Efficacy of specific exercises in general population with non-specific low back pain: A systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: Localized exercises are employed to activate, train, or restore the function of particular muscles and they are usually considered as part of treating individuals suffering low back pain. So, this systematic review and meta-analysis aimed to assess the efficacy of specific exercises in general population with non-specific low back pain (LBP). METHODS: We conducted electronic searches in MEDLINE/PubMed, Scopus, Web of Science (WoS), and Google scholar from January 1990 to June 2021. Initially, 47,740 records were identified. Following the removal of duplicates, 32,138 records were left. After reviewing titles and abstracts, 262 papers were chosen for thorough assessment. Among these, 208 studies were excluded, resulting in 54 trials meeting the inclusion criteria for this study. Additionally, 46 of these trials were randomized controlled trials and were further evaluated for the meta-analysis. We included trials investigating the effectiveness of exercise therapy, including isometric activation of deep trunk muscles, strengthening exercises, stabilization exercises, stretching exercises, and proprioceptive neuromuscular facilitation exercises (PNF) in LBP patients. The primary outcome was pain intensity, measured using tools such as the visual analogue scale (VAS) and numeric pain rating scale (NPRS). The secondary outcome was disability, assessed through instruments such as the Roland Morris Disability Questionnaire (RMDQ) and Oswestry Disability Index (ODI). The quality of the eligible studies was assessed using the Verhagen tool, and the level of evidence was evaluated using the GRADE approach. RESULTS: Based on the Verhagen tool, 46 trials (85.2%) were categorized as having low methodological quality, while 8 studies (14.8%) were considered to have medium methodological quality. The meta-analysis indicated a small efficacy in favor of isometric activation of deep trunk muscles (-0.37, 95% CI: -0.88 to 0.13), a moderate efficacy in favor of stabilization exercises (-0.53, 95% CI: -1.13 to 0.08), and a large efficacy in favor of PNF exercises (-0.91, 95% CI: -1.62 to -0.2) for reducing pain intensity as assessed by VAS or NPRS tools. Moreover, the meta-analysis revealed a moderate efficacy for isometric activation of deep trunk muscles (-0.61, CI: -1.02 to -0.19), and a large efficacy for PNF exercises (-1.26, 95% CI: -1.81 to -0.72) in improving disability, assessed using RMDQ or ODI questionnaires. The level of certainty in the evidence, as determined by the GRADE approach, was very low to low. CONCLUSION: These findings emphasize the importance of incorporating localized therapeutic exercises as a fundamental aspect of managing non-specific LBP. Clinicians should consider utilizing localized therapeutic exercise tailored to individual patient needs. Furthermore, further research investigating optimal exercise therapy, optimal dose of the exercises, durations, and long-term adherence is warranted to enhance the precision and efficacy of exercise-based interventions for non-specific LBP.

The immediate effects of deep transverse friction massage, high- power pain threshold ultrasound and whole body vibration on active myofascial trigger points.

BACKGROUND: The most important clinical problem in myofascial pain syndrome (MPS) is trigger points (TrPs). The aim of the present study was to investigate the comparison of immediate effect of deep transverse friction massage (DTFM), high-power pain threshold ultrasound (HPPTUS), and whole body vibration (WBV) on treatment of active myofascial trigger points (MTrPs). MATERIALS AND METHODS: sixty six men with active TrPs of upper trapezius muscle were randomly divided into three equal groups: DTFM, HPPT US, and WBV. Pain intensity based on the Visual Analogue Scale (VAS), pressure pain threshold (PPT) and active contralateral lateral flexion range of motion (CLF ROM) of the neck were evaluated before and immediately after the interventions. RESULTS: The VAS, PPT and the active CLF ROM were substantially improved after intervention in all groups (P < 0.01). When the three groups were compared regarding VAS, participants in the WBV group reported significantly more reduction in pain (P < 0.01). On comparing the interventions, there were no significant differences in PPT values (P > 0.05). The CLF ROM value in HPPTUS and WBV groups have significant increase in comparison to the DTFM group. CONCLUSION: All three interventions can improve neck pain, PPT and ROM in participants with active TrPs in upper trapezius muscle, but due to the fact that the DTFM has more pressure on therapist fingers, and the HPPTUS technique requires proper interaction with the participants, WBV can be used as one of the effective intervention on active MTrPs of upper trapezius. CLINICAL TRIAL REGISTRATION NUMBER: IRCT20200518047498N1.

Effects of dry needling and stretching exercise versus stretching exercise only on pain intensity, function, and sonographic characteristics of plantar fascia in the subjects with plantar fasciitis: a parallel single-blinded randomized controlled trial.

