Background : : Lumbar segmental instability is commonly assessed using sagittal translation (ST) and segmental angulation (SA) on flexion-extension radiographs, but their associations with paraspinal muscle morphology in lumbar spinal stenosis (LSS) remain unclear. Objects: To examine the associations between continuous ST/SA measurements, left-right paraspinal muscle cross-sectional area (CSA) asymmetry and total CSA at L4-5 in patients with LSS, controlling for age, sex, and body mass index (BMI). Methods : : Eighty-five patients with LSS were included. The ST (mm) and SA (°) at L4-5 were measured from flexion and extension views. CSA of the paraspinal muscle was measured on magnetic resonance imaging at the L4-5 mid-disc level. CSA asymmetry was defined as right − left and total CSA as right + left. Partial correlations between ST/SA and CSA were calculated after controlling for age, sex, and BMI. Results : : Forty-seven female and 38 male were included. The mean ST and SA were 2.15 ± 1.58 mm and 8.80° ± 5.51°, respectively. ST was weakly correlated with SA (partial r = 0.260, p < 0.05). ST showed a weak positive correlation with erector spinae (ES) CSA asymmetry (partial r = 0.223, p < 0.05) but was not associated with psoas major or multifidus asymmetry or total CSA in any muscle. SA was not associated with CSA asymmetry or the total CSA. Conclusion : : In patients with LSS, ST at L4-5 was weakly but significantly correlated with ES CSA asymmetry after controlling for age, sex, and BMI. In contrast, SA showed no significant association with paraspinal muscle CSA asymmetry or total CSA, and neither ST nor SA was significantly associated with the total CSA of the paraspinal muscles. ST and SA were weakly correlated, suggesting that translational and angular motions represent partly distinct components of segmental motion in this cohort.
Background : : Chronic ankle instability (CAI) develops following an initial ankle sprain injury, and is characterized by recurrent inversion sprains and a sensation of the ankle “giving way”, often accompanied by pain, swelling, and ankle dysfunction. Neuromuscular deficits-particularly alterations in the peroneal muscles, which act as primary ankle evertors are considered key contributors to impaired stability and function in individuals with CAI. Previous studies have reported delayed or earlier onset times of the peroneal muscles and tibialis anterior (TA) in individuals with CAI during tasks such as gait, landing, and perturbation. However, limited research has examined the onset times of the TA, peroneus longus (PL), and peroneus brevis (PB) during the heel raise (HR), which is generally utilized in clinical settings. Objects: This study aimed to compare the onset times of TA, PL, PB, and extensor digitorum longus (EDL) during unilateral HR between individuals with and without CAI. Methods : : Thirty participants with and without CAI were recruited. Surface electromyography (EMG) was used to record TA, PL, PB and EDL activity. Muscle onset times were determined relative to the heel-off event, which was identified using a footswitch synchronized with EMG recording. Independent t-test was conducted to compare muscle onset times between groups. Results : : Compared with individuals without CAI, those with CAI demonstrated significantly delayed TA, PL, and PB onset times during unilateral HR (p < 0.05). Conversely, no significant between-group difference was observed in the onset time of the EDL (p > 0.05). Conclusion : : These findings suggest that delayed onset times of the peroneal muscles and TA may contribute to the sensation of the ankle “giving way” associated with CAI. Strategies targeting earlier activation of the peroneal muscles may help improve ankle stability during HR tasks in individuals with CAI.
Background : : Neck pain is the fourth most common musculoskeletal disorder globally. Heavy helmets worn in professions like firefighting contribute to neck muscle tension and pain. However, research on muscle activity with firefighter helmets in various static postures is lacking. Objects: This study aims to analyze the changes in electromyography (EMG) signals of the left sternocleidomastoid (SCM), left upper trapezius (UT), right splenius capitis (SPC), and left cervical erector spinae (CES) during various static head movements (upright, extension, lateral flexion, rotation, running) with and without a standard firefighter helmet. Methods : : Twenty-four healthy adults (12 males, 12 females) participated. Subjects performed five static tasks in a randomized order with and without a helmet. Surface EMG was used to measure muscle activity. A paired t-test was used to compare conditions. Results : : In the extension posture, SCM and CES activity significantly increased with the helmet (SCM: 21.49% to 24.31%, CES: 9.97% to 12.18%, p < 0.05). In lateral flexion, SCM activity significantly increased (19.66% to 19.95%, p < 0.05). In rotation, CES activity significantly increased (12.20% to 14.55%, p < 0.05). No significant differences were found for UT and SPC in most postures, nor for any muscle during the static running task. Conclusion : : Firefighter helmet weight significantly increases muscle activity in the SCM and CES during specific static postures (extension, lateral flexion, rotation). These findings provide a basis for ergonomic improvements in helmet design to reduce neck fatigue.
