OBJECTIVES:This study aimed to comprehensively evaluate and compare upper extremity functions and health-related quality of life (HRQoL) between Non-specific neck pain (NSNP) patients and healthy controls. METHODS:This is a cross-sectional descriptive study included 80 individuals. The patient group comprised 40 NSNP patients, while the control group consisted of 40 healthy women. Upper extremity functions were assessed using Nine Hole Peg Test (9HPT), Disabilities of the Arm, Shoulder and Hand (DASH), hand grip and pinch strength, Ruler Drop Test (RDT), Shoulder Position Sense and Single Arm Military Press Test (SAMP). HRQoL was assessed using the Short Form-36 (SF-36). Neck pain was assessed using the Visual Analogue Scale (VAS) and neck disability using the Neck Disability Index (NDI). RESULTS:The patient and control groups showed statistically significant differences for 9HPT, SAMP, RDT, DASH scores, and hand grip and pinch strengths (p<0.05). All subcategories of HRQoL were statistically significantly lower in patients than in control group (p<0.05). CONCLUSIONS:Compared to healthy controls, women with NSNP demonstrated worse upper extremity function and HRQoL. Assessment of upper extremity function may be considered as part of routine evaluation, and rehabilitation programs could consider incorporating targeted interventions to enhance these functions. CLINICALTRIALS:gov ID: NCT06233006.
Hypermobile Ehlers-Danlos Syndrome (hEDS), a connective tissue disorder also known as Ehlers-Danlos Syndrome Type III or Ehlers-Danlos Syndrome Hypermobility Type, and Autism Spectrum Disorder (ASD), a neurodevelopmental disorder, present notable symptom overlap and higher than expected level of comorbidity. A recent systematic review and meta-analysis found that the overall prevalence of joint hypermobility in autistic individuals was 22.3%, rising to 31% when clinically assessed. The overall prevalence of Ehlers-Danlos Syndrome or Hypermobility Spectrum Disorder was 27.9%, rising to 39% when clinically assessed rather than self-reported. This comorbidity is likely underrepresented due to factors including gender-related underdiagnosis, limited awareness, and fragmented care. Despite this, research at the disorders' intersection remains limited. In this narrative review, we aim to (i) examine hEDS and ASD from a clinical and molecular perspective; (ii) review literature regarding the WNT/β-catenin pathway and matrix metalloproteinases' involvement in fibroblast phenotypes, extracellular matrix regulation, and synaptogenesis; and (iii) evaluate how pathway dysregulation may connect each disorder's tissue and neurodevelopmental traits. Although both disorders remain pathophysiologically elusive, we hope to shed light on their co-occurrence and promote future research by exploring how these disorders are possibly linked, specifically via WNT/β-catenin and matrix metalloproteinase activity.
OBJECTIVES:Jumping mechanography is a common method to analyze muscle function. To date, mainly age- or weight-specific pediatric reference centiles for jumping mechanography have been published. The use of age-related references in children with small stature (defined as height below the age-specific third centile) might lead to misinterpretation of actual jumping performance. Thus, the study aim was the development of height-specific mechanography reference centiles of healthy children and show application in children with small stature. METHODS:Data from 882 children (aged 6-18 years; height 100-200cm) from the DONALD cohort was analyzed using the LMS (lambda-mu-sigma)-method. Sex-specific centiles were calculated for maximal velocity (Vmax), Nerve-Muscle Index (NMI), maximal power (Pmax) and maximal force (Fmax), both related to body mass. Age- and height-specific jumping parameters were individually compared in healthy children with small stature. RESULTS:Vmax, Pmax and NMI increased with higher stature until a plateau was reached. Fmax stayed rather stable over time. Age-specific z-scores of Vmax, Pmax and NMI in children with small stature were lower than the height-specific z-scores. CONCLUSIONS:In this article first height- and sex-specific reference centiles for jumping mechanography in healthy German children are presented. This study highlights the beneficial application of height-specific reference centiles for interpretation of jumping performance in children with small stature.
This systematic review and meta-analysis evaluated the association between vitamin D status or vitamin D-related interventions and outcomes following lumbar spinal fusion. PubMed/MEDLINE, Scopus, and Web of Science were searched from inception to January 2026 in accordance with PRISMA guidelines. Studies including adult patients undergoing lumbar fusion with assessment of vitamin D status or supplementation and a comparator group were eligible. Random-effects models were used as the primary analyses. Nine studies were included. Five studies (n = 351) assessed radiographic fusion success, demonstrating a significantly higher likelihood of fusion in patients with better vitamin D status or supplementation (RR 1.25, 95% CI 1.13-1.38; I2 = 0%). Six studies (n = 3,081) evaluated fusion failure, showing a significantly lower risk in vitamin D-exposed groups (RR 0.45, 95% CI 0.27-0.76; I2 = 34.8%). Sensitivity analyses indicated that heterogeneity was partly related to differences in outcome definitions and study design. Patient-reported outcomes showed inconsistent results, with no significant effects in random-effects analyses and changes below minimal clinically important differences. Vitamin D exposure was associated with improved radiographic outcomes; however, findings should be interpreted cautiously due to clinical and methodological heterogeneity. Further prospective studies are required.
