Do thermal agents affect range of movement and mechanical properties in soft tissues? A systematic review

Immediate effects of foam rolling on lateral thigh soft tissue movement: A pilot study

INTRODUCTION

Foam rolling interventions have shown improved range of motion and reduced mechanical stiffness. However, little is known about the effect of foam rolling on the movement of the fascia lata and surrounding muscles. Therefore, this study aimed to evaluate the movement of the fascia lata and vastus lateralis muscle during knee joint motion before and after a foam rolling intervention.

METHOD

This was an interventional laboratory study of 18 sedentary men (age 20.8 ± 0.4 years); no controls were included. A total of 3 min of foam rolling was conducted on the right lateral thigh. The right lateral mid-thigh was assessed twice (before and 5 min after the intervention). Stiffness at rest was measured using a durometer, and video analysis of ultrasound imaging was performed to measure the movement of the fascia lata and vastus lateralis muscles during isokinetic passive knee motion. The tissue movement velocity during five cycles of knee motion was arranged as a time series. Negative values indicated displacement in the proximal direction and positive values indicated displacement in the distal direction. The maximum, minimum, and mean velocities were calculated from the time-series data.

RESULTS

After the foam rolling intervention, the stiffness (p < 0.001) and minimum velocity of the fascia lata (p = 0.04) significantly decreased.

CONCLUSIONS

Foam rolling on the lateral thigh can improve proximal sliding of the fascia lata during passive knee extension.

The effects of TECAR therapy on pain, range of motion, strength and subscale of HAGOS questionnaire in athletes with chronic adductor related groin pain: a randomized controlled trial

INTRODUCTION

Groin pain is a common issue among athletes. Adductor-related pain is known as the most common cause of groin pain. Although, non-operative treatments have limited efficacy, Capacitive and Resistive Energy Transfer (TECAR), can be used in the treatment of musculoskeletal conditions. The objective of the present study is to explore the effect of TECAR therapy on pain, range of motion (ROM), strength, and subscales of the "Copenhagen Thigh and Groin Assessment Scale"(HAGOS) questionnaire in athletes suffering from adductor-related groin pain (ARGP).

METHODS

This study was a two arm parallel groups randomized sham-controlled superiority trial. A total of 22 male professional athletes (mean age 21.36 years) were randomly assigned to either the real TECAR therapy (n = 11) or sham TECAR therapy (n = 11) group, using block-balanced randomization. Both groups received stretching exercises. Intervention group received 10 sessions of TECAR therapy while, the control group received sham TECAR therapy. Primary outcome was pain that was measured by Visual Analogue Scale (VAS). Secondary outcomes included ROM, strength, and HAGOS questionnaire subscales. All outcomes were assessed at baseline, after 5 sessions, after 10 sessions, and one month after treatment. Analysis of Variance (ANOVA) and Analysis of Covariance were used to compare between-group mean differences. P-value was set at 0.05. Effect size Cohen's d was also reported. This study took place from September 2022 to August 2023 at the Rehabilitation Clinic at Iran University of Medical Sciences.

RESULTS

A total of 22 male athletes were included (11 in each group), with a mean age of 21.09 years in the TECAR group and 21.63 years in the sham group. TECAR therapy was associated with significant reductions in pain intensity across all evaluation sessions. Specifically, after 5 sessions, there was a large effect size for pain reduction (p = 0.01, Cohen's d = -1.09 [95% CI: -0.195 to -1.987]); after 10 sessions, the effect was even larger (p = 0.001, Cohen's d = -2.153 [95% CI: -1.103 to -3.203]); and at the 1-month follow-up, the pain reduction persisted (p = 0.001, Cohen's d = -1.96 [95% CI: -0.944 to -2.978]). In terms of secondary outcomes, there was a significant improvement in hip adduction ROM at the 1-month follow-up (p = 0.03, Cohen's d = 0.908 [95% CI: 0.03 to 1.78]). However, no statistically significant differences were found for other secondary outcomes, with effect sizes ranging from no effect to intermediate.

CONCLUSION

The results of this study suggest that TECAR therapy may reduce pain and improve hip adduction range of motion in athletes with adductor-related groin pain.

TRIAL REGISTRATION

This trial was registered at the ( https://www.irct.ir ), (IRCT20220622055250N1) on 18/09/2022.

Treatment Algorithms for Continuous Low-Level Heat Wrap Therapy for the Management of Musculoskeletal Pain: An Italian Position Paper

Musculoskeletal pain (MSP), which impacts bones, muscles, tendons, and ligaments, is a substantial worldwide pain disorder, characterized by muscle soreness, fatigue, inflammation, muscle spasms, sleep disruptions, and functional limitations. MSP is predominantly managed within the primary care setting. Recent consensus recognizes that heat therapy (HT) may provide potential benefits, especially in treating chronic MSP. To develop shared algorithms for the treatment of MSP through local superficial HT (SHT) using continuous low-level heat wrap therapy, a four-member board of experts was designated. Three anatomical sites have been deemed of particular interest regarding potential response to exogenous SHT. Neck and shoulder pain are commonly attributed to traumatic experiences, muscle spasms, postural defects, or poor posture as common potential causes. HT may be helpful for painful contractures, although treatment should be limited in duration to prevent instability. Low back pain, the leading cause of disability, may have either specific or non-specific etiology. SHT, physical therapy, instrumental therapy, manual therapy, therapeutic exercise, motor activity, and trunk orthoses are all potential treatment options. SHT should be considered in chronic degenerative disc disease, non-specific LBP with muscle spasm or contracture, postural and overuse myalgia, and osteoarthritis (OA), excluding the inflammatory phase. Assessment of knee pain includes both a review of the patient's medical history and a careful physical examination. SHT of the knee should be considered in case of muscle spasms, overuse pathology, early OA, and indirect muscle lesions. Patients who receive SHT may experience a reduction in pain, restoration of muscle strength, loosening of stiffness, and an overall improvement in their quality of life. This expert opinion proposes shared algorithms for MSP treatment via local SHT with the aiming to provide practical guidance on its proper application, highlighting specific potentialities as well as contraindications.

Effects of cassava wax bath as a new therapeutic approach on patients with plantar fasciitis: a double-blind, randomised clinical trial

The aim of this study was to investigate the efficacy of a new therapeutic approach (cassava wax bath: CWB) compared with usual care (paraffin wax bath: PWB) in patients with plantar fasciitis (PF). Forty patients with PF were recruited into the study (CWB group, n = 20, PWB group, n = 20). Patients in the CWB group received cassava wax bath and patients in the PWB group received usual care (PWB). The primary outcome was pain intensity (PI). The secondary outcomes were the pressure pain threshold (PPT), pain frequency (PFr), foot and ankle ability measure (FAAM), and ankle dorsiflexion range of motion (ADROM). All outcomes were assessed before and after the five-week intervention, one month, and three months after the intervention period. After the intervention, statistically significant improvement was found in all outcomes after the intervention period and during the one month and three months follow-up study in both groups (P < 0.05). For all outcomes, no between-group differences were seen at any post-assessment time-point, except for PFr (P < 0.05). In conclusion, the findings of this study indicate that CWB was significantly superior to PWB in reducing PFr. For the other outcomes, CWB and PWB were both equally effective in reducing PI and increasing PPT, FAAM, and ADROM in patients with PF. Therefore, CWB might be considered as a novel useful therapeutic option for PF patients.Trial registration: Thai Clinical Trials Registry (TCTR) (Identification number: TCTR20220128002), First posted date: 28/01/2022.

