Spasticity often results from maladaptive neuroplastic changes in both the affected and nonaffected primary motor cortex (M1) that are accompanied by downstream effects on descending motor pathways. The aim of this study was to compare the effects of anodal transcranial direct current stimulation (a-tDCS) over the affected M1 and cathodal tDCS (c-tDCS) over the unaffected M1 in patients with stroke. Thirty-nine patients were divided into the following three groups with a block randomization method: (1) affected M1 a-tDCS, (2) unaffected M1 c-tDCS, and (3) sham tDCS. Additionally, all groups received routine physiotherapy (PT). Electromyographic activity of the lateral gastrocnemius (LG) and tibialis anterior (TA) muscles during passive and active dorsiflexion/plantarflexion (DF/PF), as well as the modified Ashworth scale (MAS) and the World Health Organization Quality of Life Questionnaire (WHOQOL), were assessed before, immediately, and 2 weeks after the interventions. The results indicated that TA activity during active DF increased immediately following the intervention in the affected M1 a-tDCS group compared to the other groups (p < 0.001). LG activity during both active and passive DF decreased, MAS and WHOQOL scores increased immediately and 2 weeks after the intervention in the a-tDCS group (p < 0.001). These findings highlight the immediate and short-term efficacies of affected M1 a-tDCS combined with PT in improving muscle spasticity and function, QOL in these patients. Trial Registration: IRCT20230104057044N1.

OBJECTIVES:Conservative management of shoulder adhesive capsulitis primarily relies on physical therapy, with non-thrust joint mobilization representing a fundamental component. This systematic review compared the clinical effects of different non-thrust joint mobilization approaches on objective and subjective outcomes among individuals with shoulder adhesive capsulitis. METHODS:English-language randomized controlled trials published between January 1, 2000, and November 30, 2025, were identified by systematically searching PubMed, the Cochrane Central Register of Controlled Trials, Web of Science, Scopus, and ScienceDirect. Eligible trials evaluated the clinical effects of different non-thrust joint mobilization approaches, delivered alone or in combination with other interventions, on objective and subjective outcomes in individuals with shoulder adhesive capsulitis. RESULTS:The Mulligan mobilization approach, compared with the Maitland mobilization approach, was more effective in restoring ranges of shoulder abduction and external rotation and decreasing shoulder pain and disability, with mean differences of 1.49 (95% CI: 0.91 to 2.07), 1.26 (95% CI: 0.85 to 1.67), and -1.23 (95% CI: -2.39 to -0.07), respectively. In addition, the random-effects model exhibited a statistically significant difference between posterior and anterior Kaltenborn mobilization techniques in the range of shoulder external rotation, with a mean difference of 2.56 (95% CI: 1.92 to 3.19). CONCLUSIONS:The comparative effects of non-thrust joint mobilization techniques in adhesive capsulitis appear to be technique-specific and outcome-dependent. Although Mulligan and posterior Kaltenborn mobilization showed favorable effects for selected outcomes, the certainty of evidence was very low. Therefore, no single mobilization technique can currently be recommended as universally superior.