OBJECTIVE:To investigate the association between foot health, musculoskeletal pain, and HRQoL in adults residing in the Makkah region, Saudi Arabia. METHODS:A cross-sectional study was conducted between December 2024 and June 2025 among 396 adults aged 19-60 years. Participants completed an online survey including the Foot Health Status Questionnaire (FHSQ), the Arabic RAND-36 HRQoL survey, and the Nordic Musculoskeletal Questionnaire. Descriptive statistics, Spearman correlation analyses, and multivariable linear regression models were used to examine associations and predictors of foot health outcomes. RESULTS:The 12-month prevalence of MSK pain was 90.2%, most commonly affecting the lower back (64.9%), shoulders (63.4%), and neck (51.3%). Significant positive correlations were observed between FHSQ domains (p < 0.001). General foot health was positively associated with social functioning and vigor. Male sex was associated with better foot health outcomes, while obesity and smoking were associated with poorer scores in several domains. CONCLUSION:MSK pain is highly prevalent and associated with poorer foot health and reduced aspects of HRQoL. Integrated assessment of foot and musculoskeletal health may improve functional outcomes and well-being in community populations.
OBJECTIVE:Chronic lumbosacral radiculopathy (LSR) patients frequently complain of recurrent chronic lumbopelvic pain. The poor lumbopelvic (LP) control may be related to this chronic pain in LSR. We aimed to investigate the relation of sagittal LP control with pain sensitivity and intensity in chronic LSR females. METHODS:This study included forty females with chronic unilateral discogenic LSR (30-46 years old). Their low back pain intensity was 6.87±1.02 by visual analogue scale (VAS). The sagittal LP control and pain sensitivity and intensity were assessed for all patients using a pressure biofeedback unit during prone hip extension task, a digital pressure algometer applied at low back area and four sciatic valleix spots, and the VAS, respectively. RESULTS:A moderate significant negative relation was found between sagittal LP control and pain sensitivity at low back point (r = -0.48, p = 0.002). There was a moderate to strong significant negative relation between sagittal LP control and pain sensitivity at the different sciatic valleix spots. In addition, a strong positive correlation between poor sagittal LP control and pain intensity was found (r= 0.69, p < 0.001). CONCLUSION:Poor lumbopelvic control may be highly related with pain sensitivity and intensity in chronic LSR females.
OBJECTIVES:To investigate the acute effects of passive stretching and explosive effort countermovement jumps on spinal reflex excitability and sit-to-stand electromyography patterns and vertical stiffness, in active adults. METHODS:A randomised within-participant crossover design was utilised, with 10 males and 10 females completing two separate sessions, each involving three sets of 60-seconds passive stretching (PS) and five sets of 20 explosive effort (EE) countermovement jumps (100 total); measures taken pre-intervention, post-PS and post-EE. RESULTS:Spinal reflex excitability decreased in both post-PS and post-EE conditions (p < 0.001) compared to pre-condition measures, with no sex effect (p = 0.115). A condition × sex interaction revealed lower spinal reflex excitability in females post-EE (p = 0.002) compared to males. Biomechanically, sit-to-stand vertical stiffness increased in both post-PS and post-EE conditions (p < 0.001) compared to pre-condition, and electromyography patterns were influenced by both condition and sex (p ≤ 0.047). CONCLUSIONS:Our findings provide insight into the neurophysiological-biomechanical link warranting further investigation as a potential mechanism contributing to the known sex-based differences in lower limb injury risk, informing our understanding of movement control, rehabilitation, and injury prevention strategies.