Hot-pack therapy increased gliding function of the iliotibial band during passive knee motion: An exploratory study

INTRODUCTION

Quantifying soft tissue dynamics during joint motion is important for the valid assessment and development of effective therapeutic interventions for the soft tissues. This study aimed to examine the immediate effect of thermotherapy on gliding of the iliotibial band (ITB), including the subcutaneous tissue, and vastus lateralis (VL) muscle during passive knee joint motion.

METHODS

Ten participants (age, 20.4 ± 0.7 years; height, 172.0 ± 8.9 cm; weight, 64.1 ± 9.7 kg; BMI, 21.6 ± 1.7 kg/m2) with no history of lower extremity surgery or neuromuscular disease participated in the study. An electrothermal hot pack with an internal temperature of 65 °C was applied to one of the lateral thighs, followed by measuring its stiffness using a durometer. Movements of both the ITB and VL were recorded using ultrasound imaging during isokinetic knee motion. The Farneback method and optical flow algorithm analysis software were adapted to create the movement velocity from ultrasound imaging. Gliding coefficient was calculated using the coefficient of correlation for each velocity in the proximal-distal direction during knee motion. The mean velocity during knee motion was calculated using absolute values. The differences between the pre-intervention values and between the pre- and post-intervention values were examined.

RESULTS

After applying the hot pack, the stiffness significantly decreased (p = 0.01), and the mean velocity of the ITB significantly increased (p = 0.03). The gliding coefficient and VL mean velocity did not significant differ (p = 0.65 and p = 0.80, respectively) between pre- and post-hot-pack applications.

CONCLUSIONS

Hot-pack therapy might increase gliding function of the ITB during passive knee motion.

Immediate Effect of Cryo-Compression Therapy on Biomechanical Properties and Perfusion of Forearm Muscles in Mixed Martial Arts Fighters

Mixed martial arts (MMA) fighters use their arms and hands for striking with the fists, grappling, and defensive techniques, which puts a high load on the forearms and hand muscles. New methods are needed to decrease the risk of injury and increase the effectiveness of regeneration. This study aimed to assess the effectiveness of cryo-compression (CC) therapy of different times (3 and 6 min) on forearm muscles in MMA fighters by investigating muscle pain, stiffness, tension, elasticity strength, and perfusion. Twenty professional male MMA fighters aged 26.5 ± 4.5 years, with training experience of 10.3 ± 5.0 years, were enrolled on an experimental within-group study design. The participants underwent CC therapy at a temperature of 3 °C and compression of 75 mmHg for 3 min and, in the second session, for 6 min. The investigated parameters were in the following order: (1) perfusion in non-reference units (PU), (2) muscle tone (T-[Hz]), (3) stiffness (S-[N/m]), (4) elasticity (E-[arb]), (5) pressure pain threshold (PPT-[N/cm]), and (6) maximum isometric force (Fmax [kgf]) at two time points: (1) at rest-2 min before CC therapy (pre) and (2) 2 min after CC therapy (post). There were significant differences between 3 and 6 min of CC therapy for PU and T. Meanwhile, F, E, PPT, and S were significantly different when comparing pre- to post-conditions. These results provide evidence that CC therapy is a stimulus that significantly affects parameters characterizing muscle biomechanical properties, pain threshold, strength, and tissue perfusion.

Quantifying the Impact of Cancer on the Viscoelastic Properties of the Prostate Gland using a Quasi-Linear Viscoelastic Model

Pathological disorders can alter the mechanical properties of biological tissues, and studying such changes can help to better understand the disease progression. The prostate gland is no exception, as previous studies have shown that cancer can affect its mechanical properties. However, most of these studies have focused on the elastic properties of the tissue and have overlooked the impact of cancer on its viscous response. To address this gap, we used a quasi-linear viscoelastic model to investigate the impact of cancer on both the elastic and viscous characteristics of the prostate gland. By comparing the viscoelastic properties of segments influenced by cancer and those unaffected by cancer in 49 fresh prostates, removed within two hours after prostatectomy surgery, we were able to determine the influence of cancer grade and tumor volume on the tissue. Our findings suggest that tumor volume significantly affects both the elastic modulus and viscosity of the prostate (p-value less than 2%). Specifically, we showed that cancer increases Young's modulus and shear relaxation modulus by 20%. These results have implications for using mechanical properties of the prostate as a potential biomarker for cancer. However, developing an in vivo apparatus to measure these properties remains a challenge that needs to be addressed in future research. STATEMENT OF SIGNIFICANCE: This study is the first to explore how cancer impacts the mechanical properties of prostate tissues using a quasi-linear viscoelastic model. We examined 49 fresh prostate samples collected immediately after surgery and correlated their properties with cancer presence identified in pathology reports. Our results demonstrate a 20% change in the viscoelastic properties of the prostate due to cancer. We initially validated our approach using tissue-mimicking phantoms and then applied it to differentiate between cancerous and normal prostate tissues. These findings offer potential for early cancer detection by assessing these properties. However, conducting these tests in vivo remains a challenge for future research.

The Effect of Contrast Bath Therapy and Knee Pad Device on Pain, Range of Motion, and Functional Disability in Patients With Osteoarthritis Knee: A Randomized Control Trial

Background and objective A degenerative joint condition mostly affecting the weight-bearing joints is osteoarthritis (OA). The majority of the time, it involves the knee joint. Pain and stiffness are common in grade 1 and 2 OA. And that's the main reason people ask for help. Physiotherapy treatment can be helpful for symptomatic management of early OA. Along with exercises, contrast bath therapy (CBT) is a therapeutic alternative to medication to alleviate pain and stiffness in OA. Many studies have been done using the traditional water immersion CBT. However, there is a paucity of studies on contrast therapy given using a device. This study intends to find the effect of a knee pad device (KPD) on pain, range of motion, and functional disability in knee OA patients when compared with CBT. Methods About 60 patients having unilateral knee OA were selected and randomly divided into two groups: group A received CBT for 20 minutes, and group B was treated with a KPD for 20 minutes and the Otago exercise program was given in both groups for 30 minutes. Both groups received treatment for three sessions per week for two weeks. Outcome measures used for assessment at baseline and post-treatment were visual analog scale (VAS), knee range of motion, Western Ontario and McMaster Universities Arthritis Index (WOMAC) scale, and distance covered in a two-minute walk test. Results Both the groups showed significant improvement post-treatment (p < 0.05). Group B showed more significant improvement when compared with group A. The enhancement in VAS (2.39, p < 0.020), range of motion (2.11, p < 0.039), WOMAC (2.09, p < 0.04), and two-minute walk test (2.03, p < 0.046) showed improvement in functional ability. Conclusion The findings of this study showed that both groups showed improvement following treatment, but that the use of a KPD in combination with strengthening and balance retraining is more efficient in reducing pain and enhancing quality of life in patients with grade 1 or 2 knee OA than conventional CBT.

Effect of Transfer Energy Capacitive and Resistive Therapy on Shoulder Pain, Disability, and Range of Motion in Patients With Adhesive Capsulitis: A Study Protocol for a Randomized Controlled Trial

Objective

We describe a protocol to evaluate the effectiveness of transfer energy capacitive and resistive (TECAR) therapy on shoulder passive range of motion, shoulder pain, and disability index in patients with adhesive capsulitis.

