Aim The purpose of this systematic review was to investigate the effects of rocker sole shoes on temporal-spatial parameters, kinematics, kinetics, plantar pressure, and electromyography (EMG) activity during walking. Method A systematic search was conducted in the PubMed, Web of Science, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL) databases. The search keywords included rocker sole, rocker bottom shoe, gait parameters, kinematics, kinetics, pressure, and EMG. The risk of bias in the included studies was assessed using a modified Downs and Black scale. Results Twenty-eight studies with low to moderate risk of bias were included. The included studies primarily assessed walking, and the evidence focused on temporal-spatial parameters and kinematics, with fewer studies analyzing kinetics and electromyography. The use of rocker sole shoes was associated with a significantly shorter stance phase duration and a greater cadence compared to conventional footwear. A primary finding was a reduction in ankle joint range of motion, while knee and hip joint kinematics remained largely unchanged. Conclusion Custom-made rocker sole shoes induce specific biomechanical adaptations during gait, notably a reduced ankle range of motion and an increased cadence. These changes result in decreased ankle power generation during the late stance phase (push-off) and a shorter stride length.

Introduction Stroke is a common cause of disability and death in adults, with spasticity being a common post-stroke complication that can significantly affect patients' quality of life. This study aimed to investigate the impact of exercise therapy alone versus exercise therapy combined with dry needling on clinical outcomes in patients with chronic spasticity after stroke. Methods Forty patients were randomly assigned to either a control or intervention group. The control group received a standard exercise program consisting of two sessions per week for six weeks. The intervention group received the same exercise program in addition to dry needling of the hip and leg muscles. Clinical outcomes were assessed using the Modified Modified Ashworth Scale, Timed Up & Go Test, and goniometer in four separate examination sessions. Results The findings of this study suggest that the addition of dry needling to exercise therapy led to faster and longer-lasting improvements in clinical outcomes. The intervention group showed significant improvements in spasticity, range of motion, and function in the second through fourth examination sessions, while the control group's improvements decreased over time. Between-group comparisons revealed significantly greater improvements in the intervention group than the control group. Conclusions The findings suggest that combining dry needling with exercise therapy may be beneficial in managing post-stroke spasticity. Dry needling may lead to faster and more significant improvements in clinical outcomes, ultimately improving function and quality of life for patients with chronic spasticity after stroke.

Background: Active video games can make physical activity more appealing and enjoyable for older people. This study compared the effects of 30 min of Exergaming versus walking on the physiological and psychological measures of asymptomatic older adults.Methods: Forty eligible participants (mean age = 69.60 & PLUSMN; 4.16 y/o) were randomly divided into two groups of 20 in a crossover design, who either performed Brisk Walking or Exergaming, one week apart. Before each session, each participant's blood pressure was measured, and the subjects were encouraged to play/walk continuously for 30 min using a self-selected intensity. During both sessions, average and peak heart rate, time spent in each of the heart rate zones, blood pressure, and double product were assessed through a Polar H10 heart rate monitor. Participants also filled out the modified Physical Activity Enjoyment Scale (PACES) questionnaire and Rate of Perceived Exertion (RPE) scale.Results: Findings indicated a significantly higher average (P = 0.003) and peak heart rate (P < 0.001) and double product (P = 0.002) during Exergaming compared to Brisk Walking. Also, the RPE score was significantly lower and PACES score was significantly higher (P < 0.001) during the Exergaming session. The analyses of blood pressure showed significant changes in systolic and diastolic blood pressures following each session, while no statistically significant difference was reported between the two exercise modalities (P = 0.012 and P < 0.001, respectively).Conclusion: This study showed that Exergaming can be a good alternative to traditional exercises like walking for older adults, providing physiological benefits while being less exhausting and more enjoyable.