OBJECTIVES:The study compared acute neuromuscular responses to three work-equivalent whole-body vibration (WBV) protocols in highly trained adolescent soccer players. METHODS:Thirteen male soccer players (16.2 ± 0.3 years, BMI = 24.5 ± 1.5 kg/m2) completed a counterbalanced crossover study, performing on separate visits three WBV protocols: (P1) 1 x 3 min, (P2) 3 x 1 min, and (P3) 6 x 30 s. Knee extension maximal voluntary isometric contraction (MVIC) and vastus lateralis EMG (root-mean-square, RMS) were measured at baseline and at 2, 5, and 15 min post-WBV, followed by two CMJ trials at baseline (best retained) and one CMJ trial post-WBV. Time-to-peak torque (TPT), rate of torque development (RTD), and neuromuscular efficiency (NME) were also evaluated. RESULTS:No significant main effects of protocol or protocol-by-time interactions were observed across outcomes. Non-protocol effects were observed for EMGRMS normalized to baseline (%) (time, period, and carryover) and for carryover in RFD0-80 and CMJ power. Estimated effects were small, with wide confidence intervals. CONCLUSIONS:Among highly trained adolescent soccer players, a 3-min, work-equivalent WBV exposure administered as 1 x 3 min, 3 x 1 min, or 6 x 30 s did not produce clear protocol-dependent changes in knee extensor isometric performance, neuromuscular indices, or CMJ performance within 2-15 min post-intervention. Any effects appear minimal relative to inter-individual variability.
OBJECTIVES:This study investigated (1) whether additional cognitive loads impair dual-task walking, especially when crossing obstacles of varying heights, and (2) if extreme gradient boosting (XGBoost) could identify key features of walking while texting. METHODS:Twenty participants completed the following conditions: baseline walking, Task (walking + Typing: copying sentences, or Texting: answering questions), Obstacle (walking + crossing obstacles of three heights: low, medium, high), and combined (Task + Obstacle). For texting performance, we computed the rate, accuracy, and dual-task cost (DTC). Gait measures included mean spatiotemporal parameters, coefficient of variation (%CV) for each parameter, and mediolateral trunk acceleration. Four machine learning models were trained for evaluation: K-Nearest Neighbor, Support Vector Machines, and Random Forest, XGBoost. RESULTS:XGBoost achieved the best performance, with a test weighted F1 score of 0.848, and identified rate, %CV for step and stride time, and DTC of rate as the most important features for classification of conditions. Task × Obstacle interaction was found for %CV of step time with greater variability during high obstacle crossing while Texting (β=1.742, p=0.029). CONCLUSIONS:Findings demonstrate that mobile phone use increases walking variability, particularly in complex environments. The result may lend weight to growing concerns about mobile phone use while walking in young adults.
OBJECTIVES:The visual system is essential for postural control, and visual input significantly affect balance. This study investigated whether a structured oculomotor exercise program improves static balance in basketball, football, and boxing. METHODS:Of the 138 athletes initially randomized (69 per group), 128 completed the study and were included in the final analysis. Participants in the experimental group (EG, n=64) performed oculomotor exercises alongside usual training, whereas those in the control group (CG, n=64) continued usual training alone for six weeks. Static balance was assessed using the Stork test (s) and the Leonardo Mechanograph® platform, with between-group differences analyzed using adjusted post-intervention comparisons. RESULTS:The EG demonstrated significantly greater improvements than the CG in both primary outcomes. Stork test standing time increased (adjusted mean difference [EG - CG] = 22.82 s, 95% CI: 19.54-26.10; p < .001). Ellipse area during dominant-leg stance with eyes open decreased (adjusted mean difference = -4.20 cm2, 95% CI: -5.10 to -3.30; p < .001), indicating better balance. No significant effect modification was observed for sex, years of sport experience, or weekly training volume (all p > 0.26). CONCLUSIONS:Oculomotor exercises were associated with improved static balance over 6 weeks, suggesting they may be a promising addition to athletic training. CLINICALTRIALS:gov ID: NCT07430384.
OBJECTIVE:To investigate whether adding kinetic control retraining to conventional physical therapy improves trunk muscle electromyographic (EMG) activity, pain, and disability in patients with lumbosacral radiculopathy in a randomized controlled trial. METHODS:Fifty patients (35-50 years) were randomly assigned to a study group (kinetic control plus conventional therapy) and an active control group (conventional therapy) for six weeks. EMG activity of transversus abdominis (TA), erector spinae (ES) and superficial multifidus (MF) was assessed during trunk flexion/extension as root mean square (RMS) normalized to maximum voluntary isometric contraction (%MVIC). Pain and disability were assessed using Visual Analog Scale (VAS) and Oswestry Disability Index (ODI). Outcomes were assessed by a blinded assessor who was unaware of group allocation at baseline and post-intervention. RESULTS:Both groups showed improvements (p < 0.05). However, the study group showed greater reductions in ES and MF activity, VAS, and ODI, and increased TA activation compared with controls, suggesting clinical improvement. No adverse events. CONCLUSION:In patients with lumbosacral radiculopathy, adding kinetic control retraining to conventional physical therapy was associated with greater short-term improvements in trunk muscle activation patterns, pain, and disability than conventional physical therapy alone. However, these findings do not isolate the independent effect of kinetic control retraining. CLINICALTRIALS:gov ID: NCT07079202.