Methods

This study will be a double-blinded randomized clinical trial with a 1-month follow-up. For the purpose of this research, 30 patients with a 3-month history of shoulder pain and disability diagnosed as adhesive capsulitis will be selected and then randomized into 2 groups, including conventional physiotherapy consisting of electrophysical modalities and therapeutic exercises, which will be given to the control group. In the intervention group, after conventional physiotherapy, 10 minutes of TECAR therapy in resistive mode will be applied on both the anterior and inferior aspects of the shoulder joint. Outcome measures will be related to shoulder passive range of abduction, flexion, and external rotation that will be measured using a digital inclinometer, as well as shoulder pain and disability index that will be assessed by the validated questionnaire. Assessment will be done at baseline, 1 day after the intervention, and by passing 1 month.

Results

The statistical analysis will describe within-group and between-group comparisons; the findings will be illustrated in tables and charts.

Conclusion

Given the reason that the effectiveness of TECAR therapy has not been widely evaluated in adhesive capsulitis, the findings of this pilot study would provide baseline information on the effectiveness and complications of this treatment method and possibly propose a more appropriate protocol for patients with adhesive capsulitis.

Time-Course Changes in Dorsiflexion Range of Motion, Stretch Tolerance, and Shear Elastic Modulus for 20 Minutes of Hot Pack Application

The application of thermal agents via hot packs is a commonly utilized method. However, the time-course changes in the range of motion (ROM), stretch sensation, shear elastic modulus, and muscle temperature during hot pack application are not well understood. This study aimed to investigate the time-course changes in these variables during a 20-minute hot pack application. Eighteen healthy young men (21.1 ± 0.2 years) participated in this study. We measured the dorsiflexion (DF) ROM, passive torque at DF ROM (an indicator of stretch tolerance), and shear elastic modulus (an indicator of muscle stiffness) of the medial gastrocnemius before and every 5 minutes during a 20-minute hot pack application. The results showed that hot pack application for ≥5 minutes significantly (p < 0.01) increased DF ROM (5 minutes: d = 0.48, 10 minutes: d = 0.59, 15 minutes: d = 0.73, 20 minutes: d = 0.88), passive torque at DF ROM (5 minutes: d = 0.71, 10 minutes: d = 0.71, 15 minutes: d = 0.82, 20 minutes: d = 0.91), and muscle temperature (5 minutes: d = 1.03, 10 minutes: d = 1.71, 15 minutes: d = 1.74, 20 minutes: d = 1.66). Additionally, the results showed that hot pack application for ≥5 minutes significantly (p < 0.05) decreased shear elastic modulus (5 minutes: d = 0.29, 10 minutes: d = 0.31, 15 minutes: d = 0.30, 20 minutes: d = 0.31). These results suggest that hot pack application for a minimum 5 minutes can increase ROM and subsequently decrease muscle stiffness.

Bilateral Knee Joint Cooling on Anaerobic Capacity and Wheel Cadence during Sprint Cycling Intervals

We compared the effect of bilateral knee joint cooling with or without a pre-cooling warm-up on sprint cycling performance to a non-cooling control condition. Seventeen healthy young males (25 ± 2 years, 174 ± 6 cm, 70 ± 9 kg) performed three conditions in a counterbalanced order (condition 1: warming + cooling + cycling; condition 2: cooling + cycling; condition 3: cycling). For warming, a single set of cycling intervals (a 10 s sprint with maximal effort followed by a 180 s active recovery; resistive load 4% and 1% body mass for sprint and recovery, respectively) was performed. For cycling, five sets of cycling intervals were performed. For cooling, 20 min of bilateral focal knee joint cooling was applied. Peak and average values of anaerobic capacity and wheel cadence during each set across conditions were statistically compared. There was no condition effect over set (condition × set) in anaerobic capacity (F8,224 < 1.49, p > 0.16) and wheel cadence (F8,224 < 1.48, p > 0.17). Regardless of set (condition effect: F2,224 > 8.64, p < 0.0002), conditions 1 and 2 produced higher values of anaerobic capacity (p ≤ 0.05). Similarly (condition effect: F2,224 > 4.62, p < 0.02), condition 1 showed higher wheel cadence (p < 0.02) than condition 3. A bilateral joint cooling for 20 min with or without pre-cooling warm-up may improve overall sprint cycling capacity during five sets of cycling intervals when compared to the non-cooling condition.

Computational Modeling of Deep Tissue Heating by an Automatic Thermal Massage Bed: Predicting the Effects on Circulation

Automatic thermal and mechanical massage beds support self-managed treatment, including reduction of pain and stress, enhanced circulation, and improved mobility. As the devices become more sophisticated (increasing the degrees of freedom), it is essential to identify the settings that best target the desired tissue. To that end, we developed an MRI-derived model of the lower back and simulated the physiological effects of a commercial thermal-mechanical massage bed. Here we specifically estimated the tissue temperature and increased circulation under steady-state conditions for typical thermal actuator settings (i.e., 45-65°C). Energy transfer across nine tissues was simulated with finite element modeling (FEM) and the resulting heating was coupled to blood flow with an empirically-guided model of temperature-dependent circulation. Our findings indicate that thermal massage increases tissue temperature by 3-8°C and 1-3°C at depths of 2 and 3 cm, respectively. Importantly, due to the rapid (non-linear) increase of circulation with local temperature, this is expected to increase blood flow four-fold (4x) at depths occupied by deep tissue and muscle. These predictions are consistent with prior clinical observations of therapeutic benefits derived from spinal thermal massage.

Post-arthrolysis rehabilitation in a patient with wrist stiffness secondary to distal radio-ulnar fracture: A case report

BACKGROUND

Arthrolysis is usually performed when stiffness has a disabling effect on quality of life and in cases where physiotherapy has not been effective. This report describes one patient with a chronic stiff wrist who underwent open arthrolysis. The purpose of this case report is to describe the rehabilitation following arthrolysis, in order to illustrate the effects of intensive physiotherapy for this patient.

CASE DESCRIPTION

A 54-year-old woman with chronic wrist stiffness secondary to a radio-ulnar fracture was described. The patient presented severe pain and unsatisfactory wrist range of motion and muscle strength almost 2 years after the traumatic event.

INTERVENTION

Post-arthrolysis rehabilitation was based on edema control, manual therapy, transcutaneous electrical nerve stimulation (TENS), static splinting and strengthening exercises. In addition, graded motor imagery and proprioceptive rehabilitation were included to address impaired motor control. Outcome measures of passive range of motion (PROM), active range of motion (AROM), grip and pinch strength, numeric rating scale (NRS), disability of the arm, shoulder and hand (DASH) and patient-rated wrist/hand evaluation (PRWHE) were recorded.

CONCLUSIONS

The outcomes of this case report suggest that arthrolysis combined with immediate and intensive physiotherapy were a suitable option for the treatment of post-traumatic wrist stiffness in this patient. The passive motion measured intraoperatively was maintained, while pain, functional active motion and strength were improved allowing for social reintegration.

Single-Leg Drop Jump Biomechanics After Ankle or Knee Joint Cooling in Healthy Young Adults

CONTEXT

It is unclear if lower-extremity joint cooling alters biomechanics during a functional movement.

OBJECTIVE

To investigate the effects of unilateral lower-extremity cryotherapy on movement alterations during a single-leg drop jump.

DESIGN

A crossover design.

SETTING

Laboratory.

PATIENTS

Twenty healthy subjects (10 males and 10 females; 23 y, 169 cm, 66 kg).