Background : : Aging is accompanied by progressive changes in neuromusculoskeletal function and sensory motor coordination that can influence balance performance in elderly individuals. The single-leg stance (SLS) is commonly used as a simple and practical tool to evaluate balance and functional lower-extremity control. Although hip abductor (HABD) muscles are regarded as the primary stabilizers of the pelvis during unilateral tasks, the association between HABD strength and trunk and pelvic kinematics during SLS in elderly remains poorly understood. Objects: This study aimed to investigate the relationship between HABD muscle strength and trunk and pelvic kinematics during SLS in community-dwelling elderly females. Methods : : Forty-three females aged 65 years or older elderly were participated in the study. The isometric HABD strength was measured using a tension sensor and normalized to body weight. Two-dimensional kinematic data, including hip adduction angle, pelvic drop angle, trunk leaning angle, and pelvic shift horizontal displacement, were analyzed during the initial 5 seconds of SLS using Kinovea software. Linear mixed-effects models adjusted for age, height, body weight, and body mass index were used as the primary analysis to examine associations between HABD strength and kinematic variables. Pearson correlation analyses were additionally performed to assess relationships. Results : : Linear mixed-effects model analyses revealed no significant associations between HABD strength and any trunk or pelvic kinematic variables during SLS. In Pearson correlation analyses, with no significant relationships between HABD strength and trunk, pelvic kinematics. Conclusion : : HABD strength was not significantly associated with trunk or pelvic kinematics during SLS in elderly females. These findings suggest that postural control during SLS is not determined by HABD strength alone.
Background : : Functional flatfoot induces medial longitudinal arch collapse and neuromuscular imbalance between intrinsic and extrinsic foot muscles. While targeted foot core training is a standard intervention, the influence of weight-bearing postures on the selective activation of these muscles remains biomechanically ambiguous. Objects: This study aimed to investigate the electromyographic (EMG) activity of the abductor hallucis (AH) and tibialis anterior (TA) under different weight-bearing conditions and specific foot core exercises in individuals with functional flatfoot. Methods : : Thirty young adults with functional flatfoot participated in this cross-sectional study. Surface EMG was utilized to measure the muscle activity of the AH and TA during three exercises: short foot (SF), toe curl (TC), and toe spread (TS). Each exercise was performed under two weight-bearing conditions: non-weight-bearing (sitting) and full-weight-bearing (standing). A 2 × 3 repeated measures ANOVA was conducted to analyze the main effects and interactions. Results : : The interaction effect between posture and exercise type was not statistically significant for either the AH (p = 0.145) or TA (p = 0.661). Furthermore, weight-bearing posture yielded no significant main effect on muscle activation. However, the type of exercise demonstrated a highly significant main effect (p < 0.001). Post-hoc analysis revealed that AH activation was significantly greater during SF and TS compared to TC (p = 0.002), with no significant difference between SF and TS. Conversely, TA activation was significantly higher during TC than during SF and TS (p < 0.001). Conclusion : : Weight-bearing posture does not dictate the magnitude of foot muscle activation; rather, specific exercise kinematics drive selective neuromuscular recruitment. Clinicians can safely prescribe the SF and TS exercises in a seated position to optimally isolate the AH without inducing compensatory TA hyperactivation, thereby providing a secure and targeted rehabilitation strategy for flexible flatfoot.