Background Although Movement System Impairment (MSI) model classifies patients with knee impairments, it has some limitations. This study compares MSI model with a new Partitioning Around Medoids (PAM) model in knee pain patients. Methods In this cross-sectional study, knee movement impairments (signs) and symptoms. (pain) of 200 patients were studied in eight different functional positions. After modification of impairments, the examinations were repeated to record the changes in symptoms. The patients were then classified based on the signs and symptoms firstly by MSI model and secondly using PAM clustering by R software. Results PAM model has a similar acceptable grouping compared to MSI because most patients are in 4 similar categories in both methods: valgus, varus, hyperextension and hypomobility. However, due to low discriminative power of the tests used for finding hypermobility and patellar dysfunctions, these sub-clusters are absent in PAM model. Instead, two new sub-clusters of self-management and valgus with hypomobility were found. Most importantly, the PAM model sorted the signs and symptoms based on their discriminative power and eliminated trivial tests so that the therapist can classify patients more quickly by performing clinically relevant tests. Conclusion The new PAM method can be advantageous for therapists since it defines the importance of signs over symptoms in examination, prioritizes examination tests, and outlines tests with lower discriminative power. In PAM model, patients in the hypermobility and patellar subgroups of MSI model merged into other sub-clusters due to low discriminating power of their characteristics.

Background: Delayed activation of medial hamstrings (MH) relative to lateral hamstrings (LH) could lead to external tibial rotation. It is a long-held belief that altered force sharing between the vastus medialis obliquus (VMO) and the vastus lateralis (VL) plays a main role in the pathophysiology of PFP. It was presumed that patients with patellofemoral pain (PFP) exhibit altered muscular activation pattern of MH and LH during functional tasks. The aim of this study was to compare the electromyography (EMG) activity of hamstrings and quadriceps in patients with PFP and healthy subjects during stair descent.Methods: Twenty-four women with PFP and 24 non-symptomatic individuals, aged 18-40 years, were recruited through convenience sampling and participated in this observational cross-sectional study. The EMG activity of MH and LH, VMO and VL was recorded during stair descent. The main outcome measures were onset latency and amplitude of muscle activity relative to the moment of foot contact measured by foot switch. Groups were compared by Mann-Whitney test. Repeatability of task was evaluated using intra-class correlation coefficient (ICC).Results: A statistically significant difference was seen in the onset of hamstring heads between groups (p=0.014). The LH activated before the MH in the PFP group. Normalized muscular activity was significantly reduced for VMO (p=0.002), VL (p=0.045), and LH (p=0.019) in patients with PFP compared to the control group.Conclusions: Differences in temporal activation patterns of LH and MH may result in a lack of rotational knee stabilization and lead to increased patellofemoral joint pressure. Earlier activation of LH rotates the tibia externally and likely produces lateral patellar tracking.

BACKGROUND:Chronic ankle instability (CAI) is a common condition following an ankle sprain. This study investigated the effects of whole body vibration (WBV) and shoe with an unstable surface training on balance, functional performance, strength, joint position sense in people with CAI.METHOD:Thirty- four peoples with unilateral CAI were randomly assigned to three groups: WBV group, WBV with shoe with an unstable surface (WBV-S), and no treatment control group (CON). The WBV group received 4 weeks progressive WBV training and the WBV-S group received progressive WBV training with shoe with an unstable surface. Modified star excursion balance test (mSEBT)reach distance, Hop-Test, muscle strength, and joint position sense were measured at baseline and after the 4 weeks; Moreover, the mSEBT and Hop-Test were reassessed again 2 weeks post intervention.RESULTS:The result showed a significant group-by-time interaction for anterior and posterolateral directions of mSEBT. The reach distance of these directions at post-intervention and follow-up increased significantly compare to pre-intervention in the WBV and WBV-S groups but not significantly change in the CON group. The Hop test in the WBV-S group was significantly more at post-intervention and follow-up compared to pre-intervention. However, no significant changes were observed in WBV and CON groups. No significant changes were observed for mSEBT posteromedial direction, muscles strength, and joint position sense errors.CONCLUSION:The 4 weeks WBV and WBV-S interventions could improve balance in peoples with CAI. Improvement in Hop test was only observed in the WBV-S group suggesting the added value of combining WBV and shoe with an unstable surface as an effective therapy compared to WBV training alone. The use of WBV and WBV-S were not associated with significant changes in strength and joint position sense variables over a four-week period.TRIAL REGISTRATION:This work registered in the Iranian Registry of Clinical Trials ( IRCT20151118025105N4 ).