Age-related declines in motor performance are associated with reduced cortical excitability and impaired neuroplasticity. Noninvasive transcranial electrical stimulation (tES) can improve motor learning, but the comparative efficacy of anodal transcranial direct current stimulation (a‑tDCS) and anodal transcranial pulsed current stimulation (a‑tPCS) in older adults with mild cognitive impairment (MCI) is unclear. This study aimed to compare the effects of a-tDCS and a-tPCS on motor learning and cortical activity in older adults with MCI. Thirty‑nine older adults (age 60–75 years; Montreal Cognitive Assessment (MoCA) 18–23) were randomized to a‑tPCS (n = 13), a‑tDCS (n = 13), or sham (n = 13). Stimulation (2 mA, 20 min) was applied over left M1 during five daily sessions of a Serial Reaction Time Task (SRTT). Behavioral outcomes were reaction time (RT) and error rate (ER). Electroencephalography (EEG) absolute and relative spectral power (theta, alpha, beta), magnitude‑squared coherence (MSC), and imaginary coherence (ICoh) between C3–C4 were measured at baseline, after five intervention sessions, and at two‑week follow‑up. Both a-tPCS and a-tDCS significantly increased alpha and theta spectral power, increased MSC, decreased ICoh, and reduced RT and ER relative to sham (p < .001). a-tPCS produced significantly greater initial changes than a-tDCS in absolute alpha power, relative theta power, alpha and theta MSC, and RT (p < .001). At follow-up, a-tPCS maintained significant changes compared to sham in absolute alpha power, absolute theta power, alpha MSC, and RT (p < .001). In contrast, the effects of a-tDCS showed notable decline over time, with only modest lasting benefits primarily observed in absolute theta and alpha power and beta MSC. Both techniques facilitate motor learning in older adults with MCI, but a‑tPCS caused stronger and more enduring neurophysiological and behavioral effects in this sample. The protocol of this trial was registered at Iranian Registry of Clinical Trials (registration number: IRCT20151228025732N79; July 30, 2023) available at https://irct.behdasht.gov.ir/search/result?query=IRCT20151228025732N79.

OBJECTIVE:The purpose of this study was to evaluate the effects of chest physiotherapy on respiratory function during rest sitting and stationary bicycle in participants hospitalized for a period with respiratory involvement after SARS-CoV-2 infection. METHODS:This study was a randomized, single-blinded, controlled study. Forty-four participants after SARS-CoV-2 met the inclusion criteria and were randomly assigned to the 2 groups. The study intervention included a program of 10 sessions of supervised chest physiotherapy (intervention) and without any intervention (control) groups. They were assessed on 2 sessions before and after the intervention according to the respiratory function, including time of inspiration (TI), time of expiration (TE), peak inspiratory flow (PIF), peak expiratory flow (PEF), forced vital capacity (FVC), and forced expiratory volume 1/forced vital capacity (FEV1/FVC). This assessment was done on 2 situations: during rest sitting position on the table and during stationary bicycle for 20 minutes. RESULTS:Analysis of variance revealed that the effect of time was significant for the PEF and FVC. Moreover, the interaction effect of "time and group" was significant for the TE, PEF, FEV1, and FEV1/FVC. A group difference was revealed for the TE, FEV1, and FEV1/FVC after the intervention. The paired t-test indicated that the PEF, FEV1, and FEV1/FVC increased in the intervention group when the spirometry was done in the sitting position (P ≤ .05). Independent t-test also showed that the FEV1 (P = .008) and FEV1/FVC (P = .004) significantly increased in the intervention group compared to the control group during sitting spirometry (P ≤ .05). Moreover, FEV1/FVC (P = .002) was decreased in the intervention group when the spirometry was done during stationary bicycle. CONCLUSION:In this study, patients after SARS-CoV-2 had improved respiratory functions and functional activities after 10 sessions of therapy.

Transcranial direct current stimulation (tDCS) is an effective rehabilitation strategy that promotes motor learning. The related studies reported different findings through different modalities of tDCS over different brain regions. This study aimed to identify the optimal effects of tDCS on motor learning through a systematic review and network meta-analysis, focusing on determining the best electrode montage and assessing the efficacy of various tDCS configurations. The search was performed from PubMed, Scopus, and Web of Science databases from inception until April 15, 2022. Nineteen eligible studies were included in the study. The findings indicated that motor cortex (M1) a-tDCS and cerebellar a-tDCS significantly enhance motor learning (short-term and long-term efficacy on both parameters of motor learning; Response Time (RT) and Error Rate (ER)) more than posterior parietal cortex (PPC) a-tDCS (P < 0.5,0.65 to 90 % in SUCRA). Dual site tDCS enhances motor learning (efficacy on parameters of motor learning; RT and ER), with more efficacy as compared to unilateral tDCS (P < 0.05, 78 % to 84 % in SUCRA). In addition, the findings indicated that PPC a-tDCS has the least efficacy of motor learning as compared to the other tDCS interventions (P < 0.05, 0.5 % to 0.13 %). It is suggested that dual site tDCS and M1 or cerebellar a-tDCS be used, as compared to other tDCS interventions in other brain regions, for the improvement of motor learning.

