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PubMed2006

Quantifying the effectiveness of the sustained muscle stretching treatments in stroke patients with ankle hypertonia.

Sustained muscle stretch (SMS) is commonly used to reduce hypertonia. The present study evaluates the effectiveness of three different SMS protocols, namely constant-angle, cyclic, and constant-torque stretching, in the immediate reducing of ankle hypertonia. Forty-seven hemiplegic subjects, 53.7+/-10.3 years old and 22.4+/-16.0 months after stroke, with hypertonic ankle joints were recruited to undergo three SMS applied to protocols treatment their hypertonic ankle joints using an integrated treatment/assessment system. The immediate post-treatment effectiveness of each stretching protocol was assessed by reference to the pre-treatment Modified Ashworth Scale (MAS), passive range of motion (ROM), and reactive torque measurement, from which the viscous-elastic components of the ankle joint were derived. All three SMS protocols successfully reduced MAS grade. Additionally, each stretching method yielded an increase in ankle ROM, from 9.7 degrees to 16 degrees , 9.6 degrees to 14.8 degrees , and 9.2 degrees to 18.3 degrees for the constant-angle, cyclic-stretching, constant-torque protocols, respectively, and reduction of the elastic and viscous properties of the ankle joint dorsiflexion (p<0.05). The changes in the ROM, elasticity, and viscosity were most pronounced in the case of the constant-torque stretching protocol. In addition to clinical scales, current biomechanical assessments indicate that three SMS protocols are all effective in reducing the immediate viscoelastic components of hypertonic ankle joints. Our quantitative analysis further shows that of the three treatment protocols, the constant-torque treatment is the most effective.

Adult↗
PubMed2006

Is there an association between self-reported warm-up behaviour and golf related injury in female golfers?

Golfing injuries have been shown to occur frequently, and injury countermeasures have been suggested to help reduce injury risk. Performing an appropriate warm-up is thought to reduce injury risk, however there is a lack of evidence to support this notion. Therefore this study aimed to investigate the relationships between warm-up participation and injury in a cohort of female golfers. A total of 522 golfers participating in the Victorian Women's Pennant Competition completed the study. Over one-third (35.2%) of the golfers reported having sustained a golfing injury within the previous 12 months, with the lower back the most commonly injured region. Most golfers reported not warming-up prior to play or practice. Golfers who reported not warming-up on a regular basis were more likely to have reported a golfing injury in the previous 12 months than those reporting frequent warm-up participation (OR=45.2; 95% CI: 13.5, 151.7). Less skilled golfers were also less likely to report sustaining a golfing injury than more skilled golfers (OR=0.2; 95% CI: 0.1, 0.5). This study is one of the few to establish an association between warm-up participation and injury. Further prospective studies are warranted to determine whether warm-up reduces injury risk for golf participation.

Adolescent↗
PubMed2006

Music education and performing arts medicine: the state of the alliance.

As a group, musicians tend to be somewhat disembodied; their awareness of their whole selves extends almost exclusively to the parts involved directly with musical technique. Even though many consider musicians to be small muscle athletes, it is unusual to see a group of beginning musicians working out or warming up on their practice field, or having a trainer present to supervise their movements or their mental performance orientation, as one would in sports. Several questions come to mind. How has this state of things come about? What do musicians know about the mental, spiritual, and physical attributes they bring to music making? What do music teachers teach students about wellness? How can a collaboration of the fields of music education and rehabilitation medicine approach these issues? This article addresses these questions.

Humanities↗
PubMed2006

Feldenkrais Method, Alexander Technique, and yoga--body awareness therapy in the performing arts.

The three disciplines described are practiced by many individuals for a myriad of reasons. Depending upon ability and depth of study, teachers of all three disciplines may have specific competencies with which to analyse, instruct, and interact with students/clients. In the author's experience, persons who seek out these practices and incorporate them into their daily lives and expressions of physical activity often are motivated to maintain or establish an optimal state of well-being and function. Physicians and therapists who work with performing artists are in a position to encourage such positive direction in patients, provide information on local resources, and consider the practices as collaborative and adjunctive to medical care.

Awareness↗
PubMed2006

Twelve weeks of nightly stretch does not reduce thumb web-space contractures in people with a neurological condition: a randomised controlled trial.

QUESTION: What is the effectiveness of 12 weeks of nightly stretch in reducing thumb web-space contracture in people with neurological conditions? DESIGN: Assessor-blinded, randomised controlled trial. PARTICIPANTS: Forty-four (one dropout)community-dwelling patients with a neurological condition (14 stroke, 7 traumatic brain injury, 23 spinal cord injury) who had uni or bilateral thumb web-space contractures (60 thumbs). INTERVENTION: The experimental thumbs were splinted into a stretched,abducted position each night for 12 weeks. The control thumbs were not splinted. OUTCOME MEASURES: Thumb web-space was measured as the carpometacarpal angle during the application of a 0.9 Nm abduction torque before and after intervention. RESULTS: The mean increase in thumb web-space after 12 weeks was 1 deg (95% CI, -1 to 2). CONCLUSION: Intensive stretch administered regularly over three months does not reduce thumb web-space contractures in neurological conditions.