BACKGROUND:Patellofemoral pain (PFP) is among the most common orthopedic complications afflicting active young people. Diminished coordination of the vastii, delayed activation of the vastus medialis obliquus (VMO), and decreased VMO-to-vastus lateralis (VL) activity ratio are well documented as underlying causes of PFP. This study compares the effects of VMO facilitatory kinesio tape (KT) versus VL inhibitory KT on electromyographic (EMG) activity of the vastii, balance, and pain in athletes with PFP. METHODS:In this single-blind randomized clinical trial, thirty-two female athletes with PFP (mean age 26.33 ± 5.93 years) were randomly assigned to VMO facilitatory KT (n = 16) or VL inhibitory KT (n = 16) groups. In the facilitatory group, a Y-shaped strip of KT at 25% of its available tension was attached from the origin of the VMO to its insertion and in the inhibitory group, an insertion-to-origin Y-shaped strip of KT at 15% of its available tension was applied on the VL. Pain intensity, dynamic balance, and EMG data were assessed respectively with a visual analogue scale, the modified Star Excursion Balance Test, and an EMG telemetry system, before and immediately after KT application. RESULTS:Pain intensity decreased and dynamic balance improved significantly after taping in both groups, and VMO: VL activity ratio increased significantly in the VL group. However, none of the parameters differed significantly between groups. CONCLUSIONS:Both VMO facilitatory and VL inhibitory KT can improve pain and balance, while the inhibitory technique might be more effective in regulating the VMO to VL activity ratio in athletes with PFP.

Background: Lateral ankle sprain results in positional faults in the fibula which are thought to limit accessory motion in the ankle, leading to hypomobility and negatively influencing sensorimotor function and postural control. Although it has been shown that fibular reposition taping (FRT) is effective in the prevention of recurrent lateral ankle sprain, its ability to produce significant changes in balance measures in patients with chronic ankle instability is inconclusive. Objective: This study aimed to determine whether a FRT intervention affects balance performance in patients with chronic ankle instability. Design: Randomized controlled trial. Methods: Sixty individuals with chronic ankle instability were randomly allocated to three groups: FRT, sham taping, or no intervention (control group). Kinesiotape was applied and then re-applied on 3 occasions per week for 2 weeks. Static and dynamic balance were measured with three functional tests before and 1 day after the last session of intervention with the tape removed: single-leg stance test, single-leg hop test for distance, and modified Star Excursion Balance Test (mSEBT). Results: The results of ANCOVA showed that there were no significant differences between the three groups except for mSEBT reach distance in the posterolateral direction, which was significantly greater in the FRT group than the control group (p = 0.03). Conclusion: Applying FRT for 2 weeks did not significantly affect static or dynamic balance measures in individuals with chronic ankle instability, hence its clinical efficacy to influence balance remains uncertain in this population.

BACKGROUND:Chronic ankle instability (CAI) is a frequent complication of ankle sprain that may be associated with long-term consequences. Although taping and bracing are common interventions that are widely used by clinicians and athletic trainers for patients with CAI, no studies have compared the effects of kinesiotaping and bracing on balance performance in these patients. The present study aimed to compare the effects of ankle kinesiotaping, a soft ankle orthosis, and a semirigid ankle orthosis on balance performance in patients with CAI.METHODS:Sixty patients with CAI were randomly assigned to 4 groups that received kinesiotaping, a soft orthosis, a semirigid orthosis, or no treatment (control group). Dynamic and static balance were measured with the modified Star Excursion Balance Test, single leg hop test, and single leg stance test before and after a 4-week intervention period.RESULTS:Significant between-group differences were seen in all evaluated outcomes (P ≤ .003). The lowest reach distances in all directions in the modified Star Excursion Balance Test were found in the control group, and these patients also had a significantly shorter measured distance in the single leg hop test, and more errors in the single leg stance test compared with the 3 intervention groups. No significant differences were found among the 3 intervention groups.CONCLUSION:Use of kinesiotaping and a soft or a semirigid ankle brace for 4 weeks were all beneficial in improving static and dynamic balance in individuals with CAI. None of the interventions was superior to the other 2.LEVEL OF EVIDENCE:Level I, randomized controlled trial.