OBJECTIVES: Plantar fasciitis is a common problem in the foot region which has negative considerable impact on foot function. METHODS: In this parallel blinded randomized controlled trial, a total of thirty-seven subjects with plantar fasciitis (forty feet) were enrolled randomly to either the control group (stretching exercise) or the experimental group (stretching exercise plus dry needling). All interventions lasted six weeks and both groups were followed for two weeks. Primary outcomes were first step pain, pain, and activity daily function subscales of the FAOS questionnaire and secondary outcomes were plantar fascia thickness, and echogenicity. RESULTS: The mixed model ANOVAs showed significant group × time interactions for all primary outcomes. In both groups, first step pain and both subscales of the FAOS questionnaire were improved compared to baseline measurements. There were considerable differences between the two groups and the experimental group experienced more improvements in primary outcomes compared to the control group. For secondary outcomes, plantar fascia thickness at insertion significantly decreased, and the echogenicity in the two regions significantly increased in the experimental group compared to the control group. CONCLUSION: These results suggest that the combination of dry needling and stretching exercises can be an effective conservative treatment for plantar fasciitis subjects.

Effects of Innovative Aquatic Proprioceptive Training on Knee Proprioception in Athletes with Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Trial.

BACKGROUND: Proprioceptive training in the aquatic environment is more beneficial owing to water properties. The primary goal of the present study was to investigate the effectiveness of the incorporation of innovative aquatic proprioceptive training into conventional accelerated land-based rehabilitation protocol in knee function and joint position sense in male athletes after anterior cruciate ligament reconstruction (ACLR). METHODS: A total of 38 athlete male athletes with ACLR were randomly assigned to two rehabilitation groups. The conventional therapy group (CT) (n=19) received conventional rehabilitation for 6 weeks, while the hydrotherapy group (HT) (n=19) received the same conventional rehabilitation, in addition to 12 sessions of innovative aquatic proprioceptive training. The outcomes included the joint position sense (JPS) errors, visual analog scale (VAS), and international knee documentation committee (IKDC). Repeated measures analysis of variance (ANOVA) was used to compare the means between the two groups. Cohen's d from an independent t-test was used to calculate the effect sizes for all variables after the intervention for both groups. RESULTS: Base on the results, there were a significant difference in absolute errors (AE) (FAE=56.231, P<0.001) and variable errors (VE) (FVE=60.245, P<0.001) between the two groups. No significant differences were detected in constant error (CE), VAS, and IKDC between the two groups (P>0.05). Both groups displayed a significant difference in terms of AE, VE, VAS, and IKDC after the intervention (P<0.05). Percent changes after the intervention for AE(69.19%), VE (68.20%), CE (65.20%), VAS37.50%, and IKDC (38.61%) were greater in the HT group, compared to the CT group. CONCLUSION: As evidenced by the obtained results, innovative aquatic proprioceptive training incorporate into the conventional rehabilitation accelerated protocol offers the improvement of proprioception efficiency for individuals with ACL reconstruction. Therefore, it could be useful to clinicians when designing rehabilitation protocol to ensure the optimal engagement of proprioception.

Ultrasonographic measurements of plantar fascia thickness and echogenicity in individuals with and without plantar fasciitis: Reliability and group differences.

OBJECTIVE: Imaging techniques such as ultrasonography are beneficial for diagnosis of plantar fasciitis. The purpose of this study was to investigate intra-rater reliability of plantar fascia thickness and echogenicity in subjects with and without plantar fasciitis and to compare the measurements between the two groups. DESIGN: Sonographic evaluation of the plantar fascia was performed in prone position in 20 subjects without plantar fasciitis and 20 subjects with plantar fasciitis. The outcome measures extracted from the ultrasound images included plantar fascia thickness at the insertion, 1 cm and 3 cm distal from the insertion and plantar fascia echogenicity. The reliability of outcome measures was estimated for both groups using absolute and relative reliability variables. The two groups were compared using analysis of variance (ANOVA). RESULTS: ICCs (3, 3) for intra-rater reliability of plantar fascia thickness and echogenicity were, respectively, ≥0.89 and ≥0.89 in the healthy controls and 0.87≥ and 0.90≥ in the plantar fasciitis group. The subjects with plantar fasciitis showed a thicker plantar fascia with lower echogenicity in all of measurement stations of plantar fascia compared to the healthy controls. CONCLUSION: The results of the present study indicated that ultrasonography is a reliable method to measure plantar fascia thickness and echogenicity. Furthermore, the findings showed that plantar fascia is affected not only at its insertion but also in other points remote from the insertion in patients with plantar fasciitis. These findings support the diagnostic value of ultrasonography in therapy and research of the patients with plantar fasciitis.