INTERVENTION(S)

Subjects completed a single-leg drop jump before and after a 20-minute ankle or knee joint cooling on the right leg, or control (seated without cooling) on 3 separate days.

MAIN OUTCOME MEASURES

Time to peak knee flexion, vertical ground reaction force, lower-extremity joint angular velocity (sagittal plane only), and angle and moment (sagittal and frontal planes) in the involved leg over the entire ground contact (GC; from initial contact to jump-off) during the first landing. Time to peak knee flexion was compared using an analysis of variance; the rest of the outcome measures were analyzed using functional analyses of variance (P < .05).

RESULTS

Neither joint cooling condition changed the time to peak knee flexion (F2,95 = 0.73, P = .49). Ankle joint cooling reduced vertical ground reaction force (55 N at 4% of GC), knee joint angular velocity (44°/s during 5%-9% of GC), and knee varus moment (181 N·m during 18%-20% of GC). Knee joint cooling resulted in a reduction in knee joint angular velocity (24°/s during 37%-40% of GC) and hip adduction moment (151 N·m during 46%-48% of GC), and an increase in hip joint angular velocity (16°/s during 49%-53% of GC) and plantarflexion angle (1.5° during 11%-29% of GC).

CONCLUSION

Resuming activity immediately after lower-extremity joint cooling does not seem to predispose an individual to injury during landing because altered mechanics are neither overlapping with the injury time period nor of sufficient magnitude to lead to an injury.

Cryostimulation for Post-exercise Recovery in Athletes: A Consensus and Position Paper

Recovery after exercise is a crucial key in preventing muscle injuries and in speeding up the processes to return to homeostasis level. There are several ways of developing a recovery strategy with the use of different kinds of traditional and up-to-date techniques. The use of cold has traditionally been used after physical exercise for recovery purposes. In recent years, the use of whole-body cryotherapy/cryostimulation (WBC; an extreme cold stimulation lasting 1-4 min and given in a cold room at a temperature comprised from -60 to -195°C) has been tremendously increased for such purposes. However, there are controversies about the benefits that the use of this technique may provide. Therefore, the main objectives of this paper are to describe what is whole body cryotherapy/cryostimulation, review and debate the benefits that its use may provide, present practical considerations and applications, and emphasize the need of customization depending on the context, the purpose, and the subject's characteristics. This review is written by international experts from the working group on WBC from the International Institute of Refrigeration.

Effects of hot pack application before high-intensity stretching on the quadriceps muscle

Background/aims

High-intensity static stretching is assumed to increase the range of motion and/or decrease muscle stiffness; however, the effects of high-intensity static stretching on the quadriceps muscle have been debated. Hot pack application before high-intensity static stretching was assumed to decrease stretching pain, which is the main problem in high-intensity static stretching, and decrease quadriceps muscle stiffness. This study aimed to examine hot pack application before high-intensity static stretching on stretching pain, knee flexion range of motion, and quadriceps muscle stiffness.

Methods

In total, 21 healthy sedentary male participants randomly performed two interventions: high-intensity static stretching and hot pack application before stretching. Static stretching was performed at three 60-second stretching interventions with a 30-second interval. Then, a 20-minute hot pack was applied before high-intensity static stretching. The knee flexion range of motion and shear elastic modulus of the quadriceps muscle were measured by ultrasonic shear-wave elastography before and after the static stretching intervention.

Results

Stretching pain after hot pack application before stretching was lower than high-intensity static stretching alone. Significant increases were also found in knee flexion range of motion after both stretching interventions, but no significant difference was noted in the increase in the knee flexion range of motion with or without hot pack application. No significant change was found in quadriceps muscle stiffness in either intervention.

Conclusions

The results suggest that hot pack application before high-intensity static stretching could decrease stretching pain, but no significant difference in knee flexion range of motion increase was found.

Rehabilitation of the Canine Forelimb

The goal of rehabilitation is to restore function and mobility and reduce pain associated with chronic disease. In human medicine, physical therapy is standard of care for acute and chronic injuries and an integral component of postoperative recovery. Although there is a dearth of evidence-based veterinary medical studies in rehabilitation therapy and modalities for forelimb injuries in dogs, some extrapolation from human medicine can be made and applied. When developing a rehabilitation and therapeutic plan, the biomechanics of the affected limb and timeline of tissue healing of the target tissue and/or joint are important to consider.

Role and effectiveness of complex and supervised rehabilitation on overall and hand function in systemic sclerosis patients-one-year follow-up study

The aim of this study was to estimate the long-term results of complex and supervised rehabilitation of the hands in systemic sclerosis (SSc) patients. Fifty-one patients were enrolled in this study: 27 patients (study group) were treated with a 4-week complex, supervised rehabilitation protocol. The control group of 24 patients was prescribed a home exercise program alone. Both groups were evaluated at baseline and after 1-, 3-, 6-, and 12-months of follow-up with the Disability of the Arm, Shoulder and Hand Questionnaire (DAHS) as the primary outcome, pain (VAS—visual analog scale), Cochin Hand Function Scale (CHFS), Health Assessment Questionnaire Disability Index (HAQ-DI), Scleroderma-HAQ (SHAQ), range of motion (d-FTP—delta finger to palm, Kapandji finger opposition test) and hand grip and pinch as the secondary outcomes. Only the study group showed significant improvements in the DASH, VAS, CHFS and SHAQ after 1, 3 and 6 months of follow-up (P = 0.0001). Additionally, moderate correlations between the DASH, CHFS and SHAQ (R = 0.7203; R = 0.6788; P = 0.0001) were found. Complex, supervised rehabilitation improves hand and overall function in SSc patients up to 6 months after the treatment but not in the long term. The regular repetition of this rehabilitation program should be recommended every 3–6 months to maintain better hand and overall function.

Local heat applications as a treatment of physical and functional parameters in acute and chronic musculoskeletal disorders or pain

OBJECTIVES

The aim of this systematic review and meta-analysis was to evaluate the effectiveness of local heat applications (LHA) in individuals with acute or chronic musculoskeletal disorders.

DATA SOURCES

An electronic search was conducted on MEDLINE, CENTRAL, CINHAL and the PEDro databases up to December 2019.

STUDY SELECTION

Studies incorporating adults suffering from any kind of musculoskeletal issues treated by LHA compared to any treatment other than heat were included.

QUALITY ASSESSMENT

Two authors independently performed the methodological quality assessment using the Cochrane Risk of Bias tool.

DATA SYNTHESIS

LHA showed beneficial immediate effects to reduce pain vs no treatment (p < 0.001), standard therapy (p = 0.020), pharmacological therapy (p < 0.001) and placebo/sham (p = 0.044). Physical function was restored after LHA compared to no treatment (p = 0.025) and standard therapy (p = 0.006) whilst disability improved directly after LHA compared to pharmacological therapy (p = 0.003) and placebo/sham (p < 0.028). Quality of life was improved directly after LHA treatment compared to exercise therapy (p < 0.021). Range of motion increased and stiffness decreased after LHA treatment compared to pharmacological therapy (p = 0.009., p < 0.001) and placebo/sham (p < 0.001, p = 0.023). The immediate superior effects of LHA on muscular strength could be observed compared to no treatment (p < 0.001), cold (p < 0.001) and placebo/sham (p = 0.023).

CONCLUSIONS

Individuals suffering from acute musculoskeletal disorders might benefit from using LHA as an adjunct therapy. However, the studies included in this meta-analysis demonstrated a high heterogeneity and mostly an unclear risk of bias.