Background: Temporal difference in activation of medial-lateral hamstrings could lead to external tibial rotation. It was assumed that patients with patellofemoral pain syndrome (PFPS) exhibit altered medial-lateral hamstrings muscular pattern during functional tasks. Objectives: The aim of this study was to compare the electromyography (EMG) activity of quadriceps and hamstrings in patients with PFPS and healthy subjects during stair descending. Design: cross sectional comparative study Setting: Motion analysis Lab, Rehabilitation research center, Shiraz University of Medical Sciences Participants: 24 women with PFPS and 24 healthy subjects, aged 18-40 years recruited through convenience sampling method participated in this study. Interventions: The EMG activity of vastus medialis obliqus (VMO), vastus lateralis (VL), medial (MH) and lateral hamstrings (LH) recorded during stair descending. Main outcome measures: Onset latency and intensity of muscle activity measured relative to the moment of foot contact. Results: There were statistically significant difference in onset of hamstrings heads (LH-MH) between groups (p=0.014). The BF activated before ST in PFPS group. Normalized muscular activity was significantly reduced for VMO (p=0.002), VL (p=.045), and LH (p=0.019) in PFPS patients. Conclusions: Difference in temporal activation patterns of BF and ST may result in lack of rotational knee stabilization and lead to increased patellofemoral joint pressure. Earlier activation of LH rotates tibia externally, and hence, produced lateral patellar tracking.

Purpose Achilles tendinopathy is a prevalent overuse injury among athletes and in those with a sedentary lifestyle. Current evidence indicates that the Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire is a valid, reliable and disease-specific outcome measure for assessing the clinical symptoms in patients with Achilles tendinopathy. The objective of this study was to translate and cross-culturally adapt the VISA-A questionnaire into Persian (VISA-A-P) and evaluating its psychometric properties. Materials and methods Cultural adaptation of VISA-A-P was conducted according to Beaton's guideline. The final version of VISA-A-P was handed to 61 patients for analysis of psychometric properties. Test-retest reliability, internal consistency, concurrent validity, item-total correlation, and floor/ceiling effect were evaluated in patients with Achilles tendinopathy. To assess test-retest reliability, 35 patients refilled the VISA-A-P twice within 5-7 days. Known-group validity was evaluated using 50 healthy individuals. Results VISA-A-P showed excellent test-retest reliability (ICC = 0.90), excellent internal consistency (Cronbach's alpha = 0.95), strong correlation with FAAM, and moderate to strong correlation with FAOS questionnaires. There was a significant difference between the average score of patients (34.55 +/- 18.24) and the healthy group (73.1 +/- 20.10). VISA-A-P showed neither ceiling nor floor effect. Conclusions The VISA-A-P is a reliable and valid instrument for measuring the symptoms in Persian speaking populations with Achilles tendinopathy.

Background: The movement system impairment (MSI) model is a clinical model that can be used for the classification, diagnosis, and treatment of knee impairments. By using the partitioning around medoids (PAM) clustering method, patients can be easily clustered in homogeneous groups through the determination of the most discriminative variables. The present study aimed to reduce the number of clinical examination variables, determine the important variables, and simplify the MSI model using the PAM clustering method. Methods: The present cross-sectional study was performed in Shiraz, Iran, during February-December 2018. A total of 209 patients with knee pain were recruited. Patients' knee, femoral and tibial movement impairments, and the perceived pain level were examined in quiet standing, sitting, walking, partial squatting, single-leg stance (both sides), sit-to-stand transfer, and stair ambulation. The tests were repeated after correction for impairments. Both the pain pattern and the types of impairment were subsequently used in the PAM clustering analysis. Results: PAM clustering analysis categorized the patients in two main clusters (valgus and non-valgus) based on the presence or absence of valgus impairment. Secondary analysis of the valgus cluster identified two sub-clusters based on the presence of hypomobility. Analysis of the non-valgus cluster showed four sub-clusters with different characteristics. PAM clustering organized important variables in each analysis and showed that only 23 out of the 41 variables were essential in the sub-clustering of patients with knee pain. Conclusion: A new direct knee examination method is introduced for the organization of important discriminative tests, which requires fewer clinical examination variables.

