence-based practice has given scientific weight to the physical therapist profession; it is essential that all medical professional and physical therapists know the usefulness of new tools that optimize the effectiveness of their interventions and allow the growing of the scientific knowledge base. The use of ultrasound imaging (USI) by physiotherapists has evolved in recent years, consolidating as an increasingly standardized technique, low cost compared to other imaging techniques, quickly of execution, feasible and reliable tool. USI offers a wide range of opportunities in clinical practice as well as in different research areas. Therefore, ultrasound has been currently used as a diagnostic tool by physicians and in recent years there has been an expansion of the use of ultrasound equipment by non-physicians professionals such as physical therapist or physical trainers, who incorporates USI as a means of assessing musculoskeletal system architecture and composition, musculoskeletal changes in dysfunction, pain or injury conditions, as an interventional technique assisting echo-guided procedures or using the visual real-time information as a biofeedback in control motor approaches, as guiding tool in clinical decisions as well as to improve the understanding of tissue adaptations to exercise or movement. The purpose of this article is to review and provide an overview about the currently research of the USI applications and their benefits for the diagnosis and management in individuals with musculoskeletal conditions.

Quantitative Ultrasound Imaging Differences in Multifidus and Thoracolumbar Fasciae between Athletes with and without Chronic Lumbopelvic Pain: A Case-Control Study.

New trends in ultrasound imaging are focused on exploration of morphology and muscle quality. The main goal of the study was to evaluate the first-order descriptor and echostructure of lumbar multifidus at the L4 vertebral level in athletes with and without chronic lumbopelvic pain (CLPP). A case-control study was performed in 15 semiprofessional athletes with CLPP and 15 without (healthy athletes). Lumbar multifidus echointensity and echovariation were measured for muscle quality assessment. Echostructure was used to evaluate lumbar multifidus cross-sectional area (CSA) at resting and during muscle contraction, respective differences during both phases (CSADif.), activation patterns, and thoracolumbar fasciae morphology and thickness. Significant differences with a large effect size were observed in quantitative data from CLPP and healthy athletes for left lumbar multifidus CSADif. and thoracolumbar fasciae morphology. Categorical data showed statistically significant differences with a small-to-moderate effect size for lumbar multifidus activation pattern and thoracolumbar fasciae morphology. Athletes with CLPP showed a reduced CSA difference between lumbar multifidus contraction and at resting and higher disorganization of thoracolumbar fasciae morphology compared to healthy athletes. These findings suggest the importance of dynamic exploration of the lumbar region and connective tissue in sports performance and injury prevention.

Ultrasound imaging evaluation of structural and textural features in asymptomatic achilles tendons in pre-professional dancers: A cross-sectional study.

OBJECTIVE: To evaluate performance descriptors, sociodemographics variables and tendon echogenicity of asymptomatic Achilles tendons and to compare the echotexture from different classification subgroups. DESIGN: A prospective, randomized cross-sectional study was carried out. SETTING: laboratory of university. PARTICIPANTS: Forty-two Achilles tendons (AT) were recruited from pre-professional dancers. Based on the echogenicity pattern, the sample was divided into two groups (n = 21, Heterogeneous group; n = 21, Homogeneous group). MAIN OUTOCOME MEASURES: Ultrasound images and ImageJ measurements were performed to evaluate thickness (AT-TH), echointensity (EI) and echovariation (EV), in addition to a balance and endurance test were measured as performance parameter. RESULTS: EI (p = 0.001) and EV (p = 0.001) reported statistically significant differences between groups. AT-TH, endurance test, balance test, years of dance, training hours per week and average pointe hours per week did not showed differences between groups. A multivariate prediction model between groups and the echotexture variables (EI (R2 = 0.569; EV (R2 = 0.341)) were determined. CONCLUSION: Asymptomatic AT of heterogeneous group showed a lower EI and a higher EV compared to homogeneous group. Tendon echogenicity did not interact with performance variables.

Intrinsic foot muscles morphological modifications in patients with Achilles tendinopathy: A novel case-control research study.

OBJECTIVE: To compare the thickness and cross-sectional area (CSA) of the Abductor Hallucis Brevis (AHB), Flexor Digitorum Brevis (FDB) and Flexor Hallucis Brevis (FHB) in subjects with and without chronic mid-portion Achilles tendinopathy (AT). DESIGN: A case-control research study. SETTING: A private clinic. PARTICIPANTS: A total sample of 143 subjects was recruited for the study and divided in two groups, such as chronic mid-portion AT group (n = 71) and healthy group (n = 72). MAIN OUTCOME MEASURES: Ultrasound B-Mode imaging was used to measure the thickness and CSA of the AHB, FDB and FHB in subjects with and without chronic mid-portion AT at rest. RESULTS: USI measurements of the AHB (p < .001) and FDB (p < .001) thicknesses, as well as FDB (p = .005) and FHB CSA (p = .048), were increased for the tendinopathy group with respect to healthy group. However, FHB muscle thickness (p < .001) increases were showed for the control group with respect the tendinopathy group. CONCLUSIONS: USI measurements of ABH and FDB thicknesses, as well as FDB and FHB CSA, were increased in patients who suffered from AT with respect to healthy group.