Introduction: The aim of this study was to investigate the immediate effect of real and sham kinesiology tape on the H-reflex recruitment pattern of the gastrocnemius muscle and its performance in athletes with trigger points of this muscle. Methodology: Thirty-eight athletes (13 women and 25 men) with trigger points in the gastrocnemius muscle were allocated to either the kinesiology tape group or the sham tape group. Standard adhesive elastic kinesiology tape was used for inhibitory application in the kinesiology tape group. The kinesiology tape group received real elastic kinesiology taping on the gastrocnemius muscle, while the sham tape group received a placebo application. In the sham group, the kinesiology tape was applied horizontally above the navel without any tension. After a 3-day washout period, participants switched groups (sham to real, and vice versa). Outcome measures included the H-reflex recruitment curve of the lateral gastrocnemius muscle and functional performance tests, recorded by a blinded evaluator. The primary H-reflex parameters included: threshold, ascending slope of the recruitment curve, stimulation intensity required to record maximum H, descending slope of the curve, final intensity of the curve, Hmax/Mmax ratio. Functional tests included a 20-m sprint and a vertical jump. Results: H-reflex parameters (maximum H current intensity and descending slope) were inhibited following real taping. In the sham group, H-reflex parameters (maximum H current intensity, final H, and descending slope) were also inhibited compared to the real group. The jump height in the sham group was lower than in the real group, and jump height in both groups decreased after the intervention compared to before. Conclusion: Kinesiology taping led to inhibition of motor neuron excitability in the gastrocnemius muscle.

Repeated transcranial magnetic stimulation (rTMS) is a technique used to enhance motor learning in older adults. Some studies have shown that applying rTMS to the primary motor cortex (M1) and the cerebellum enhances motor learning. This study investigates the effects of M1 rTMS and cerebellar rTMS on motor learning in older adults. Seventy healthy older participants were randomly divided into M1, cerebellar rTMS, and sham rTMS groups. Participants completed the Serial Reaction Time Task (SRTT), while receiving 10 min of 10 Hz rTMS, with the sham group receiving inactive stimulation. Reaction time (RT) and error rate (ER) were recorded before, immediately, and 48 h post-task. RT and ER decreased immediately after the SRTT in all groups (P < 0.001). Both intervention groups showed greater online motor learning than the sham group (P < 0.05). Additionally, both intervention groups exhibited offline motor learning and learning consolidation with more significant changes in the cerebellar-rTMS group during lasting time (P < 0.03), whereas the sham rTMS group could not maintain motor learning (P > 0.05). The findings suggest that both M1 and cerebellar rTMS enhance motor learning in healthy older adults, with cerebellar rTMS being more effective in consolidating motor learning.

INTRODUCTION:Plantar Fasciitis (PF) is a common foot disorder. Kinesio Taping (KT) and dry needling (DN) are frequently used treatment options; however, their comparative efficacy remains poorly understood. This study aimed to evaluate and compare the effects of KT and DN on pain, functional performance, and plantar fascia thickness in patients with PF. METHODS:In this single-blinded randomized controlled trial, 52 PF patients (30 women and 22 men; mean age 45.3 ± 8.1 years) were randomly assigned to DN, KT, and control groups. All groups received routine physiotherapy five days per week. Pain, functional performance, and plantar fascia thickness were evaluated at three time points: before, immediately, and two weeks post-intervention. Assessments included the Visual Analog Scale (VAS) for pain, the Foot and Ankle Outcome Score (FAOS) for performance, and ultrasonography for plantar fascia thickness. RESULTS:VAS scores decreased significantly across all groups immediately post-intervention (p < 0.05). However, no significant interaction effect was observed, indicating similar pain reduction trends among groups at the two-week follow-up. The mean VAS scores before the intervention were 6.53 ± 0.91 (DN group), 6.07 ± 1.10 (KT group), and 6.00 ± 1.51 (control group), and after the intervention were 4.20 ± 2.00 (DN group), 4.33 ± 1.87 (KT group), and 4.87 ± 2.16 (control group). Both KT and DN groups showed improvements in FAOS score (p < 0.02), with a significant time × group interaction effect favoring greater improvements in the DN group compared to the control group. A significant group effect was observed for D2 thickness, with the DN group showing a greater reduction compared to the KT and control groups (p < 0.002). CONCLUSION:All interventions effectively reduced pain, improved performance, and decreased plantar fascia thickness in PF patients. DN demonstrated superior efficacy in reducing central plantar fascia thickness (D2) compared to KT.