Randomized controlled trial of bikram yoga and aerobic exercise for depression in women: Efficacy and stress-based mechanisms

BACKGROUND

The current study presents a randomized controlled 8-week trial of Bikram yoga, aerobic exercise, and waitlist for depression. Bikram yoga was chosen specifically for its standardized nature. Further, we examined changes in three stress-related constructs-perceived stress, rumination, and mindfulness-as mediators of antidepressant effects.

METHOD

Fifty-three women (age 18-65; 74% White) with a unipolar depressive disorder were randomly assigned to one of the three conditions. Response was defined as >50% reduction on the Hamilton Rating Scale for Depression (HAM-D). Remission was defined as no longer meeting criteria for depression and a HAM-D ≤ 7. Self-reported perceived stress, rumination, and mindfulness were assessed weekly.

RESULTS

In the intention-to-treat sample (n = 53), response rates were significantly higher in the Bikram yoga (61.1%; χ² = 10.48, p = .001) and aerobic exercise (60.0%; χ² = 10.44, p = .001) conditions relative to waitlist (6.7%). In the completer sample (n = 42), 73.3% (χ² = 11.41, p = .001) of women in yoga and 80.0% (χ² = 13.72, p < .001) in exercise achieved response compared to 8.3% in waitlist. Reductions in rumination significantly mediated HAM-D change for both active treatments, and mindful acceptance was a partial mediator in the exercise condition.

LIMITATIONS

The sample was small in size, consisted of women only, and was ethnically homogenous. Inter-rater reliability was not assessed, aerobic exercise was not standardized, and mediators were assessed by self-report.

CONCLUSIONS

Bikram yoga showed descriptively similar efficacy to aerobic exercise and both may work, in part, by helping individuals interrupt negative thinking.

Hyperthermia reduces electromechanical delay via accelerated electrochemical processes

The present study aimed to determine the effect of hyperthermia on both electrochemical and mechanical components of the electromechanical delay (EMD), using very-high-frame-rate ultrasound. Electrically evoked peak twitch force, EMD, electrochemical (D_m; i.e., delay between stimulation and muscle fascicle motion), and mechanical (T_m; i.e., delay between fascicle motion and force production onset) components of EMD were assessed in 16 participants. Assessments were conducted in a control ambient environment (CON; 26°C, 34% relative humidity) and in a hot ambient environment (HOT; 46-50°C, 18% relative humidity, after ∼127 min of heat exposure). Following heat exposure, gastrocnemius medialis temperature was 37.0 ± 0.6°C in HOT vs. 34.0 ± 0.8°C in CON (P < 0.001). EMD was shorter (9.4 ± 0.8 ms) in HOT than in CON (10.8 ± 0.6 ms, P < 0.001). Electrochemical processes were shorter in HOT than in CON (4.0 ± 0.8 ms vs. 5.5 ± 0.9 ms, respectively, P < 0.001), whereas mechanical processes were unchanged (P = 0.622). These results demonstrate that hyperthermia reduces electromechanical delay via accelerated electrochemical processes, whereas force transmission along the active and passive parts of the series elastic component is not affected following heat exposure. The present study demonstrates that heat exposure accelerates muscle contraction thanks to faster electrochemical processes. Further investigations during voluntary contractions would contribute to better understand how these findings translate into motor performance.NEW & NOTEWORTHY Hyperthermia (targeted core temperature: 38.5°C) reduces the time between gastrocnemius medialis stimulation and the onset of plantar flexor force production in vivo. This reduction in electromechanical delay is concomitant to an earlier motion of muscle fascicle compared with thermoneutral environment. However, hyperthermia has no impact on the duration of force transmission along aponeurosis and tendon, thereby reflecting different effects of heat exposure on contractile and elastic properties of the muscle-tendon unit.

The tolerance to stretch is linked with endogenous modulation of pain

OBJECTIVES

The effect of stretching on joint range of motion is well documented, and although sensory perception has significance for changes in the tolerance to stretch following stretching the underlining mechanisms responsible for these changes is insufficiently understood. The aim of this study was to examine the influence of endogenous pain inhibitory mechanisms on stretch tolerance and to investigate the relationship between range of motion and changes in pain sensitivity.

METHODS

Nineteen healthy males participated in this randomized, repeated-measures crossover study, conducted on 2 separate days. Knee extension range of motion, passive resistive torque, and pressure pain thresholds were recorded before, after, and 10 min after each of four experimental conditions; (i) Exercise-induced hypoalgesia, (ii) two bouts of static stretching, (iii) resting, and (iv) a remote, painful stimulus induced by the cold pressor test.

RESULTS

Exercise-induced hypoalgesia and cold pressor test caused an increase in range of motion (p<0.034) and pressure pain thresholds (p<0.027). Moderate correlations in pressure pain thresholds were found between exercise-induced hypoalgesia and static stretch (Rho>0.507, p=0.01) and exercise-induced hypoalgesia and the cold pressor test (Rho=0.562, p=0.01). A weak correlation in pressure pain thresholds and changes in range of motion were found following the cold pressor test (Rho=0.460, p=0.047). However, a potential carryover hypoalgesic effect may have affected the results of the static stretch.

CONCLUSIONS

These results suggest that stretch tolerance may be linked with endogenous modulation of pain. Present results suggest, that stretch tolerance may merely be a marker for pain sensitivity which may have clinical significance given that stretching is often prescribed in the rehabilitation of different musculoskeletal pain conditions where reduced endogenous pain inhibition is frequently seen.

The effects of stretching with cryotherapy, stretching with heat and stretching alone on hamstring flexibility in physically active females

Background/Aims

A pre- and post-intervention study was conducted to examine the effects of acute cryotherapy with stretching, heat with stretching, and stretching alone on hamstring flexibility.

Methods

Thirty female participants were randomly allocated into three groups: stretching with cryotherapy, stretching with heat, or stretching without an intervention. A sit and reach test and the 90/90 active knee extension test were conducted before and after a 20-minute stretching routine to measure hamstring flexibility.

Results

Differences were observed pre- and post-test in the sit and reach test and knee 90/90 extension tasks (P<0.05) within all three groups. However, there were no significant differences (P>0.05) between the three intervention groups.

Conclusions

Combining stretching with cryotherapy or heat application potentially provides no additional benefit to stretching alone in short-term enhancements to hamstring muscle flexibility in physically active females.

High-impact Routines to Ameliorate Trunk and Lower Limbs Flexibility in Women

Several types of routines and methods have been experimented to gain neuro/muscular advantages, in terms of overall range of motion, in athletes and fitness enthusiasts. The aim of the present study was to evaluate the impact of different routines on trunk- and lower limbs flexibility in a sample of young women. In a randomized-crossover fashion, eleven subjects underwent to: hamstrings stretching [S]; hamstrings stretching plus whole-body vibration [S+WBV]; partial-body cryotherapy [Cryo]; rest [Control]. Standing hamstrings stretch performance and sit-and-reach amplitude resulted to be improved with [S+WBV] compared to all other protocols (p<0.05). [Cryo] ameliorated the active knee extension performance with respect to all other interventions (p<0.05). These flexibility improvements were obtained without a loss in the trunk position sense proprioception. These results represent the first evidence that a single session of either vibration or cryotherapy can ameliorate flexibility without losing the trunk position sense proprioception in young women.