Ultrasonography comparison of diaphragm thickness and excursion between athletes with and without lumbopelvic pain.

OBJECTIVE: The aim of this study was to compare diaphragm thickness and excursion between athletes with and without lumbopelvic pain (LPP) by trans-costal and trans-hepatic rehabilitative ultrasound imaging (RUSI), respectively. DESIGN: A case-control study. SETTING: Amateur and semiprofessional athletes teams. PARTICIPANTS: Forty matched-paired athletes with LPP (n = 20; LPP case group) and without LPP (n = 20; Healthy control group) were recruited. MAIN OUTCOME MEASURES: Diaphragm thickness and excursion (cm) were assessed during relaxed respiratory activity (maximum inspiration-Tins, expiration-Texp and difference-Tins-exp) by trans-costal and trans-hepatic rehabilitative ultrasound imaging (RUSI), respectively. RESULTS: Statistically significant differences (P < .05) with an effect size from moderate to large (d = 0.63-1.07) were shown for bilateral diaphragm thickness reductions at Tins and thickness difference at Tins-Texp of the right hemi-diaphragm for athletes with LPP compared to healthy athletes. CONCLUSIONS: Athletes who suffered from LPP presented a reduced diaphragm thickness compared to healthy matched-paired athletes. Therefore, these novel findings may suggest that diaphragm reeducation could be a main focus of intervention related to athletic performance, prevention and rehabilitation. Nevertheless, these findings should be considered with caution due to the possible influence of the RUSI measurement errors of the diaphragm activation during normal breathing.

Quantitative Ultrasound Imaging Pixel Analysis of the Intrinsic Plantar Muscle Tissue between Hemiparesis and Contralateral Feet in Post-Stroke Patients.

Quantitative ultrasound imaging of the muscle tissue may be applied in the neurology field, due to B-mode grayscale pixels values could be used as potential biomarkers for disease progression and intervention effects in poststroke patients. Thus, the study aim was to compare and analyze the ultrasound imaging B-mode pixels differences between the intrinsic plantar muscles cross-sectional area (CSA) in hemiparetic and contralateral feet from poststroke patients by means of the Image J software. A case-control design and a convenience sampling method were used in order to recruit 22 feet from 11 poststroke patients. This total sample was divided into 11 hemiparetic feet and 11 contralateral feet. The Image J software was used in order to evaluate the interface distance, CSA as well as measure the pixels mean, standard deviation (SD) and count from all offline images in the flexor digitorum brevis, abductor hallucis (AbH), and flexor hallucis brevis muscles. Statistically significant differences (p = 0.003) were only shown for the pixels count in the AbH muscle. The rest of outcome measurements did not show any statistically significant difference (p > 0.05). Therefore, B-mode ultrasound imaging Image J software differences for the pixels count reduction were shown in the AbH muscle between hemiparetic and contralateral feet from poststroke patients. Further studies are necessary in order to apply our findings as potential biomarkers during the stroke disease course.

Rehabilitative ultrasound imaging of the bilateral intrinsic plantar muscles and fascia in post-stroke survivors with hemiparesis: A case-control study.

Purpose: The study main aim was to compare the cross-sectional area (CSA) and thickness of the plantar muscles and fascia in the hemiparesis and contralateral feet of poststroke survivors with respect to healthy feet of matched controls. Methods: A case-control observational study was performed using B-mode rehabilitative ultrasound imaging. A convenience sampling method was used to select 60 feet. The sample was divided into 20 feet ipsilateral and 20 feet contralateral to the hemiparesis lower limb from poststroke survivors, as well as 20 healthy feet from matched controls. The CSA and thickness of the abductor hallucis, flexor digitorum brevis and flexor hallucis brevis, as well as the thickness for the posterior, middle and anterior plantar fascia portions were measured. Comparisons and multivariate predictive analyses were carried out for ultrasound measurements. In all analyses, a P-value<.01 with a 99% confidence interval was considered as statistically significant. Results: Statistically significant differences (P<.01) were shown for a flexor hallucis brevis thickness increase as well as middle and anterior plantar fascia thickness decrease of the hemiparesis feet and contralateral feet with respect to the healthy matched control feet. The rest of measurements did not show any statistically significant difference (P>.01). Conclusions: The thickness of the flexor hallucis brevis muscle as well as the middle and anterior plantar fascia portions of the hemiparesis and contralateral feet from poststroke survivors presented morphology changes with respect to the healthy matched control feet.