OBJECTIVES:To examine the anticipatory effect on lower extremity muscle activation during single leg drop landing and jumping. METHODS:Seventeen healthy males performed single leg drop landing and jumping, under conditions manipulating the subsequent movement after landing. Participants performed the anticipated condition (subsequent movement-land/jump-was preplanned), followed by the unanticipated condition (subsequent movement was given via visual signals). Electromyography of the gluteus medius (GM), rectus femoris (RF), vastus medialis (VM), semitendinosus (ST), biceps femoris (BF), tibialis anterior (TA), and medial gastrocnemius (MG) were obtained. The time of onset, time-to-peak amplitude (from onset or initial contact), and peak amplitude were compared (p<0.05). RESULTS:Overall, under the unanticipated condition, the time (0 = initial contact) of onset of RF (-101 ms vs. -245 ms), TA (-116 ms vs. -232 ms) and MG (-122 ms vs. -180 ms) and time-to-peak amplitude (from initial contact) of RF (223 ms vs. 13 ms), ST (111 ms vs. -9 ms), and MG (79 ms vs. -41 ms for unanticipated and anticipated, respectively) were delayed compared to anticipated condition. CONCLUSIONS:When visual cues were unanticipated, participants demonstrated delayed and redistributed muscle activation timing during single leg landing and jumping.
OBJECTIVES:This pilot study compared the effects of Active Vibration Exercise (AVE) involving dynamic movements and static Whole-Body Vibration Exercise (WBVE) on deep trunk muscle activation, dynamic balance, and peripheral circulation in healthy adults. METHODS:Ten participants were randomly assigned to AVE or WBVE groups (n=5 each) for two weeks of twice-daily 5-minute sessions. Primary outcomes measured deep trunk muscle (internal oblique [IO] and multifidus) activation via surface electromyography. Secondary outcomes assessed dynamic balance, peripheral circulation, grip strength, and flexibility. RESULTS:Within-group comparisons indicated no significant pre-to-post changes for either group. However, between-group change score analysis showed a statistically significant difference in left IO activation (p=0.032, effect size r=0.694), favoring the AVE group. Both groups showed non-significant numerical improvements in skin temperature, balance, and flexibility. CONCLUSIONS:These preliminary findings suggest that integrating dynamic movements with vibration (AVE) may be more effective for specific deep trunk muscle activation than static WBVE. Further large-scale trials are needed to confirm AVE's therapeutic value for core stabilization due to this study's limited sample size.
OBJECTIVES:To examine the influence of vision and somatosensory information on anticipatory postural adjustments (APA) and compensatory postural adjustments (CPA) in response to an external perturbation in older adults. METHODS:Twenty healthy older adults were included in the study. Postural stability was tested under four different vision and surface support conditions using a sandbag drop while the participants were holding a tray. Electromyography (EMG) latency, amplitude amplitude - root mean square (RMS) of the erector spinae (ES) and lateral gastrocnemius (LG) muscles and centre of pressure (COP) displacement were recorded. RESULTS:Significant differences in muscle activity and COP displacements were observed across visual and somatosensory conditions. LG activity and compensatory COP displacement (CPA-COP) were significantly greater under eyes-closed and unstable surface conditions (ECUS). This indicates that the absence of visual input and altered somatosensory feedback independently and collectively amplify compensatory postural responses. Anticipatory responses were less effective under sensory- compromised conditions. CONCLUSIONS:Both vision and somatosensory inputs critically influence APA and CPA in older adults. Visual deprivation and unstable surfaces reduce the efficiency of APA and heighten CPA, reflecting the need to address both systems in balance training.
OBJECTIVES:To determine the relationship between age, hamstring tightness, trunk flexibility, and lumbar lordosis angle (LLA), and examine how these variables relate independently of age. Furthermore, we identified the most significant predictor of LLA in sedentary adult females with hamstring tightness. METHODS:This cross-sectional study included 80 sedentary adult females (20-59 years old) with hamstring tightness, which was assessed using the active knee extension (AKE) and straight leg raising (SLR) tests with a universal goniometer. Trunk flexibility was assessed using the fingertip-to-floor test, and the LLA was evaluated non-radiographically using a flexicurve (flexible ruler). RESULTS:A significant correlation was observed between age and all examined variables (p < 0.001). Specifically, age was associated with increased fingertip-to-floor distance, suggesting reduced trunk flexibility (β = 0.756), and increased SLR (β = 0.517) and AKE (β = 0.424) angles, indicating increased hamstring tightness. Furthermore, age was the significant independent predictor (p < 0.001) of LLA. CONCLUSIONS:Age is significantly correlated with decreased flexibility and reduced lumbar lordosis angle in adult females. Among the variables examined, age was the significant independent predictor of LLA. These findings highlight the need for early detection and management of age-related musculoskeletal alterations to maintain proper spinal alignment and functional mobility.