Background : : Robot-assisted gait training (RAGT) is widely used to improve gait function in children with cerebral palsy (CP). Exoskeleton and end-effector type robots provide different mechanical assistance; however, their immediate effects on plantar pressure distribution and gait speed have not been directly compared. Objects: This study compared the immediate effects of a single session of two robot types of RAGT on plantar pressure distribution and gait speed in children with spastic CP, and examined associations between changes in plantar pressure and gait speed. Methods : : Twelve children with spastic CP (4-18 years; Gross Motor Function Classification System I-III) participated in a randomized cross-over design. Each participant completed one 30-minute session of exoskeleton- and end-effector type RAGT with a washout period of ≥ 2 days. Gait speed was assessed using the 10-meter walk test (10MWT), and plantar pressure was measured using the GaitView® system. Outcomes included symmetry ratio (SR), more affected side plantar pressure ratio (MAPR), and more affected side forefoot and rearfoot plantar pressure ratios (MAFPR and MARPR). Robot type effects were examined using two-way repeated-measures analysis, within-robot pre-post changes using paired t-tests, and associations using Pearson correlation coefficients (α = 0.05). Results : : No significant main or interaction effects of robot type were found for 10MWT, SR, MAPR, MAFPR, or MARPR (all p > 0.10). Within-robot analyses showed significant reductions in 10MWT and SR and significant increases in MAPR following both interventions (p < 0.05). A significant increase in MARPR was observed only after exoskeleton type RAGT. Changes in gait speed were associated with changes in MAPR in the exoskeleton type condition (r = 0.587, p = 0.045), whereas no significant correlations were observed in the end-effector type condition. Conclusion : : Although no significant between-robot differences were observed, exoskeleton and end-effector type robots demonstrated distinct within-robot changes in plantar pressure distribution following a single session of RAGT.
Falls during walking, often triggered by trips and slips, are a major cause of injury in older adults. Perturbation-based training is promising to prevent the falls, but the key biomechanical strategies-;elevating and lowering responses and arm movements-;that distinguish successful recovery from falls are not clearly suggested. To synthesize evidence on biomechanical strategies and determinants of successful balance recovery after trip- or slip-related perturbations during walking. A systematic search of PubMed, Scopus and EMBASE (1984-2025) identified studies of healthy young and older adults exposed to unexpected trips or slips while walking. Following PRISMA 2020, 15 studies were included and appraised with a modified Downs and Black checklist. Trip recovery was mainly determined by perturbation timing: elevating responses were more common after early-to-mid swing trips, whereas lowering responses were more common after late-swing trips and required greater inter-joint coordination. Slip recovery depended primarily on rapid compensatory stepping of the unperturbed limb executed within a narrow time window. Across both perturbation types, arm movements supported trunk stabilization, yet age-related slowing reduced the margin for successful recovery. Successful balance recovery after trips and slips depends more on the spatial and temporal precision of elevating, lowering and compensatory stepping and arm movements. These findings suggest that fall-prevention interventions should move beyond general balance exercise and incorporate cause-specific perturbation-based balance training. Clinically, training should emphasize rapid strategy selection after trips, accurate compensatory stepping after slips, and coordinated upper- and lower-limb responses, particularly in older adults with reduced recovery capacity.
Background : : Lumbar disc herniation (LDH) can cause distal lower-extremity weakness through nerve root compression. Specifically, compression of the L5 nerve root may cause weakness in great toe extension (GTE), ankle dorsiflexion (DF), and eversion (EV). Although magnetic resonance imaging (MRI)-derived disc height reflects structural degeneration, few studies have quantitatively examined the association between disc height and L5-innervated muscle strength in individuals with LDH. Objects: This study compared GTE, DF, and EV strength between individuals with LDH and healthy controls and examined the association between MRI-derived disc height and muscle strength within the LDH group. Methods : : Thirty participants were divided into two groups: individuals with LDH (n = 15) and healthy controls (n = 15). GTE, DF, and EV strengths were measured using a digital dynamometer. In the LDH group, lumbar MRI was analyzed to measure anterior, middle, and posterior disc heights at both L4-5 and L5-S1. Results : : GTE, DF, and EV strength were significantly lower in individuals with LDH than in healthy controls (all p < 0.001). After adjustment for visual analogue scale, the between-group differences in normalized GTE, DF, and EV strength remained significant. Within the LDH group, posterior disc height at L4-5 was positively correlated with GTE and DF strength, while posterior disc height at L5-S1 was positively correlated with EV strength (r = 0.532, 0.613, and 0.631, respectively; p < 0.001, respectively). Conclusion : : Individuals with LDH showed significantly lower GTE, DF, and EV strength than healthy controls. Within the LDH group, posterior disc height was positively correlated with GTE and DF strength at L4-5 and with EV strength at L5-S1.