Background: There is concern that wearing soft lumbosacral orthoses for prolonged periods may impair motor function. Moreover, the pressure applied by lumbosacral orthoses on the abdominal wall is usually ignored when these orthoses are prescribed. Method In this randomized controlled trial study, 48 patients with chronic nonspecific low back pain were randomly divided into high pressure, normal pressure and control groups. All groups received medication for 4 weeks. The normal pressure and high pressure groups, in addition to medication, used soft lumbosacral orthoses at normal pressure and 50% increased pressure, respectively. Motor function outcome measures were strength, endurance, proprioception and electromyographic activity of the trunk muscles. Clinical outcome measures were pain and disability, which were evaluated in two sessions before and after a 4-week interval. Findings. Isometric strength, endurance and most of the electromyographic parameters were generally unaffected by wearing the lumbosacral orthosis. Pain improved in all groups, and disability and proprioception improved in the high pressure and normal pressure groups. Between-group differences in these three measures indicated better results in the lumbosacral orthoses groups than in the control group. The improvements in pain and proprioception were significantly greater in the high pressure group than the normal pressure group. Interpretation. Long-term use of lumbosacral orthoses had no significant adverse effects on motor function or clinical factors in patients with chronic low back pain. Increasing lumbosacral orthosis tightness may improve motor functioning and the clinical efficacy of the orthosis.

Many occupations require standing for prolonged periods, which can be a major contributor to musculoskeletal problems and cause disturbances in different parts of the body, especially the lower back and lower extremities. The aim of this study was to investigate the effect of custom‐made insoles and exercise training on the lower limb and lower back discomfort in workers on a production line at a rubber tire factory. One hundred male workers (mean age 35.96 years, work experience of 10.62 years, standing time 6.58 hr) participated in this randomized controlled trial. The men were randomly assigned to one of four groups: (a) custom‐made insole plus lower limb exercises, (b) insoles only, (c) lower limb exercises only, and (d) no intervention. Discomfort level was recorded with a visual analog scale and a body map. The data were analyzed with analysis of covariance. The results showed a significant difference in discomfort levels between groups in the lower back (p = .001), thigh (p = .001), and knee (p = .001) areas. The combined insole and exercise group had less discomfort in the lower back, thigh, and knee. In the group that used the insole only without exercises, the discomfort level in the lower back area was reduced. The results indicate that the simultaneous use of insoles and exercises might be an effective intervention to reduce discomfort in the lower limbs and lower back in workers who remain standing for prolonged periods.

Background:: People with Multiple sclerosis (MS) have been found to impair strength and endurance of core muscles compared with healthy people. Whole body vibration (WBV) is a relatively new method of neuromuscular training which can induce positive effects on mobility and postural control of MS patients. Objective:: To evaluate the effects of a 6-week WBV training program on the strength and endurance of core muscles in patients with MS. Methods:: Fifty patients were allocated to two groups, one receiving WBV training (intervention) and one no treatment (control). The endurance of core muscles were evaluated using Sorensen, flexion, and side bridge endurance tests. The strength of core muscles was evaluated using a dynamometer. We used the quality of life-54 questionnaire (MSQOL-54) to evaluate patients' quality of life aspects at baseline and two months after the end of study. Results:: Forty six patients completed the study (mean age: 37.9 +/- 7.7; BMI: 23.8 +/- 4.3). All outcome measures including strength and endurance of core muscles as well as MSQOL-54 scores significantly improved in WBV group in comparison to control group. While the within-group comparison showed significant improvement in the WBV group (P < 0.001), in the control group, some outcomes measures including physical and mental components of MSQOL-54 deteriorated (P < 0.001) over the course of study. Conclusions:: Our study shows that strength and endurance of core muscles as well as quality of life of MS patients can be positively influenced by a 6-week WBV training. The program was well-tolerated by patients and no adverse event was observed.

Cold modalities are widely used after athletic injuries, with known physiological effects. The aim of this study was to determine the effects of cold-water immersion on physical performance. Thirty healthy volunteers (average age of 19-23 years) took part in this pre-post interventional study. First, participants performed two tasks: a 40-yard dash run (to measure speed) and a vertical jump (to measure lower limb power). Then, both legs were immersed in a water bath at 5 degrees C for 15 min. Following cold-water immersion, the measurements were repeated after 2, 5, 10, 15, 20, 25 and 30 min. Immediately (2 min) after cold-water immersion, there was a decline in both the vertical jump and 40-yard dash tests compared to pre-intervention scores. While this effect lasted up to 20 min after cryotherapy for the 40-yard dash test, for the jump test, the effect only remained up to 10 min. The results showed a decrease in physical performance immediately and 20 min after immersion in cold water (p < 0.05). In addition, there was a gradual increase in the level of physical function over time. Therefore, before returning athletes to activity after the use of cold modalities, care should be taken. (C) 2018 Elsevier Ltd. All rights reserved.