Investigation of Aneusomy of Chromosome 21 in the Micronuclei of 13 Patients with Early Onset Alzheimer's Disease Using Fluorescence in Situ Hybridization: A Pilot Study.

BACKGROUND: Alzheimer's disease is one of the most common neurodegenerative and dementia disorders in people between the ages of 30 and 65. When symptoms appear in this age group, the disease is referred to as early-onset Alzheimer's disease (EOAD). Unfortunately, the symptoms are progressive and no current treatments are effective. METHODS: In this research, 13 patients, aged 37 to 65 years with symptoms of early-onset Alzheimer's disease, were studied. First, patient lymphocytes were isolated and cultured in RPMI 1640 medium using a special micronucleus (MN) culture method. Next, the lymphocytes were harvested and prepared on slides. The slides were then examined by fluorescent microscopy using a unique FISH protocol specific for MNs. The patients were divided into groups aged 30-39, 40-49, and 50-65. RESULTS: We found that 19.76% of the MNs from our EOAD patients originated in chromosome 21. Micronuclei originated in chromosome 21 in 21.20 and 16.52% of patients without and with family histories of Alzheimer's, respectively. This difference was not significant. Also, the percentage of micronuclei originating in chromosome 21 was not dependent on the patient age at the time of the study, or symptom onset age or duration. CONCLUSION: This study shows that the rate of micronuclei with the origin of chromosome 21 is high in these patients. However, the micronucleus increased has no significant relationship with age and duration of disease or family history of it.

Improvements in strength and functional performance after Kinesio taping in semi-professional male soccer players with and without functional ankle instability.

OBJECTIVE: The objectives of this study were to compare the immediate effects of two methods of Kinesio taping on muscle strength, functional performance, and balance in athletes with and without functional ankle instability (FAI). METHODS: The present study investigated the effects of distal taping (muscle application over peroneus longus) and proximal- distal taping (muscle application over gluteus medius and peroneus longus) on the strength of evertor and hip abductor muscles, side hop test, figure of 8 hop test, and star excursion balance test in semi-professional male soccer players with and without FAI (n=15 in each group). A Multifactorial repeated measure ANOVA was used for comparison. RESULTS: There were significant differences for factor effect in all outcome measures (P<0.05), except for the figure of 8 hop test. No significant differences for group effects and group by factor interaction effects (P>0.05) was observed except for the side hop test. CONCLUSION: Kinesio taping had immediate effects on improving strength, performance and balance. However, there were no differences on the method of application. Clinicians can consider the application Kinesio taping during the rehabilitation process of athletes with FAI, to improve balance and strength. The long-term impacts of taping on the functional, balance and strength measures should be investigated in future studies.

The role of scapular kinematics in patients with different shoulder musculoskeletal disorders: A systematic review approach.

This study aimed to identify the role of the scapula in shoulder musculoskeletal disorders (SMDs) and provided a systematic review of available studies in the field of scapular three-dimensional kinematics. We systematically searched 5 international databases, including Scopus, EMBASE, PubMed, CINAHL, PEDro, and Cochrane Library from June to September 2015. Twenty studies met the inclusion criteria and were retrieved in full paper. The selected studies were critically appraised independently by two researchers. The patients with shoulder impingement syndrome (SIS) and shoulder instability had an increased protraction, lesser upward rotation (UR), and increased internal rotation (IR) during scapular plane elevation, whereas the patients with frozen shoulders had lesser protraction. Moreover, the patients with SIS had a greater scapular posterior tilt (PT) and external rotation during shoulder abduction. Increased scapular UR and PT with decreased scapular IR was seen in patients with stiffness of Latissimus Dorsi and fibromyalgia without any changes in the scapular IR. The results of this systematic review help the clinicians to have an insight about scapular kinematics as a predictive index for SMDs.

The Genotoxic and Cytotoxic Effects of Bisphenol-A (BPA) in MCF-7 Cell Line and Amniocytes.

Bisphenol-A (BPA) is an industrial xenoestrogen used widely in our living environment. Recently, several studies suggested that BPA has destructive effects on DNA and chromosomes in normal body cells via estrogen receptors (ER). Therefore, BPA could be considered as an important mediator in many diseases such as cancer. However, there are still many controversial issues which need clarification. In this study, we investigated the BPA-induced chromosomal damages in MCF-7 cell line, ER-positive and negative amniocyte cells. Cytotoxicity and genotoxicity effects of BPA were also compared between these three cell groups. Expression of estrogen receptors was determined using immunocytochemistry technique. The cell cytotoxicity of BPA was measured by MTT assay. Classic cytogenetic technique was carried out for the investigation of chromosome damage. BPA, in addition to cytotoxicity, had remarkable genotoxicity at concentrations close to the traceable levels in tissues or biological fluids. Although some differences were observed in the amount of damages between ER-positive and negative fetal cells, interestingly, these differences were not significant. The present study showed that BPA could lead to chromosomal aberrations in both ER-dependent and independent pathways at some concentrations or in cell types yet not reported. Also, BPA could probably be considered as a facilitator for some predisposed cells to be cancerous by raising the chromosome instability levels. Finally, estrogen receptor seems to have a different role in cytotoxicity and genotoxicity effects.