Myofascial pain is a common musculoskeletal condition characterized by myofascial trigger points, functional limitations, and reduced quality of life. Therapeutic ultrasound (TUS) is frequently used in physiotherapy management, yet its effects remain controversial. This systematic review aims to evaluate the effects of TUS compared with placebo, other physical modalities, or conventional treatment in individuals with myofascial pain syndrome, focusing on outcomes of pain, function, and range of motion. This systematic review followed PRISMA 2020 guidelines. Searches were conducted in PubMed, PEDro, CENTRAL, LILACS, and Google Scholar. Eligible studies were randomized controlled trials or quasi-experimental studies comparing TUS to placebo, exercise, other physical modalities, or conventional treatment. Outcomes included pain, function, range of motion, and sensitivity. Risk of bias was assessed using the Cochrane RoB-2 tool. Eight studies were included. Ultrasound was superior to placebo for pain, pressure pain threshold, and function. It demonstrated comparable efficacy to lidocaine injection and other physical modalities. Benefits were observed for trapezius and masticatory muscles across pain, pressure pain threshold, cervical range of motion, and disability outcomes. No serious adverse effects were reported. Methodological quality varied, with only two studies showing low risk of bias; heterogeneity in parameters and co-interventions precluded meta-analysis. TUS appears to be a safe intervention for myofascial pain syndrome, with preliminary evidence of benefits for pain, pressure pain threshold, and function in the trapezius and masticatory muscles. However, given the methodological heterogeneity, limited number of studies, and risk of publication bias, these findings should be interpreted cautiously. Further high-quality trials are needed before firm clinical recommendations can be made.
Background : : Modern service-oriented occupations have increased concern regarding work-related musculoskeletal disorders (WMSDs). Food service workers (FSWs) are at elevated risk of wrist-related WMSDs because their duties involve repetitive wrist movements during cooking, utensil handling, and tray carrying. Although ulnar deviation is frequently used in these tasks, ulnar-sided wrist pain (USWP) may be accompanied by direction-specific limitations and functional imbalance. Objects: This study aimed to compare radial and ulnar deviation strength and range of motion (ROM) between FSWs with and without USWP. Methods : : Thirty FSWs were classified into USWP (n = 15) and non-USWP (n = 15) groups. USWP was defined as dominant-side pain lasting more than 3 months, a numeric pain rating scale score of ≥ 4 during work, and tenderness reproduced by the ulnar fovea sign test. Active wrist radial deviation ROM (WRDR) and ulnar deviation ROM (WUDR) were measured using a goniometer. Maximal voluntary isometric radial and ulnar deviation strengths were measured using a Smart KEMA strength sensor and normalized to body weight. ROM and strength asymmetry index (AI) were calculated to quantify directional imbalance. Results : : The USWP group showed significantly lower WRDR (p = 0.002) and a higher ROM AI (p = 0.001) than the non-USWP group. Normalized radial deviation strength (p < 0.001) and ulnar deviation strength (p = 0.036) were also significantly lower in the USWP group, whereas the strength AI was significantly higher (p < 0.001). No significant between-group differences were observed in WUDR or raw ulnar deviation strength. Conclusion : : USWP in FSWs was associated with reduced radial deviation ROM, lower normalized wrist deviation strength, and greater directional asymmetry. These findings suggest that USWP should not be viewed as localized ulnar-sided pain, but as a condition involving altered wrist deviation function. Pain-related limitation or neuromuscular factors may have contributed; however, causality requires caution.