OBJECTIVES:Shoulder mobilization techniques, with and without movement, may restore the range of intra-articular glenohumeral motions and expand the subacromial space during arm abduction. The primary purpose of this study was to measure and compare the acromiohumeral distance at three static angles of passive scapular arm abduction (no arm abduction, 45° of arm abduction, and 60° of arm abduction) in overhead athletes diagnosed with primary subacromial impingement syndrome, before and after shoulder mobilization techniques with and without movement, combined with contemporary physical therapy. METHODS:Fifty-one overhead athletes diagnosed with primary subacromial impingement syndrome were randomly assigned to three parallel groups. One intervention group received the Mulligan shoulder mobilization techniques, whereas the other intervention group received the Maitland shoulder mobilization techniques. Both mobilization approaches were accompanied by contemporary physical therapy and were administered every other day for two weeks. The control group received no specific intervention for two weeks. Using an ultrasound device, the acromiohumeral distance was assessed in the intervention groups one day before and one day after treatment with manual therapy and in the control group at two-week intervals. RESULTS:Both the Mulligan and Maitland approaches significantly increased the acromiohumeral distance at all three static angles of passive scapular arm abduction (p-values < 0.001). In contrast, no significant changes were observed in the control group (p-values > 0.317).The Mulligan approach, compared to the Maitland approach, exhibited significantly greater increases in the acromiohumeral distance at all three static angles of passive scapular arm abduction (p-values < 0.001). CONCLUSIONS:Both the Mulligan and Maitland shoulder mobilization techniques, combined with contemporary physical therapy, significantly increased the acromiohumeral distance at static angles of passive scapular arm abduction in individuals suffering from primary subacromial impingement syndrome. Moreover, the Mulligan approach provided significantly greater improvements in the acromiohumeral distance compared to the Maitland approach.

Individuals diagnosed with multiple sclerosis (MS) are known to face more challenging situations, such as gait initiation (GI), compared to healthy individuals. This provides a deeper insight into the mechanisms that govern dynamic postural control. A search was conducted across several databases, including PubMed, Cochrane, ScienceDirect, Web of Science, Scopus, ProQuest, and Google Scholar. Studies of any design were included if they satisfied the following criteria: the experimental group consisted of individuals with MS or clinically isolated syndrome, the control group included healthy individuals or MS patients, and the studies examined gait patterns across various parameters, such as the center of pressure (COP), center of mass, and anticipatory postural adjustments, while also assessing the gait initiation phase. Utilizing the modified Downs and Black checklist, nine articles were selected for the final analysis. The results indicated deceleration, a reduction in posterior COP displacement, and an increase in COP during anterior GI. Compared with healthy controls, individuals with MS exhibited greater instability during balance recovery and in kinetic parameters of the stance limb. Furthermore, a delay and reduction in muscle activity were noted in individuals with MS who had a history of falls, in contrast to non-falling MS patients and healthy individuals.