Objective: The purpose of this study was to compare the efficacy of 4 weeks of whole body vibration training on balance in older adults who word two different types of shoes: unstable (unstable group) versus standard shoes (stable group). Design: Randomized, single-blind clinical trial. Participants: Seventy eight eligible older adults were initially enrolled; 59 participants (mean age 69.7 +/- 5.3 years) completed the program. Intervention: Participants were randomized 1:1 to an intervention group that received whole body vibration with unstable shoes, and a control group that received whole body vibration with standard shoes. Outcome measures: The Fullerton Advanced Balance scale, preferred gait speed, maximum gait speed, and Fall Efficacy Scale were recorded at baseline, after the 4-week intervention, and 1 month after the end of the training program. Results: Both groups showed improvement in all outcome measures at 4 weeks (p < 0.01) with no significant between-group differences. In the unstable group, the gains were maintained at follow-up (p < 0.01) whereas the scores returned to baseline values in the stable group. At follow-up, significant between-group differences were found for Fullerton Advanced Balance scale (p < 0.001), preferred gait speed (p = 0.007) and maximum gait speed (p = 0.007), and all were in favor of the unstable group. Conclusion: Combining whole body vibration with unstable shoes can be proposed as a beneficial method with relatively long-term effects to improve balance measures in older people.

Objectives: To evaluate the added value of isolated core postural control training on knee pain and function in women with patellofemoral pain syndrome (PFPS). Design: Randomized controlled trial. Setting: Rehabilitation sciences research center. Participants: Women (N=33) between 18 and 30 years of age with PFPS were randomly assigned to a control group (n =16) or the experimental group (n = 17). Interventions: Participants in both groups received the same stretching and strengthening exercises during 4 weeks (12 sessions 3 days per week). The experimental group also received isolated core postural training with an unstable seat apparatus. Main Outcome Measures: Center of pressure (CoP) trajectories in sitting postural control, pain intensity, and function were recorded before and after the 4-week intervention period. Functional capacity and pain intensity were reassessed 3 months after the intervention. Results: After treatment, both groups had significant improvements in pain, function (P<.001), and CoP trajectories in sitting postural control (control group P<.05, experimental group P<.001). Between-group comparisons demonstrated greater improvements in pain, function, and CoP trajectories in the experimental group (P<001). This group also had significantly greater improvements in pain and Kujala Anterior Knee Pain Scale score at 3-month follow-up compared to the control group (P<.001). Conclusions: Adding isolated core postural control training to physiotherapy exercises was associated with significantly greater improvements in pain, function, and CoP trajectories than physiotherapy exercises alone. Therefore, unstable sitting postural control training is potentially useful to enhance rehabilitation management in patients with PFPS. (C) 2018 by the American Congress of Rehabilitation Medicine

The aim of this study was to investigate the effect of equipment modification on acquisition and retention of basketball free throw skill in children aged between 9 and 10 with an emphasis on working memory capacity. 40malestudents were randomly selected and divided into 4 groups of modified and standard equipment with high and low working memory capacity based on the Memory for Digit Span assessment by Wechsler. Mini-basketball rules were used as a reference. The acquisition phase included 10 sessions, 4blocks each session and 15 attempts each block. Free throw basketball test (AAHPERD) was conducted as the pretest and acquisition and retention tests were conducted after a week. In the acquisition phase, 2x2x2 multivariate analysis of variance (eqipement×working memory×test) with repeated measures showed that interactive effect between working memory (high and low) and test (pretest and posttest) on performance was significant. Also, interactive effect between equipment (standard and modified) and test (pretest and posttest) on performance was significant while the interactive effect of working memory, equipment and test on performance was not significant. In retention phase, 2x2 multivariate analysis of variance (eqipement×working memory) showed that the main and interactive effect of working memory and equipment on performance was significant. The results showed that the effect of equipment employment in working memory levels on performance was similar in both pretest and posttest and also it seems that the effect of the modified equipment on performance in retention test was better in children with low working memory than children with high working memory.