Background : : Subacromial impingement syndrome (SIS) is a common cause of shoulder pain and functional limitation. Biomechanical factors, including uncontrolled humeral head motion, rotator cuff dysfunction, and reduced glenohumeral internal rotation (IR) range of motion (ROM), contribute to narrowing of the subacromial space. Excessive anterior and superior humeral head translation is a risk factor for impingement. Quantifying olecranon marker displacement during shoulder rotation at 90° of abduction provides an indirect and clinically feasible approach for assessing humeral rotational control. However, few studies have simultaneously compared shoulder rotational strength, ROM, and humeral rotational control between individuals with and without SIS. Objects: Using olecranon marker displacement, we aimed to compare humeral head rotational control during shoulder IR and external rotation (ER), as well as shoulder IR/ER strength and ROM, between individuals with and without SIS. Methods : : Forty male participants were recruited and classified into the SIS and non-SIS groups. Shoulder IR and ER ROM, isometric IR and ER strength, and humeral rotational control were assessed on the dominant side. Rotational control was evaluated by measuring olecranon marker displacement during shoulder IR and ER at 90° of shoulder abduction using a two-dimensional motion-tracking system. Independent t-tests were used for between-group comparisons, with statistical significance set at p < 0.05. Results : : Compared with the non-SIS group, the SIS group demonstrated significantly reduced shoulder IR ROM and greater vertical displacement of the olecranon marker during IR (p < 0.05). No significant between-group differences were observed in ER ROM, IR or ER strength, or horizontal displacement of the olecranon marker during IR or ER (p > 0.05). Conclusion : : Individuals with SIS exhibited reduced shoulder IR ROM and altered humeral rotational control during IR. Clinically, assessment of shoulder IR ROM and humeral rotational control should be considered when evaluating and managing individuals with SIS.
Background : : Squat exercises are widely used to strengthen the lower limbs and improve functional performance. Proper ankle stability is essential during squatting because ankle joint instability can alter the neuromuscular control of the proximal muscles. Floss-band application has recently been proposed as a method for enhancing joint stability and muscle activation through external compression and proprioceptive stimulation.Objects: To investigate the effects of applying an ankle floss band during squatting on the activity of the vastus medialis, vastus lateralis, medial hamstring, and lateral hamstring muscles. Methods : : Twenty healthy adult males performed squat exercises under 2 conditions (with and without ankle floss bands) using a single-group crossover design. The squat movements were divided into eccentric, isometric, and concentric phases. Muscle activity was recorded using surface electromyography, normalized to percent of maximal voluntary isometric contraction, and analyzed using two-way repeated-measures analysis of variance (ANOVA) and Bonferroni post-hoc tests. Results : : Two-way repeated-measures ANOVA revealed a significant main effect of condition, with greater quadriceps and hamstring muscle activity observed in the ankle floss band condition compared with the no-floss condition. Phase-specific analyses further indicated that these differences were most pronounced during the concentric phase. Conclusion : : Application of an ankle floss band during squatting exercises effectively enhanced lower limb muscle activity. These findings suggest that ankle flossing may contribute to improved neuromuscular coordination and activation of the lower limb muscles by providing stabilization, and could serve as a useful adjunctive intervention in rehabilitation and training settings.
Background : : Neuromuscular electrical stimulation (NMES) has long been used to strengthen skeletal muscles. Voluntary muscle contraction (VMC) obeys the size principle, whereas NMES does not. Thus, the therapeutic effects of VMC vs. NMES on muscle strength may be different, which may in turn impact on balance and proprioception. Objects: To examine the effects of NMES training on muscle strength, balance and proprioception in young adults. Methods : : Thirty healthy young adults were randomly assigned to VMC or NMES+ group. All participants performed one-leg standing on a force plate to measure balance, and sat on Biodex for ankle strength and proprioception measures before and after muscle strengthening training, which involved a 4-week resistance exercise training with a theraband for the VMC group, and electrical stimulation of the tibialis anterior, gastrocnemius, and soleus muscles along with VMC for the NMES+ group. Outcome variables included mean distance, root mean square distance, total excursion (TOTEX), mean velocity (MVELO), and 95% confidence circle area acquired from the force plate during single-leg standing; absolute error and strength of ankle dorsiflexion/plantarflexion as measured by Biodex. Results : : There were no significant differences between groups in dorsiflexion strength, balance, and proprioception (p > 0.051). However, all outcome variables were associated with time (p < 0.05), and when compared to pre-intervention, the TOTEX and MVELO were 5.6% and 6.5% lower, respectively, in the NMES+ group, and 7.5% and 7.4% lower, respectively, in the VMC group in post-intervention. However, there were no interactions between the group and time for all outcome variables (p > 0.05). Conclusion : : A 4-week ankle muscle strengthening training with NMES+ has improved ankle muscle strength, proprioception, and static balance. However, when compared to conventional strengthening exercise, the NMES did not provide additional benefits.