The short-term effects of hot packs vs therapeutic whirlpool on active wrist range of motion for patients with distal radius fracture: A randomized controlled trial

STUDY DESIGN

Blinded randomized controlled trial.

INTRODUCTION

It is generally accepted that heat is beneficial for improving range of motion (ROM). However, the mechanism of action is not clearly understood, and the optimal method of heat application has not been established.

PURPOSE OF THE STUDY

To investigate the immediate effects of using a moist hot pack (MHP) vs therapeutic whirlpool bath (WB) for improving wrist ROM during a therapy session for patients with distal radius fracture.

METHODS

About 60 adult patients, with a mean age of 54 years in the MHP group and 53 years in the WB group, with healed distal radius fracture were randomized into 2 groups of 30. Patients in group 1 were placed in an MHP for 15 minutes during therapy. Patients in group 2 had their arm placed in a WB and were asked to perform active wrist ROM exercises for the same period. This occurred for 3 consecutive therapy visits, with wrist and forearm ROM being measured before and after heat during each visit.

RESULTS

The multivariate analysis of variance demonstrated that the canonical variate for ROM was significantly different between groups (F[6,53] = 6.01; P < .05), indicating that patients in the WB group had a significantly larger increase in ROM than patients receiving MHP application.

DISCUSSION

Both WB and MHP improved wrist ROM during therapy sessions in this study, making both these acceptable options for clinical use when the goal is to precondition a patient for other treatments.

CONCLUSIONS

Individuals who received WB showed a statistically greater increase in wrist ROM than those receiving MHP during a therapy session, although the difference between groups may or may not be clinically important considering the small changes in ROM observed in this study.

LEVEL OF EVIDENCE

Level II.

Effect of Static Stretching with Superficial Cooling on Muscle Stiffness

This study aimed to clarify the acute effect of static stretching (SS) with superficial cooling on dorsiflexion range of motion (DF ROM) and muscle stiffness. Sixteen healthy males participated in the cooling condition and a control condition in a random order. The DF ROM and the shear elastic modulus of medial gastrocnemius (MG) in the dominant leg were measured during passive dorsiflexion. All measurements were performed prior to (PRE) and immediately after 20 min of cooling or rested for 20 min (POST), followed by 2 min SS (POST SS). In cooling condition, DF ROM at POST and POST SS were significantly higher than that at PRE and DF ROM at POST SS was significantly higher than that at POST. In addition, the shear elastic modulus at POST was significantly higher than that at PRE and the shear elastic modulus at POST SS was significantly lower than those at PRE and POST. However, there were no significant differences in the percentage changes between PRE and POST SS between the cooling and control conditions. Our results showed that effects of SS with superficial cooling on increases in ROM and decrease in muscle stiffness were no more beneficial than those of SS alone.

Delayed effects of a 20-min crushed ice application on knee joint position sense assessed by a functional task during a re-warming period

Delayed effects of a 20-min crushed ice application on knee joint position sense assessed by a functional task during a re-warming period.

INTRODUCTION

The effect of cryotherapy on joint positioning presents conflicting debates as to whether individuals are at an increased risk of injury when returning to play following cryotherapy application at the lower limb.

OBJECTIVES

The aim of this study was to investigate whether a 20 min application of crushed ice at the knee affects knee joint kinematics immediately post and up to 20 mins post ice removal, during a small knee bend.

METHOD

17 healthy male participants took part in the study performing a functional task. Using three-dimensional motion analysis (Qualisys Medical AB Gothenburg, Sweden), kinematics of the knee were measured during a weight bearing functional task pre and immediately post, 5, 10, 15 and 20 min post cryotherapy intervention. Skin surface temperature (T_sk) cooling was measured via infrared non-contact thermal imaging (Flir Systems, Danderyd, Sweden) over the anterior and medial aspect of the knee.

RESULTS

Results demonstrated significant reductions in the ability to accurately replicate knee joint positioning. A significant increase (P ≧ 0.05) in rotational movement in the transverse plane occurred, 20 min post ice removal.

DISCUSSION

A 20-min application of crushed ice to the anterior aspect of the non-dominant knee has an adverse effect on knee joint repositioning and dynamic stability, 20 min after ice is removed. In consideration of returning a land-based athlete to dynamic functional activities, post cryotherapeutic intervention at the knee, clinicians should consider these findings due to the potential increase risk of injury.

Therapeutic heat and cold around the elbow on the response of median neurodynamic test 1

OBJECTIVE

To compare the effects of the application of therapeutic heat and cold on the mechanical response of the median nerve neurodynamic testing.

DESIGN

Single-blinded randomized crossover trial.

METHODOLOGY

56 asymptomatic university students (mean age = 21.82 ± 1.64 years) of either gender with a limited elbow extension range of motion during a Median Neurodynamic Test 1 were recruited. Each subject was administered 3 testing conditions on separate days with a 24-hr washout period. The interventions included 1) therapeutic moist heat around the elbow, 2) therapeutic cold around the elbow and 3) no thermal agent as a controlled condition. Outcome measure of elbow extension range of motion at the onset of pain and submaximal pain were recorded before the intervention, immediately after the removal of the thermal agents (20^th min) and at 2 subsequent readings of 30 min and 1 hour after the removal of the thermal agent.

RESULTS

There was a significant effect of using a thermal agent with time on the elbow range of motion at the onset of pain [F(2,165) = 3.622, p = 0.029] and submaximal pain[F(2,165) = 3.841, p = 0.023] at the 20th min. A posthoc comparison indicated that at the 20th min the mean elbow range at the onset of pain and submaximal pain for the therapeutic heat condition (mean = 33.5, S.D = 13.37 and mean = 16.80, S.D = 12.99 respectively) was significantly different than the no thermal agent condition (mean = 40.17, S.D = 12.34 and mean = 23.4, S.D = 13.82 respectively). However, therapeutic cold condition did not significantly differ from both the other conditions.

CONCLUSION

Therapeutic heat causes an immediate increase in elbow extension range of motion during a Median Neurodynamic Test1 and testing post the application of thermal agents can alter the test response.

Effects of a Thermal Agent and Physical Activity on Muscle Tendon Stiffness, as Well as the Effects Combined With Static Stretching

CONTEXT

A recent review or article reported that thermal agents (TA) or physical activity (PA) can increase range of motion (ROM) and that the combination of TA with stretching is superior to performing stretching only. However, since ROM is affected by the psychological factors, it is questionable whether these studies measured the effect of these interventions on muscle flexibility. By measuring muscle stiffness, the authors attempted to evaluate the effect these interventions on muscle flexibility.

OBJECTIVE

To compare the individual effects of TA and PA on muscle flexibility, as well as their effectiveness when combined with static stretching (SS).

DESIGN

Crossover trial.

SETTING

University research laboratory.

PARTICIPANTS

15 healthy men without a history of orthopedic disease in their lower limbs.

INTERVENTIONS

15 minutes of 3 different conditions: hot pack as TA, pedaling exercise as PA, and the control group with no TA or PA intervention, followed by 3 min of SS for the hamstrings.

MAIN OUTCOME MEASURES

Joint angle and passive torque of the knee during passive elongation were obtained prior to interventions, after 3 kinds of intervention, and after SS. From these data, muscle-tendon-unit (MTU) stiffness of the hamstrings was calculated.

RESULTS

Although knee-joint ROM increased with both TA and PA (P < .05), there were no significant differences in MTU stiffness between pre- and postintervention measurements for either of the interventions (TA, P = .477; PA, P = .377; control, P = .388). However, there were similar significant decreases in MTU stiffness between postintervention and post-SS for all conditions (P < .01).