Adult↗
PubMed2006

Complete semimembranosus rupture following therapeutic stretching after a traumatic brain injury.

Acute hamstring rupture is an uncommon event often occurring during high impact sports. Such events have not been previously reported during neurological rehabilitation. This case report describes a 30 year-old Chinese male presenting in a minimally responsive state 5 years after a severe traumatic brain injury. He was tetraplegic and bed-bound with spasticity involving all four limbs and flexion contracture of the right knee. During an episode of inpatient rehabilitation, he developed acute swelling and bruising of the posterior proximal thigh region associated with fever, tachycardia and diaphoresis. MRI showed a large soft tissue rim-enhancing mass in the right proximal hamstring muscle. During surgical exploration, complete rupture of the right semi-membranosus muscle was found without evidence of pus. The possible causative factors of hamstring rupture in this subject and a brief literature review are discussed. To the authors' knowledge, this is the first such reported case.

Acute Disease↗
PubMedDate not supplied

A pilot study of mindfulness-based stress reduction for hot flashes.

OBJECTIVE: A variety of results from both population and laboratory studies suggest that stress and hot flashes (HFs) are correlated and that HFs are more severe in women with lower coping abilities. The objective of this pilot study was to obtain information on the feasibility and effect of participation in a mindfulness-based stress reduction (MBSR) program on HF severity and menopause-related quality of life. DESIGN: Fifteen women volunteers reporting a minimum of seven moderate to severe HFs per day at study intake attended the eight weekly MBSR classes at the University of Massachusetts Medical School. Participants were assessed for menopause-related quality of life before beginning and at the conclusion of the MBSR program. Women also kept a daily log of their HFs through the course of the 7 weeks of the MBSR program and for 4 weeks after it. RESULTS: Women's scores on quality-of-life measures increased significantly, and the median reported HF severity, calculated as the weekly average of a daily HF severity score, decreased 40% over the course of the 11 weeks of the assessment period. The women were individually interviewed at the completion of their participation, and the results of the interviews were consistent with the results from daily diaries. CONCLUSIONS: These results provide preliminary positive evidence of the feasibility and efficacy of MBSR in supporting women who are experiencing severe HFs, and it warrants further investigation.

Female↗
PubMed2006

Neuromusculoskeletal models provide insights into the mechanisms and rehabilitation of hamstring strains.

Neuromusculoskeletal models are used to investigate hamstring mechanics during sprinting. We show that peak hamstring stretch occurs during late swing phase and is invariant with speed, but does depend on tendon compliance and the action of other muscles in the lumbopelvic region. The insights gained are relevant for improving the scientific basis of hamstring strain injury prevention and rehabilitation programs.

Biomechanical Phenomena↗
PubMed2006

Dynamic vs. static-stretching warm up: the effect on power and agility performance.

The purpose of this study was to compare the effect of a dynamic warm up (DWU) with a static-stretching warm up (SWU) on selected measures of power and agility. Thirty cadets at the United States Military Academy completed the study (14 women and 16 men, ages 18-24 years). On 3 consecutive days, subjects performed 1 of the 2 warm up routines (DWU or SWU) or performed no warm up (NWU). The 3 warm up protocols lasted 10 minutes each and were counterbalanced to avoid carryover effects. After 1-2 minutes of recovery, subjects performed 3 tests of power or agility. The order of the performance tests (T-shuttle run, underhand medicine ball throw for distance, and 5-step jump) also was counterbalanced. Repeated measures analysis of variance revealed better performance scores after the DWU for all 3 performance tests (p < 0.01), relative to the SWU and NWU. There were no significant differences between the SWU and NWU for the medicine ball throw and the T-shuttle run, but the SWU was associated with better scores on the 5-step jump (p < 0.01). Because the results of this study indicate a relative performance enhancement with the DWU, the utility of warm up routines that use static stretching as a stand-alone activity should be reassessed.

Adolescent↗
PubMed2006

Proprioceptive neuromuscular facilitation stretching : mechanisms and clinical implications.