Background: Urinary incontinence (UI) is a prevalent condition that thereby reducing quality of life (QOL) in adult women. Therefore, it is important to assess the impact of UI on daily functioning, social participation, and sexual health. The Incontinence Quality of Life (I-QOL) and the Incontinence Impact Questionnaire (IIQ) are the most widely used assessment tools. The I-QOL focuses on emotional impacts, whereas the IIQ targets activity-related limitations. Using both instruments could provide a more comprehensive assessment; however, this approach increases administration time and introduces redundancy. Objects: This study aimed to develop a concise questionnaire to assess the QOL in patients with UI by merging the Korean version I-QOL and IIQ through Rasch analysis. Methods: A total of 250 women aged 40–69 who had experienced UI were recruited. The combined responses from the 52 items of a questionnaire integrating I-QOL and IIQ were analyzed using Rasch analysis to evaluate item difficulty and separation reliability. Misfit items were excluded and the remaining items were converted into logit values to determine the order of item difficulty. The separation reliability was evaluated using person and item separation indices. Results: By analyzing item difficulty, redundant items with overlapping levels were excluded while retaining the most significant ones, resulting in a final selection of 10 items. Upon reanalysis of these 10 items, the person separation index decreased from 4.96 to 2.47, and the person reliability index decreased from 0.96 to 0.86. However, the item separation index remained high at 7.29 and 7.59, and item reliability index remained at 0.98. Conclusion: The brief questionnaire maintained high reliability and demonstrated the potential for streamlined clinical assessment. The brief instrument offers a reliable and efficient tool for clinical assessment, enhancing the feasibility of evaluating the severity, type, and impact of UI on patients’ QOL.
With a growing number of working-age individuals receiving knee arthroplasty, optimizing return to work (RTW) has become a crucial goal for both public health and society. This paper highlights three evidence-based actions demonstrating how physical therapists (PTs) play a pivotal role in facilitating timely RTW after knee arthroplasty. This review presents a narrative synthesis of recent studies on RTW after knee arthroplasty highlighting the important role of PT’s. The studies focus on the Work, Osteoarthritis and joint-Replacement Questionnaire (WORQ), Goal Attainment Scaling (GAS), and the Back At work After Surgery (BAAS) work-integrated care pathway. The WORQ effectively identifies patients at risk for delayed RTW based on their ability to perform knee-demanding work activities. Patients with WORQ scores < 51 at 3 months post-surgery showed significantly delayed RTW compared with those scoring > 70. Incorporating GAS into rehabilitation significantly increased satisfaction with work-related activities by 11 points (95% confidence interval: 2.0–19.4) vs. usual care. The BAAS pathway— which integrates hospital, outpatient, and occupational care—resulted in full RTW 27 days earlier than usual care. One year post-surgery, 98% of BAAS patients had fully resumed work vs. 84%–87% in controls. BAAS yielded cost reductions of €4,493 (7,442,452 KRW, employer perspective) with a return on investment of 532%. This corresponds to a total cost reduction of about €69.5 million (115,123 million KRW) annually in The Netherlands. In conclusion, PTs are key drivers of successful work reintegration after knee arthroplasty. By using the WORQ for early detection of patients at risk for delayed RTW, implementing GAS to align rehabilitation with individual work goals, and participating in perioperative interdisciplinary care such as BAAS, PTs can substantially enhance RTW and reduce socioeconomic burden.