CONCLUSIONS

TA and PA did not decrease MTU stiffness, and combining these interventions with SS did not provide additional decreases in MTU stiffness compared with performing SS alone.

Effects of superficial heating and insulation on walking speed in people with hereditary and spontaneous spastic paraparesis: A randomised crossover study

OBJECTIVES

Cooling of the lower limb in people with Hereditary and Spontaneous Spastic Paraparesis (pwHSSP) has been shown to affect walking speed and neuromuscular impairments. The investigation of practical strategies, which may help to alleviate these problems is important. The potential of superficial heat to improve walking speed has not been explored in pwHSSP. Primary objective was to explore whether the application of superficial heat (hot packs) to lower limbs in pwHSSP improves walking speed. Secondary objective was to explore whether wearing insulation after heating would prolong any benefits.

METHODS

A randomised crossover study design with 21 pwHSSP. On two separate occasions two hot packs and an insulating wrap (Neo-G™) were applied for 30minutes to the lower limbs of pwHSSP. On one occasion the insulating wrap was maintained for a further 30minutes and on the other occasion it was removed. Measures of temperature (skin, room and core), walking speed (10 metre timed walk) and co-ordination (foot tap time) were taken at baseline (T1), after 30 mins (T2) and at one hour (T3).

RESULTS

All 21 pwHSSP reported increased lower limb stiffness and decreased walking ability when their legs were cold. After thirty minutes of heating, improvements were seen in walking speed (12.2%, P<0.0001, effect size 0.18) and foot tap time (21.5%, P<0.0001, effect size 0.59). Continuing to wear insulation for a further 30minutes gave no additional benefit; with significant improvements in walking speed maintained at one hour (9.9%, P>0.001) in both conditions.

CONCLUSIONS

Application of 30minutes superficial heating moderately improved walking speed in pwHSSP with effects maintained at 1hour. The use of hot packs applied to lower limbs should be the focus of further research for the clinical management of pwHSSP who report increased stiffness of limbs in cold weather and do not have sensory deficits.

Therapeutic heat and cryotherapy increases knee range of movement on hamstring muscles of healthy volunteers

Purpose:

To investigate the effects of heat (surface and deep) and cold on the range of motion of the knee.

Methods:

A total of 40 volunteers were randomly allocated into four groups, with 10 participants in each group. The control group had no intervention, the infrared group received an application of surface heat conducted through an infrared device, the shortwave group received deep heating through a shortwave device, and the cryotherapy group had ice packs placed on them. A blind measurer performed the flexibility evaluation using a goniometer coupled to a board that evaluated range of movement of the knee. Data were statistically analysed by one-way analysis of variance and Tukey's comparison (for comparison between groups) and paired t-student tests (for before and after comparisons) to determine differences between groups, with a significance level of p<0.05.

Findings:

The infrared, cryotherapy and shortwave groups showed an increase in the range of motion compared with the control group. It was observed that the control and infrared groups showed no significant differences before and after application (p>0.05). However, the cryotherapy and shortwave groups demonstrated an effective increase (p<0.05).

Conclusions:

The three heating and cooling techniques caused a favourable increase of range of movement compared with no intervention. However, the shortwave and cryotherapy interventions were more effective in increasing the knee joint's range of motion.

The Role of Therapeutic Modalities in Surgical and Nonsurgical Management of Orthopaedic Injuries

Rehabilitation professionals often use therapeutic modalities as a component of the surgical and nonsurgical management of orthopaedic injuries. Myriad therapeutic modalities, including cryotherapy, thermotherapy, ultrasonography, electrical stimulation, iontophoresis, and laser therapy, are available. Knowledge of the scientific basis of each modality and the principles of implementation for specific injuries enables musculoskeletal treatment providers to prescribe these modalities effectively. The selection of specific therapeutic modalities is based on their efficacy during a particular phase of rehabilitation. Therapeutic modalities are an adjunct to standard exercise and manual therapy techniques and should not be used in isolation.

Contrast Therapy and Heat Therapy in Subacute Stage of Grade I and II Lateral Ankle Sprains

Objective This study was conducted to determine the most effective thermal modality; heat or contrast therapy-in reducing pain, reducing swelling, and increasing range of movement (ROM) of the grade I and II lateral ankle sprain in the prechronic stage of the subacute phase. Design Randomized control trail. Methods One hundred and fifteen participants of both genders who were diagnosed as having grade I or II lateral ankle sprain were randomly assigned to the study on the fifth day of injury. Pain, volume, and ROM were recorded before and after treatment continuously for 3 days. Results Effects were evaluated as "Immediately after application" and "3 days after continuous application." Immediately after application, there was no difference between the 2 modalities on ankle ROM; heat reduced pain over contrast therapy, and both modalities increased swelling. When considering the effects after continuous application for 3 days, no difference was found between the 2 modalities on ROM and the reduction of pain. Contrast therapy reduced swelling while heat caused increased swelling even after 3 days. Conclusion The use of different thermal modalities during the transition from the acute to chronic phase of injury can be suggested as effective treatment options according to the objectives of injury management: pain reduction, improve ROM, and swelling management.

LEVELS OF EVIDENCE

Therapeutic, Level II: Randomized clinical trial.

Does knee joint cooling change in vivo patellar tendon mechanical properties?

Purpose

This study aimed to assess the influence of knee joint cooling on the in vivo mechanical properties of the patellar tendon.

Methods

Twenty young, healthy women volunteered for the study. B-mode ultrasonography was used to record patellar tendon elongation during isometric ramp contraction of the knee extensors (5–7 s, 90° knee angle) and calculate tendon stiffness. Skin temperature was measured by infrared thermometry. Data were acquired before and after 30 min of local icing of the knee joint and compared by paired samples t-tests.

Results

After cold exposure, skin temperature as measured over the patellar tendon dropped by 16.8 ± 2.0 °C. Tendon stiffness increased from 2189 ± 551 to 2705 ± 902 N mm⁻¹ (+25 %, p = 0.007). Tendon strain decreased by 9 % (p = 0.004). A small, albeit significant reduction in maximum tendon force was observed (−3.3 %, p = 0.03).

Conclusions

Knee cooling is associated with a significant increase in patellar tendon stiffness. The observed tendon stiffening may influence the operating range of sarcomeres, possibly limiting the maximal force generation capacity of knee extensor muscles. In addition, a stiffer tendon might benefit rate of force development, thus countering the loss in explosiveness typically described for cold muscles.

Acute effects of neural mobilization and infrared on the mechanics of the median nerve

[Purpose] This study analyzed the acute effects of infrared and neural mobilization on the median nerve on the range of elbow extension of the dominant limb. [Subjects and Methods] Forty participants from university, neurologically asymptomatic, 12 males and 28 females (22.8 ± 1.9 years), were randomly divided into four groups: Group 1 (control) rested for 25 minutes in the supine position; Group 2 received the specific neural mobilization for the median nerve; Group 3 received an application of infrared for 15 minutes on the forearm; Group 4 received the same application of infrared followed by neural mobilization. The goniometric parameters of elbow extension were evaluated after the intervention. [Results] Significant differences of extension value were observed between Group 1 and Group 3 (15.75 degrees), and between Group 1 and Group 4 (14.60 degrees), and the average higher in Group 3 (26.35 degrees). [Conclusion] This research provides new experimental evidence that NM in relation to superficial heat produces an immediate effect on elbow range of motion versus NM isolated.