Proprioceptive neuromuscular facilitation (PNF) stretching techniques are commonly used in the athletic and clinical environments to enhance both active and passive range of motion (ROM) with a view to optimising motor performance and rehabilitation. PNF stretching is positioned in the literature as the most effective stretching technique when the aim is to increase ROM, particularly in respect to short-term changes in ROM. With due consideration of the heterogeneity across the applied PNF stretching research, a summary of the findings suggests that an 'active' PNF stretching technique achieves the greatest gains in ROM, e.g. utilising a shortening contraction of the opposing muscle to place the target muscle on stretch, followed by a static contraction of the target muscle. The inclusion of a shortening contraction of the opposing muscle appears to have the greatest impact on enhancing ROM. When including a static contraction of the target muscle, this needs to be held for approximately 3 seconds at no more than 20% of a maximum voluntary contraction. The greatest changes in ROM generally occur after the first repetition and in order to achieve more lasting changes in ROM, PNF stretching needs to be performed once or twice per week. The superior changes in ROM that PNF stretching often produces compared with other stretching techniques has traditionally been attributed to autogenic and/or reciprocal inhibition, although the literature does not support this hypothesis. Instead, and in the absence of a biomechanical explanation, the contemporary view proposes that PNF stretching influences the point at which stretch is perceived or tolerated. The mechanism(s) underpinning the change in stretch perception or tolerance are not known, although pain modulation has been suggested.

Evidence-Based Medicine↗
PubMed2006

The efficacy of self-administered stretching for finger joint motion in Japanese patients with systemic sclerosis.

OBJECTIVE: To determine the efficacy of self-administered stretching of each finger in Japanese patients with systemic sclerosis (SSc). METHODS: Forty-five patients with SSc (32 with diffuse cutaneous SSc and 13 with limited cutaneous SSc) were given instructions on self-administered stretching and were directed to perform it every day. Individual fingers were maintained in a stretched position using the opposite hand for 10 seconds and this was repeated 3-10 times. To evaluate the effect of the stretching program, finger passive range of motion (ROM) was assessed using a goniometer on the first visit and after 1 month and 1 year of the stretching program. The Health Assessment Questionnaire (HAQ) was also assessed on the first visit and 1 year afterward. RESULTS: The total passive ROM was significantly improved in each finger after 1 month of finger stretching. The total passive ROM was further improved or maintained within 1 year after the first visit. Although ROM was less in patients with diffuse cutaneous SSc than in those with limited cutaneous SSc at the first visit, ROM increased significantly irrespective of disease duration or severity of skin sclerosis. Finger stretching may improve the finger function, since the HAQ score for hand functions such as eating and gripping was significantly decreased. CONCLUSION: Our original self-administered stretching program may be useful for improving finger joint motion in patients with SSc; future studies in various ethnic populations will be needed to determine the universal efficacy of this method.

Female↗
PubMed1981

Management of muscular hyperactivity.

A treatment plan for jaw pain and dysfunction due to muscular hyperactivity can only be formulated after the exclusion of systemic disease or an inflammatory condition as a possible cause thorough physical examination of the head and neck and the study of an appropriate radiographic survey. The treatment plan should consist of a series of progressively graded stages which must be fully explained to the patient. This will reduce the problem of overtreatment and maintain the confidence of the patient in the dentist should the early conservative measures by unsuccessful. The level at which a patient will be entered upon the treatment ladder will vary with the severity of the presenting symptoms. The usual stages will include the following: (a) elimination or neutralization of the cause, (b) initial conservative treatment involving prescription of a mild anti- inflammatory analgesic, soft diet, rest, moist heat and where indicated an anxiolytic drug such as Valium, (c) exercise to stretch muscles and remobilize the joint, (d) physical therapy including diathermy, (e) stress control treatment and relaxation training and, finally (f) referral to a centre for chronic pain relief. Advice is given on the management of a patient who either discontinues treatment or for whom complete remission os symptoms is not possible.

Humans↗
PubMed2003

Manipulation of the wrist for management of lateral epicondylitis: a randomized pilot study.

BACKGROUND AND PURPOSE: Lateral epicondylitis ("tennis elbow") is a common entity. Several nonoperative interventions, with varying success rates, have been described. The aim of this study was to compare the effectiveness of 2 protocols for the management of lateral epicondylitis: (1) manipulation of the wrist and (2) ultrasound, friction massage, and muscle stretching and strengthening exercises. SUBJECTS AND METHODS: Thirty-one subjects with a history and examination results consistent with lateral epicondylitis participated in the study. The subjects were randomly assigned to either a group that received manipulation of the wrist (group 1) or a group that received ultrasound, friction massage, and muscle stretching and strengthening exercises (group 2). Three subjects were lost to follow-up, leaving 28 subjects for analysis. Follow-up was at 3 and 6 weeks. The primary outcome measure was a global measure of improvement, as assessed on a 6-point scale. Analysis was performed using independent t tests, Mann-Whitney U tests, and Fisher exact tests. RESULTS: Differences were found for 2 outcome measures: success rate at 3 weeks and decrease in pain at 6 weeks. Both findings indicated manipulation was more effective than the other protocol. After 3 weeks of intervention, the success rate in group 1 was 62%, as compared with 20% in group 2. After 6 weeks of intervention, improvement in pain as measured on an 11-point numeric scale was 5.2 (SD=2.4) in group 1, as compared with 3.2 (SD=2.1) in group 2. DISCUSSION AND CONCLUSION: Manipulation of the wrist appeared to be more effective than ultrasound, friction massage, and muscle stretching and strengthening exercises for the management of lateral epicondylitis when there was a short-term follow-up. However, replication of our results is needed in a large-scale randomized clinical trial with a control group and a longer-term follow-up.