Background: Tensor fasciae latae (TFL) and iliotibial tract (ITB) tightness can pull the pelvis during hip lateral rotation (HLR), increasing pelvic rotation due to muscle tension. Among various tests, the HLR test in the prone position (HLRP) is a clinical evaluation tool for assessing lumbopelvic motion with lower-extremity movement. However, performing the HLRP may result in less compensatory motion and a relatively decreased pelvic rotation angle (PRA) because of a wide base of support. Moreover, there were no studies investigating PRA during an HLR test in the standing position (HLRS). Objects: This study aimed to compare the PRA in the horizontal plane during HLRS and the HLRP between individuals with and without TFL/ITB tightness. Methods: Thirty participants with (n = 15) and without (n = 15) TFL/ITB tightness as assessed by Ober’s test, were recruited. The PRA was measured during active HLRS and HLRP. Two-way mixed analysis of variance was used to identify significant differences in the PRA between groups and within positions. Results: When HLRP and HLRS were performed, the PRA in the horizontal plane occurred at 1.65° ± 0.98° and 7.68° ± 4.69°, respectively, in the TFL/ITB tightness group, and at 1.27° ± 1.07° and 2.37° ± 1.96°, respectively, in the control group. A significant interaction effect was identified between groups and positions on the PRA (p < 0.05). Individuals with TFL/ITB tightness had a significantly greater PRA during HLRS than those in the control group. The PRA during HLRS was significantly greater than that during HLRP in individuals with TFL/ITB tightness. Conclusion: These results suggest that TFL/ITB tightness contributes to increased PRA during HLRS compared with HLRP. Clinically, assessment of the PRA in the standing may provide a functional indicator of compensatory pelvic motion during hip rotation of 45°.
Background: Grip strength is a widely accepted clinical indicator of upper limb function. The grip strength measurement validity and clinical relevance of the American Society of Hand Therapists (ASHT) and suboptimal postures, such as slumped sitting, remain unclear. Objects: This study aimed to investigate whether sitting postures, including slumped posture, influence grip strength and upper limb muscle activation and to determine the clinical significance of grip strength assessment in the slumped position. Methods: Forty healthy adult males participated in a cross-over design study. Grip strength and surface electromyography of the triceps brachii, biceps brachii, anterior deltoid, and upper trapezius were measured in ASHT-recommended, slumped, and self-balanced postures. The Friedman test was used to compare outcomes across postures, and the relationship between grip strength and muscle activation was determined using Pearson correlation. Results: Grip strength significantly differed across postures (χ² = 25.37, p < 0.001), with ASHT posture having the highest values and slumped posture the lowest. Triceps brachii and upper trapezius showed significant variations in muscle activity across postures (p < 0.05). The electromyography-to-force ratio, representing neuromuscular efficiency, was the highest in ASHT posture. Grip strength strongly correlated with triceps brachii activity (r = 0.72, p < 0.001). Conclusion: Postural alignment significantly affects grip strength and upper limb muscle efficiency. These results highlight the clinical relevance that grip strength assessment should consider both ideal and habitual postures to improve the validity of functional evaluation and rehabilitation planning.
Background: Early recovery of cognitive function and lower-limb strength is critical for regaining mobility and independence after stroke. However, patients with cognitive impairment often have limited participation in conventional rehabilitation (CR). Objects: This study compared the effects of robotic tilt-table training (RT) group and CR group on cognitive function, lower-limb strength, balance, gait, and activities of daily living in patients with subacute stroke. Methods: In this retrospective study, 122 patients with subacute stroke were divided into two groups: the RT group and the CR group. The interventions were administered 5 times per week for a period of 4 weeks. Cognitive function was assessed using the Korean version of the Mini-Mental State Examination, muscle strength using Manual Muscle Test, spasticity using the Modified Ashworth Scale, balance using the Berg Balance Scale, gait using the Functional Ambulation Category, and activities of daily living using the Korean version of the Modified Barthel Index, both before and after the intervention. Data were analyzed using Wilcoxon signed-rank tests and Mann–Whitney U-tests. Between-group comparisons were performed on change scores (Δ = post − pre), and baseline differences were adjusted using ANCOVA or rank ANCOVA as appropriate (two-sided α = 0.05). Results: After 4 weeks of intervention, both groups showed within-group improvements in balance, gait, and activities of daily living (p < 0.05); however, the RT group demonstrated greater improvements in cognitive function and lower-limb muscle strength compared to the CR group. The two groups differed significantly in cognitive function and lower extremity muscle strength (p < 0.05) but not in spasticity, balance, gait, or activities of daily living (p > 0.05). Conclusion: RT may be effective in improving cognitive function and lower-limb strength in patients with subacute stroke, potentially serving as an adjunct rehabilitation strategy to promote early mobility and functional recovery. However, its effects on balance, gait, and spasticity were not significant, indicating the need for complementary task-specific training and further controlled studies.