Heat transfer by three types of hot pack and its implication on the flexibility of the lower back: a randomized, controlled trial

ABSTRACT The use of hot pack is a common superficial thermotherapy strategy and one of its benefits is the increase of muscle flexibility. However, there is a lack of information about the effects of the heat pack alone, without being used in association with other therapeutic interventions, in the flexibility of the lumbar region. The aim of this study was to compare the effects generated by the application of three different pack on the flexibility of the lower backs of healthy students. Three sessions of 15 minutes of superficial heat through a hot pack (moist heat pack-MHP, seed pack-SP or gel pack-GP) were applied to the lower back. Pack and lower back temperatures and erythema were registered every 5 minutes. A Schober test was performed before the first session and after the third session. After 15 minutes of treatment, pack temperature was higher in the SP group. At the same time, lumbar temperature was lower in the GP group. The heat treatment also increased erythema in the lower back for all three groups. There was a significant increase in intragroup flexibility as assessed by the Schober Test for all groups. There are significant differences in the effect generated between the three types of pack on the flexibility of the lower back. The MHP was able to transfer more heat to the lumbar area and provided a more pronounced increase in the flexibility of lower back tissues.

Principles and Application of Hydrotherapy for Equine Athletes

Hydrotherapy has become a key element within equine rehabilitation protocols and is used to address range of motion, proprioception, strength, neuromotor control, pain, and inflammation. Various forms of hydrotherapy can be tailored to the individual's injury and the expected return to athletic performance. This article describes the mechanisms of action of hydrotherapies and potential use in the clinical management of equine musculoskeletal injuries.

An exploratory study into the effects of a 20 minute crushed ice application on knee joint position sense during a small knee bend

OBJECTIVES

The effect of cryotherapy on joint positioning presents conflicting debates as to whether individuals are at an increased risk of injury when returning to play or activity immediately following cryotherapy application at the knee. The aim of this study was to investigate whether a 20 min application of crushed ice at the knee immediately affects knee joint position sense during a small knee bend.

DESIGN

Pre- and post-intervention.

SETTING

University movement analysis laboratory.

PARTICIPANTS

Eleven healthy male participants.

MAIN OUTCOME MEASURES

Kinematics of the knee were measured during a weight bearing functional task pre and post cryotherapy intervention using three-dimensional motion analysis (Qualisys Medical AB Gothenburg, Sweden). Tissue cooling was measured via a digital thermometer at the knee.

RESULTS

Results demonstrated significant reductions in the ability to accurately replicate knee joint positioning in both sagittal (P = .035) and coronal (P = .011) planes during the descent phase of a small knee bend following cryotherapy.

CONCLUSION

In conclusion a 20 min application of crushed ice to the knee has an adverse effect on knee joint repositioning. Team doctors, clinicians, therapists and athletes should consider these findings when deciding to return an athlete to functional weight bearing tasks immediately following ice application at the knee, due to the potential increase risk of injury.

Acute effects of whole-body cryotherapy on sit-and-reach amplitude in women and men

Flexibility is an intrinsic property of body tissues, which among other factors determines the range of motion (ROM). A decrease in neural activation of the muscle has been linked with greater ROM. Cryotherapy is an effective technique to reduces neural activation. Hence, the aim of the present study was to evaluate if a single session of whole-body cryotherapy (WBC) affects ROM. 60 women and 60 men were divided into two groups (control and experimental). After the initial sit-and-reach test, experimental group performed a 150 s session of WBC, whereas the control group stayed in thermo-neutral environment. Immediately after, both groups performed another sit-and-reach test. A 3-way analysis of variance revealed statistically significant time×group and time × gender interaction. Experimental groups improved sit-and-reach amplitude to a greater extend than the control group. Our results support the hypothesis that ROM is increased immediately after a single session of WBC.

Cold-water immersion alters muscle recruitment and balance of basketball players during vertical jump landing

The purpose of this study was to evaluate the effects of cold-water immersion on the electromyographic (EMG) response of the lower limb and balance during unipodal jump landing. The evaluation comprised 40 individuals (20 basketball players and 20 non-athletes). The EMG response in the lateral gastrocnemius, tibialis anterior, fibular longus, rectus femoris, hamstring and gluteus medius; amplitude and mean speed of the centre of pressure, flight time and ground reaction force (GRF) were analysed. All volunteers remained for 20 min with their ankle immersed in cold-water, and were re-evaluated immediately post and after 10, 20 and 30 min of reheating. The Shapiro-Wilk test, Friedman test and Dunn's post test (P < 0.05) were used. The EMG response values decreased for the lateral gastrocnemius, tibialis anterior, fibular longus and rectus femoris of both athletes and non-athletes (P < 0.05). The comparison between the groups showed that the EMG response was lower for the athletes. Lower jump flight time and GRF, greater amplitude and mean speed of centre of pressure were predominant in the athletes. Cold-water immersion decreased the EMG activity of the lower limb, flight time and GRF and increased the amplitude and mean speed of centre of pressure.

Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury

Nonpharmacological treatment strategies for acute musculoskeletal injury revolve around pain reduction and promotion of healing in order to facilitate a return to normal function and activity. Heat and cold therapy modalities are often used to facilitate this outcome despite prevalent confusion about which modality (heat vs cold) to use and when to use it. Most recommendations for the use of heat and cold therapy are based on empirical experience, with limited evidence to support the efficacy of specific modalities. This literature review provides information for practitioners on the use of heat and cold therapies based on the mechanisms of action, physiological effects, and the medical evidence to support their clinical use. The physiological effects of cold therapy include reductions in pain, blood flow, edema, inflammation, muscle spasm, and metabolic demand. There is limited evidence from randomized clinical trials (RCTs) supporting the use of cold therapy following acute musculoskeletal injury and delayed-onset muscle soreness (DOMS). The physiological effects of heat therapy include pain relief and increases in blood flow, metabolism, and elasticity of connective tissues. There is limited overall evidence to support the use of topical heat in general; however, RCTs have shown that heat-wrap therapy provides short-term reductions in pain and disability in patients with acute low back pain and provides significantly greater pain relief of DOMS than does cold therapy. There remains an ongoing need for more sufficiently powered high-quality RCTs on the effects of cold and heat therapy on recovery from acute musculoskeletal injury and DOMS.

Cold water immersion of the ankle decreases neuromuscular response of lower limb after inversion movement

Background

Cryotherapy has been associated with a significant decrease in nerve conduction velocity and muscle contraction with possible effects on exercise and physical training.

Objectives

To quantify the electromyographic response of the lateral gastrocnemius, tibialis anterior, fibularis longus, rectus femoris and gluteus medius to ankle inversion following cold water immersion.

Method

The peak values of the root mean square (RMS) were obtained from 35 healthy and active university subjects after the use of a tilt platform to force the ankle into 30º of inversion before, immediately after, and 10, 20, and 30 minutes after water immersion at 4±2ºC, for 20 minutes. The Shapiro-Wilk test, repeated measures analysis, Bonferroni's post-hoc, and linear regression analysis provided the results.

Results

Peak RMS was significantly lower at all times after cold water immersion, with residual effect of up to 30 minutes, when compared to pre-immersion for all muscles, except for immediate post-immersion for the gluteus medius.

Conclusions

After cold water immersion of the ankle, special care should be taken in activities that require greater neuromuscular control.