Adult↗
PubMed2004

The short -term effects of an exercise programme as an adjunct to an orthosis in neuromuscular scoliosis.

The purpose of this study was to investigate the effects of a 4 week physiotherapy programme on patients who were given a spinal orthosis for neuromuscular scoliosis. This study was planned as a single group pre- and post-intervention repeated measures design. All patients were given a polyethylene spinal orthosis with an anterior opening. Fifteen (15) patients with neuromuscular diseases and a mean age of 12.46 years were evaluated. An exercises programme consisting of postural training, muscle strengthening and stretching exercises with special emphasis on respiratory exercises was given as an adjunct to orthotic treatment. The degree of impairment in forced vital capacity was 17.56% upon wearing an orthosis, it decreased to 9.28% following therapy (p < 0.05). There was also a statistically significant increase in muscle strength, balance duration and a significant decrease in limitation of range of motion. The results of the study imply that the conservative treatment of neuromuscular scoliosis should include an exercise programme as an adjunct to an orthosis, both to reduce the compromising effect of an orthosis on respiratory function and to support the patient's physical capacities.

Adolescent↗
PubMed2003

Comparison of force-velocity relationships of vastus lateralis muscle in isokinetic and in stretch-shortening cycle exercises.

AIM: This study investigated the force-velocity characteristics of the vastus lateralis (VL) muscle fascicle and muscle-tendon unit (MTU) in isolated lengthening and shortening actions, and during natural movement. METHODS: Four subjects performed maximal eccentric and concentric knee extensions (60, 120 and 180 degrees s-1). Unilateral counter movement jumps and drop jumps in the sledge apparatus served as natural movements. Vastus lateralis fascicle lengths were determined from ultrasonography. In vivo patellar tendon forces (PTF) were measured with an optic fibre technique. Patellar tendon force was derived to VL force according to the cross-sectional area of the muscle. Force in the direction of fascicle was calculated by dividing the VL force value by cosine of the fascicle angle. Force-velocity curves were constructed using angle specific values from isokinetic knee extensions (classical curve) and using instantaneous values from jumping exercises. RESULTS: In the fascicle level, we did not find an enhanced muscle force in the jumping performances as compared with the classical force-velocity curve. In the muscle-tendon level, the instantaneous force at high muscle-tendon shortening speeds exceeded that extrapolated according to Hill's equation. CONCLUSION: This difference between fascicle and muscle-tendon behaviour suggests that the neural input in fast stretch-shortening cycle exercises minimizes the length changes in muscle fascicle and enables storage and recoil of energy from elastic components that contributes to the enhanced mechanical output of the MTU during the push-off phase.

Adult↗
PubMed2006

Evaluation of physiotherapy in the treatment of Legg-Calvé-Perthes disease.

INTRODUCTION: Physiotherapy using muscle strengthening and stretching exercises is claimed to have beneficial effects in the treatment of Legg-Calvé-Perthes disease; however, no scientific evidence is available concerning effectiveness of treatment. PURPOSE: The purpose of the present study was to clinically evaluate possible effects of the proposed physiotherapeutic effects compared to observational follow-up in patients with Legg-Calvé-Perthes disease. METHOD: A prospective follow-up study was conducted in 17 patients with unilateral Legg-Calvé-Perthes disease, divided into 2 groups: Group A (observational follow-up) and Group B (physiotherapeutic follow-up). In order to evaluate the outcome of the adopted treatments, the following parameters were assessed: articular range of motion, level of muscular strength, level of articular dysfunction, and radiographic status, both before and after the treatment. RESULTS: Group B exhibited significant improvement in articular range of motion concerning hip flexion, extension, abduction, adduction, medial rotation, and lateral rotation, while in Group A an equally significant worsening occurred concerning abduction, adduction, and medial rotation. Muscular strength also improved in Group B, mainly in the set of hip flexor muscles, while Group A showed no changes. Articular dysfunction after therapy compared to pretherapy was significantly reduced in Group B and increased in Group A. Patients undergoing physiotherapy exercises showed no changes in their radiographic features. CONCLUSION: Physiotherapy produced significant improvement in articular range of motion, muscular strength, and articular dysfunction in patients with Legg-Calvé-Perthes disease, but these improvements were not evident on radiographs.

Child↗