CONTEXT:Following a lateral ankle sprain, chronic ankle instability (CAI) subjects show recurrent episodes of giving way, while copers do not exhibit giving way and overcome the challenging condition of postural control. During gait initiation (GI), individuals with CAI reveal shorter center of pressure (COP) displacement and earlier muscle activity compared with healthy controls. Copers have not been previously compared with healthy controls and individuals with CAI during GI. DESIGN:The study design was cross-sectional. METHOD:Sixty participants (20 CAI, 20 copers, and 20 healthy controls) with a right (dominant) limb injury participated in the study based on inclusion and exclusion criteria. The short form of the Tampa Scale of Kinesiophobia was filled out. Participants performed GI with the nonaffected leg on the force plate that was synchronized with Electromyography Megawin for 2 strides. GI was divided into 3 phases based on COP excursion (S1, S2, and S3). Onset time and electromyography activity of both soleus and tibialis anterior muscles were analyzed along with maximum and mean excursion and velocity of COP excursion in the anterior-posterior and medial-lateral directions and the total phases of GI. RESULTS:The results indicated that the copers had a significantly higher peak of COP excursion in the medial-lateral direction during S2 (P = .029), S3 (P = .018), and total phases (P = .018) of GI compared with the individuals with CAI. Additionally, individuals with CAI showed earlier activation of the right soleus compared with healthy controls (P = .022). There was a significant difference in short form of the Tampa Scale of Kinesiophobia scores between individuals with CAI and other groups (P < .001). CONCLUSION:The findings demonstrated that individuals with CAI had earlier soleus activation and supraspinal alteration compared with controls. Copers who had lower Tampa Scale of Kinesiophobia scores exhibited an increased peak of COP excursion in the medial-lateral direction during GI compared with individuals with CAI.

Gait initiation (GI) can be divided into three sections according to the center of pressure (COP) trace (S1, S2, and S3). Almost all studies do not separate each phase of the GI profile in postural control assessment and muscular investigation, whereas differences in the COP and muscles are found in each phase of the GI profile in people with gait problems. Twenty individuals with CAI and twenty healthy controls were included in the present study. A force plate synchronized with Qualisys motion analysis, MEGAWIN electromyography, and a pair of auditory cues were used for data capture. The participants carried out five trials of GI with the affected leg (dominant leg). The peak and mean COP excursions; the mean and maximum velocities of COP excursion during S1, S2,, S3, and the total phases in the mediolateral (ML) and anterior‒posterior (AP) directions; the root mean square (RMS); and the onset activity of the Tibialis Anterior (TA) and Soleus (SOL) muscles for both legs were used for statistical analysis. Independent t tests and Mann‒Whitney U tests were used for statistical analysis on the basis of a significance level of ≤ 0.05. Compared with those of healthy controls, independent t tests revealed a significant decrease in the peak COP excursion in the AP direction during S2 (P = 0.021) and in the mean velocity of COP excursion in the AP direction during S1 (P = 0.044) in the CAI group. Additionally, there was a significant increase in the duration of S1 in the GI profile (P = 0.045) in the CAI group compared with the healthy control group. There was no significant difference in the other COP variables, TA or SOL RMS or onset activity for either leg during S1, S2, or S3 between the two groups (P > 0.065). Individuals with CAI exhibit increased stiffness in the AP direction in the injured ankle. This leads to a reduction in the velocity and peak of COP excursion, as well as an increase in the time required for postural control adjustment. These findings highlight the challenges individuals with CAI may face in meeting postural demands when trying to unload the affected foot. IR.SBMU.RETECH.REC.1402.095, 2023–5-28.

BACKGROUND: Impairment in both the motor and cognitive aspects of postural control is a critical issue in patients with chronic low back pain (CLBP) who experience high pain anxiety (HPA). OBJECTIVE: This study aimed to compare the effects of cathodal and anodal transcranial direct current stimulation (c-tDCS and a-tDCS) over the dorsolateral prefrontal cortex (DLPFC) on postural control during cognitive postural tasks in CLBP patients with HPA. METHODS: This study included 66 patients randomly assigned to three groups: DLPFC a-tDCS, DLPFC c-tDCS, and sham tDCS. All groups received 20 minutes of tDCS, but the stimulation was gradually turned off in the sham group. Postural stability indices were assessed using the Biodex Balance System. RESULTS: Both the a-tDCS and c-tDCS groups showed a significant reduction in most postural stability indices at static and dynamic levels after the interventions (immediately, 24 hours, and one-week follow-up) during the cognitive postural task (P< 0.01). Additionally, there was a significant improvement in postural balance in the a-tDCS and c-tDCS groups compared to the sham tDCS group (P< 0.01). Furthermore, the a-tDCS group showed significantly greater improvement than the c-tDCS group (P< 0.01). CONCLUSION: Based on the results, both a-tDCS and c-tDCS over the DLPFC had positive effects on postural control during cognitive postural tasks in CLBP patients with HPA.