OBJECTIVES:This study compared the acute effects of static stretching (SS) and the Mulligan bent leg raise (BLR) technique on hamstring flexibility and jumping performance in asymptomatic young adults. METHODS:Forty-two participants with bilateral hamstring tightness were randomly assigned to the SS or BLR group (n = 21 each). Active knee extension (AKE), vertical jump (VJ), and single-leg hop (SLH) performance were assessed before and immediately after a single intervention session. RESULTS:A significant main effect of time was found for all outcomes (p < 0.05). Significant time × method interactions were observed for AKE and SLH, but not for VJ. The BLR group showed greater improvements in hamstring flexibility (AKE: +6.38°) compared with the SS group (+2.10°). SLH performance improved more in the BLR group, whereas VJ improvements were similar between groups. After adjusting for baseline AKE differences, post-intervention AKE remained significantly higher in the BLR group. CONCLUSION:Both SS and BLR produced beneficial acute effects on hamstring flexibility and jumping performance. BLR demonstrated larger acute improvements in hamstring flexibility and single-leg hop performance in this sample; however, these findings should be interpreted cautiously and may not be directly generalizable to athletic populations. CLINICALTRIALS:gov ID: NCT07138950.
OBJECTIVES:This study aimed to examine the effects of unilateral long-duration static stretching (LS) on range of motion (ROM), musculotendinous unit (MTU) stiffness, muscle thickness (MT), strength, and contralateral effects (CE) in young men with hamstring tightness. METHODS:Sixty-eight young men (22.0 ± 1.7 years) were randomly assigned to one of four groups: LS, typical-duration static stretching (SS), hamstring resistance exercise (HRE), or control. ROM, MTU stiffness, MT, and knee-flexor peak torque were assessed at baseline, after the 6-week intervention, and at the 3-month follow-up. RESULTS:ROM improvement after the 6-week was observed across the LS, SS, and HRE groups (all p<0.05). Significant decreases in MTU stiffness were observed, with reductions of 0.13 Nm/deg in the hamstrings for both the stretching groups (all p<0.05). At the 3-month follow-up, reductions in MTU stiffness remained evident in the LS group. A significant time effect was observed for bilateral peak torque without interaction or group effects, while MT showed no changes. CONCLUSIONS:One hour of hamstring stretching did not result in superior improvements in ROM, MTU stiffness, or morphological and CE adaptations compared to other exercise modalities. Nevertheless, SS remains a time-efficient approach to enhance flexibility and mechanical properties in a home-based setting. CLINICAL TRIAL REGISTRATION:Thai Clinical Trials Registry (TCTR20250219007).
OBJECTIVES:This study evaluated the effect of sensory re-education on quality of life and sensation in patients with post-COVID-19 polyneuropathy. METHODS:Forty patients with post-COVID-19 polyneuropathy were randomly assigned to a study group (Group A) or a control group (Group B), each with 20 participants. Group A received a sensory re-education protocol plus the traditional physiotherapy, including proprioceptive neuromuscular facilitation (PNF) and strengthening exercises for wrist extensors, hand grip, and thumb opposition. Group B received the traditional physiotherapy alone. Both groups were treated for one hour, three times weekly, for six weeks. Quality of life was assessed using the Arabic WHOQOL-BREF. Tactile sensation was assessed using the Semmes-Weinstein Monofilament (SWM) test, and proprioception via the laser-pointer angle reproduction test (LP-ART). Assessments were performed pre- and post-intervention. RESULTS:Both groups showed significant pre- to post-treatment improvements in quality of life, proprioception, and tactile sensation (p≤ 0.05). Group A demonstrated significantly greater gains in quality of life and proprioception compared to Group B (p≤ 0.05), but no statistically significant difference between groups in tactile sensation (p> 0.05). CONCLUSION:Sensory re-education, when integrated into traditional physiotherapy, significantly improves quality of life and proprioception in post-COVID-19 polyneuropathy but does not significantly affect tactile sensation. These findings support incorporating sensory re-education into rehabilitation protocols to enhance functional outcomes in this population. CLINICALTRIALS:gov ID: NCT05911113.