Assessment of Knee Proprioception in the Anterior Cruciate Ligament Injury Risk Position in Healthy Subjects: A Cross-sectional Study.

[Purpose] Knee joint proprioception combines sensory input from a variety of afferent receptors that encompasses the sensations of joint position and motion. Poor proprioception is one of the risk factors of anterior cruciate ligament injury. Most studies have favored testing knee joint position sense in the sagittal plane and non-weight-bearing position. One of the most common mechanisms of noncontact anterior cruciate ligament injury is dynamic knee valgus. No study has measured joint position sense in a manner relevant to the mechanism of injury. Therefore, the aim of this study was to measure knee joint position sense in the noncontact anterior cruciate ligament injury risk position and normal condition. [Subjects and Methods] Thirty healthy male athletes participated in the study. Joint position sense was evaluated by active reproduction of the anterior cruciate ligament injury risk position and normal condition. The dominant knees of subjects were tested. [Results] The results showed less accurate knee joint position sense in the noncontact anterior cruciate ligament injury risk position rather than the normal condition. [Conclusion] The poorer joint position sense in non-contact anterior cruciate ligament injury risk position compared with the normal condition may contribute to the increased incidence of anterior cruciate ligament injury.

C - reactive protein levels in patients with periodontal disease and normal subjects.

Although periodontitis is a chronic inflammatory disease but some factors of acute inflammation phase are involved in this disease among which is the C-Reactive protein (CRP). To minimize its effects, anti-inflammatory drugs or non-pharmacological approaches such as oral hygiene is recommended. CRP can also be used for the prediction and early detection of periodontal disease. The aim of the present study was the comparison of the amount of salivary C-Reactive protein (CRP) in healthy subjects and patients with periodontal disease. This case-control study was done on 90 patients referred to the Department of Periodontology of Babol Dentistry School. These subjects were divided into three groups of healthy (n = 30), gingivitis (n = 30), and chronic periodontitis (n = 30), based on Gingival Index (GI) and Clinical Attachment Loss (CAL) indices. 2ml saliva samples were collected from these people and clinical indicators including GI, CAL, Periodontal Pocket Depth (PPD), and Bleeding Index (BI) were assessed. ELISA method was used to evaluate the salivary CRP levels. Collected data were analyzed using SPSS statistical software by non-Parametric Kruskal-Wallis and Mann-Whitney test and Spearman correlation coefficient and P<0.05 was considered significant. The mean salivary CRP levels were 5332.62±5051.63pg/ml in periodontitis patients, 3545.41±3061.38pg/ml in gingivitis group and 3108.51±3574.47pg/ml in healthy subjects. The statistic analysis showed a significant difference in salivary CRP concentrations between the periodontitis patients and healthy subjects (P=0.045). The results indicate that there is a significant association between periodontitis and salivary CRP concentrations.

Effects of Teucrium Polium Aerial Parts extract on oral glucose tolerance tests and pancreas histopathology in Streptozocin-induced diabetic rats.

Teucrium polium can reduce serum glucose. There are few reports in the literature related to this subject and the resolution of this mechanism requires further experiments. The aim of the present study was to evaluate the effects of Teucrium polium aerial parts extracts on oral glucose tolerance tests and pancreas histology in streptozocin-induced diabetic rats. In order to prepare the aqueous concentrate, aerial parts extract was dissolved in distilled water and was boiled for 30 minutes. For the preparation of ethanolic solution, powder was dissolved in ethanol and mixed by a shaker. Diabetic rats were induced with single IP injection of streptozotocin (STZ) at a dose of 50 mg/kg body weight dissolved in normal saline just before use to the 16 hr fast rats. Both groups, diabetic and normal were sacrificed by ether anesthesia. The tissue samples were formalin fixed and paraffin embedded for microscopic examination in accordance with routine laboratory procedures. Blood was collected from the tail vein of the rats. Serum glucose levels were then measured by commercial kits by using a glucose oxidized method. There were no biochemical abnormalities or histological changes in the pancreas of control rats. Post treatment of Teucrium polium aerial parts extract reduced the severity of streptozotocin diabetic pancreases. Our histopathological investigation along with the biochemical evaluations showed a significant effect on histological changes in the pancreas of induced diabetic rats upon Teucrium polium aerial parts extract treatment (P<0.05).