Abstract Whole-body vibration (WBV), a training method based on the stimulation of muscle contraction by mechanical vibration generated in a vibrating platform, is claimed to be effective in diabetes management. This meta-analysis evaluated WBV effects against other exercises, placebo, or no intervention in type-2 diabetes. Medline, Scopus, and Web of Science databases were systematically searched through June 2023. Randomized controlled trials reported the effect of WBV on glucose (hemoglobin A1C and fasting blood glucose), and lipid profiles (total cholesterol, triglycerides, high, and low-density lipoprotein) were included. Two researchers independently extracted the characteristics of the studies, participants, WBV intervention and comparisons, and the outcomes from the included articles. The Physiotherapy Evidence Database (PEDro) scale assessed trial quality. In this review, all articles had no high risk of bias according to the PEDro scale, with studies achieving optimal, excellent, and good scores. Network meta-analysis revealed that WBV was effective for reducing hemoglobin A1C when compared with conventional (mean difference: − 1.58%, 95%CrI: − 2.51, − 0.47) and resistance exercise (mean difference: − 1.32%, 95%CrI: − 1.96, − 0.33). WBV had also a desirable but insignificant effect on hemoglobin A1C compared to stretching and balance exercises, placebo, and no intervention. The current pairwise meta-analysis did not show that WBV favors fasting blood glucose and lipids. WBV may have potential advantages for glycemic control in type-2 diabetes. However, uncertainties in the findings remain due to the limited number of studies and their heterogeneity.

Objectives: Myofascial pain syndrome in the popliteus muscle may change motor control in the affected and related muscles due to changes in proprioceptive and nociceptive afferents, which can exacerbate patellofemoral pain syndrome. The primary purpose of the current study was to explore the electromyographic activity of the local and proximal muscles of the knee joint in patellofemoral pain syndrome accompanied by secondary myofascial pain syndrome specifically affecting the popliteus muscle following dry needling. Methods: Myofascial pain syndrome in the popliteus muscle may change motor control in the affected and related muscles due to changes in proprioceptive and nociceptive afferents, which can exacerbate patellofemoral pain syndrome. The primary purpose of the current study was to explore the electromyographic activity of the local and proximal muscles of the knee joint in patellofemoral pain syndrome accompanied by secondary myofascial pain syndrome specifically affecting the popliteus muscle following dry needling. Results: During step-up, the onset and offset latencies of the local and proximal muscles of the knee joint, except for the offset latency of the gluteus maximus muscle (p-value=0.162), significantly decreased in the intervention group compared to the control group (p-value<0.046). Additionally, there were no significant differences (p-value>0.116) between the groups in the amplitude ratio of the local and proximal muscles of the knee joint during both step-up and step-down. Conclusions: The present study revealed that dry needling of the popliteus muscle with secondary myofascial pain syndrome associated with patellofemoral pain syndrome constructively modified the local and proximal motor control of the knee joint during step-up.

Inconsistent results are observed in the effects of transcranial direct current stimulation (tDCS) with different montages on motor learning. This study aimed to compare the effects of anodal and cathodal tDCS (c-tDCS) over primary motor cortex (M1) at different intensities on motor learning in healthy young adults. The participants were randomly divided into: (1) 1 mA M1 c-tDCS, (2) 1 mA M1 anodal tDCS (a-tDCS), (3) 2 mA M1 c-tDCS, (4) 2 mA M1 a-tDCS and (5) M1 sham tDCS groups. The groups received 20-min stimulation with serial reaction time task (SRTT) incidentally, while the tDCS was turned off after 30 s in the sham tDCS group. Response time (RT) and error rate (ER) during SRTT were assessed prior, during and 72 h after the intervention. The results of the paired t-test indicated that online learning occurred in all groups (p < 0.05), except in M1 c-tDCS (1 mA) (p > 0.05). One-way ANOVA analysis also indicated that there were differences in offline learning (RT (F(DF) = 5.19(4); p < 0.001; and ER (F(DF) = 9(4), p < 0.0001) among groups, with more offline learning in 1 mA M1 a-tDCS, 2 mA M1 c-tDCS and 2 mA M1 a-tDCS groups (p < 0.05). On the other hand, the 1 mA M1 c-tDCS group did not indicate any consolidation effect or even a trend toward negative offline learning. M1 a-tDCS with different intensities and also 2 mA M1 c-tDCS may be helpful for the enhancement of motor learning in young healthy adults. This study enhances our understanding of tDCS intensity and polarity effects on motor learning, with potential for optimizing therapeutic protocols.