Background: Due to the variety of etiological factors in chronic low back pain (CLBP), there is significant variability in functional measurements. Objects: This study aimed to determine if using metrics in addition to inferential statistics could change how the impact of poor prognosis risk for pain among volunteers with CLBP is interpreted. Methods: In this cross-sectional observational study, 74 adult volunteers were allocated to four groups: a pain-free control group (CG) and three CLBP groups stratified by the STarT Back Screening Tool into low (LR), medium (MR) and high risk (HR). Spatiotemporal gait parameters outcomes were self-selected walking speed (SWS), optimum walking speed (OWS) and the locomotor rehabilitation index (LRI). Data were analyzed using a generalized estimating equation model. Reproducibility, responsiveness (minimum detectable change [MDC]) and effect sizes were also computed. Results: No differences were found for OWS. SWS and LRI were significantly higher in CG than in all CLBP groups, but observed differences did not exceed MDC, indicating they are likely to reflect measurement error. Nevertheless, large effect sizes suggest these reductions in SWS and LRI are clinically meaningful. Comparisons among the LR, MR, and HR groups revealed no significant differences or meaningful effect sizes. Conclusion: Combining complementary metrics with inferential statistics confirms that individuals with CLBP walk more slowly and exhibit lower LRI than pain-free controls, while prognostic risk strata do not influence these spatiotemporal gait parameters.
Background: Muscle thickness (MT) measurement using ultrasound image is emerging as a useful method to assess muscle mass during stretching. Traditionally, range of motion (ROM) measurements assessed by digital inclinometer are considered reliable and valid parameter for monitoring muscle flexibility. The ultrasound-based measurement for MT to monitor muscle flexibility has yet to be validated. Objects: This study aimed to determine whether ultrasound measurement can serve as a valid alternative to a digital inclinometer for assessing muscle flexibility following stretching interventions. Methods: A randomized crossover design study was conducted with 20 healthy young participants. The stretching exercise program was carried out passive static and hold-relax proprioceptive neuromuscular facilitation stretching exercises applied on gastrocnemius-soleus muscle group with 3 times a week for 2 weeks. Data were collected 3 times for pre- and post-tests. Dorsiflexion ROM was measured by a digital inclinometer and the MT of gastrocnemius muscle by the ultrasound. Intraclass correlation coefficient (ICC) analysis for test-retest reliability, Wilcoxon sign rank test for stretching effects, and Spearman’s correlation analysis for determining the concurrent validity of two measurements. Results: ICC values of pre- and post-tests in both ROM and MT measurements were showed good to excellent intra rater reliabilities ranging from 0.782 to 0.968 (p < 0.001). A significant increase in the ROM measurements was observed following the stretching program (p < 0.01), whereas no significant change in the MT measurement was showed. Spearman’s correlations revealed weak relationships between the ROM and MT measurements (r = –0.217 for pre-test, r = –0.259 for post-test, r = –0.282, p < 0.05 for changes). Conclusion: These findings suggest that both the MT and ROM measurements were not compatible for monitoring muscle flexibility following stretching exercises regardless of their good reliabilities. Further investigations may be required to the MT measurement alone to be an alternative method. 키워드1 (원어) Muscle flexibility, Proprioceptive neuromuscular facilitation, Static stretching, Ultrasound imaging