Polycystic ovarian syndrome (PCOS) is one of the most common endocrine illnesses. There is evidence that exercise training positively affects on improvement of the pathogenic factors in women with PCOS. On the other hand, some studies reported similar effects of aerobic and resistance exercises or no effect of exercises on the improvement of the pathogenic factors. The aim of the current study was to perform a network meta-analysis of RCTs to evaluate the efficacy of exercises on body mass index (BMI), hormone concentrations, and regular menstruation in women with PCOS. The search was performed from databases of PubMed, Scopus, and Web of Science with the keywords of exercise, resistance exercise, aerobic exercise, endurance exercise, yoga, polycystic ovary syndrome, randomized controlled trial based on the CONSORT, BMI, sex hormone and regular menstruation from inception until April 15, 2022. Bayesian random-effects network meta-analyses were performed to calculate mean difference and 95

CONTEXT:To stabilize the humeral head within the glenoid fossa during arm elevation, the rotator cuff muscles may contribute through internal and external rotation. The main purpose of the current study was to compare the acromiohumeral distance between athletes with primary subacromial impingement syndrome who received progressive resistance exercises consisting of either shoulder internal or external rotation. DESIGN:A randomized and controlled clinical study. METHODS:Thirty athletes with primary subacromial impingement syndrome were enrolled and randomly divided into 2 experimental groups. The progressive resistance exercise protocol in experimental group I comprised shoulder internal rotation, while in experimental group II consisted of shoulder external rotation. The experimental groups worked out 3 days a week for 6 weeks. The experimental groups were compared with the control group consisting of 15 healthy athletes. The acromiohumeral distance was measured before and after the intervention using an ultrasound machine under the passive and active across no arm elevation and 45°of arm elevation. RESULTS:The acromiohumeral distance significantly increased in both experimental groups under the passive and active arm positions following the intervention (P < .001), with no significant differences detected between the experimental groups (P > .665). The paired comparisons of the acromiohumeral distance discrepancy indicated a significant difference between the control group and each experimental group under the active and passive arm positions (P < .001), while no significant difference was observed between the experimental groups (P > .999). CONCLUSIONS:The present study revealed, for the first time, that both progressive resistance exercise protocols involving either the shoulder internal or the external rotation increased the acromiohumeral distance in individuals with primary subacromial impingement syndrome and improved associated pain and disabilities.

ObjectiveThe purpose of this study was to evaluate the association of pain-related anxiety on abdominal muscles thickness during standing postural tasks among individuals with chronic low back pain (CLBP).MethodsWe obtained responses to a pain-related anxiety symptoms questionnaire from 50 participants with CLBP. We then separated participants into high (11 men, 14 women) and low pain-related anxiety (13 men, 12 women) groups and compared assessments of their lateral abdominal muscles thickness during standing tasks on a computerized balance assessment device, using one static level and 2 movable levels (levels 6 and 3 are represented easy and difficult tasks respectively).ResultsWe found a significant interaction effect of standing difficulty (2 levels) and abdominal muscle thickness (transverse abdominis, oblique internal and oblique external muscles) (p< .001, effect size= .7). The high pain-related anxiety group exhibited greater abdominal muscle thickness during standing postural tasks compared with the low pain-related anxiety group (p< .05, mean difference= .04-.06) except for the internal oblique muscle during the difficult standing task (p=.2).ConclusionWe suggest that, among individuals with CLBP, pain-related anxiety and psychological pain-related anxiety may be possibly associated with abdominal muscles thickness during dynamic standing.