Effects of therapeutic ultrasound on range of motion and stretch pain

Effects of Myofascial Release Techniques on Joint Range of Motion of Athletes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Although myofascial release techniques (MRTs) are commonly used to improve athletes' range of motion (ROM), the effectiveness of MRTs may vary depending on the specific method performed. This systematic review and meta-analysis aimed to evaluate the effects of MRTs on the ROM performance of athletes. (2) Methods: The electronic databases of Cochrane Library, PubMed, Scopus, and Web of Science were searched to identify relevant articles published up to June 2023. This study utilized the PRISMA guidelines, and four databases were searched. The methodological quality of the studies was assessed using the PEDro scale, and the certainty of evidence was reported using the GRADE scale. The overall effect size was calculated using the robust variance estimator, and subgroup analyses were conducted using the Hotelling Zhang test. (3) Ten studies met the inclusion criteria. The overall effect size results indicated that the myofascial release intervention had a moderate effect on ROM performance in athletes when compared to the active or passive control groups. (4) Conclusions: Alternative MRTs, such as myofascial trigger point therapy, can further improve the ROM performance of athletes. Gender, duration of intervention, and joint type may have a moderating effect on the effectiveness of MRTs.

Effects of Neuromuscular Electrical Stimulation and Therapeutic Ultrasound on Quadriceps Contracture of Immobilized Rats

Quadriceps contracture is a condition where the muscle-tendon unit is abnormally shortened. The treatment prognosis is guarded to poor depending on the progress of the disease. To improve the prognosis, we investigated the effectiveness of therapeutic ultrasound and NMES in treating quadriceps contracture in an immobilized rat model. Thirty-six Wistar rats were randomized into control, immobilization alone, immobilization and spontaneous recovery, immobilization and therapeutic ultrasound, immobilization and NMES, and immobilization and therapeutic ultrasound and NMES combination groups. The continuous therapeutic ultrasound (frequency, 3 MHz, intensity 1 W/cm2) and NMES (TENS mode, frequency 50 Hz; intensity 5.0 ± 0.8 mA) were performed on the quadriceps muscle. On Day 15, immobilization-induced quadriceps contracture resulted in a decreased ROM of the stifle joint, reduction in the sarcomere length, muscle atrophy, and muscle fibrosis. On Day 43, therapeutic ultrasound, NMES, and combining both methods improved muscle atrophy and shortening and decreased collagen type I and III and α-SMA protein. The combination of therapeutic ultrasound and NMES significantly reduced the mRNA expression of IL-1β, TGF-β1, and HIF-1α and increased TGF-β3. Therefore, the combination of therapeutic ultrasound and NMES is the most potent rehabilitation program for treating quadriceps contracture.

Short-Term Thermal Effect of Continuous Ultrasound from 3 MHz to 1 and 0.5 W/cm2 Applied to Gastrocnemius Muscle

Continuous ultrasound is recognized for its thermal effect and use in the tissue repair process. However, there is controversy about its dosage and efficacy. This study used infrared thermography, a non-invasive technique, to measure the short-term thermal effect of 3 MHz continuous ultrasound vs. a placebo, referencing the intensity applied. It was a single-blind, randomized clinical trial of 60 healthy volunteers (19-24 years old) divided into three equal groups. Group 1:1 W/cm2 for 5 min; Group 2: 0.5 W/cm2 for 10 min; and Group 3: the placebo for 5 min. The temperature was recorded through five thermographic images per patient: pre- and post-application, 5, 10, and 15 min later. After statistical analysis, a more significant decrease in temperature (p<0.05 ) was observed in the placebo group compared with the remaining groups after the application of continuous ultrasound. Group 1 was the one that generated the highest significant thermal effect (p<0.001), with an increase of 3.05 °C at 15 min, compared with the other two groups. It is concluded that to generate a thermal effect in the muscle, intensities of ≥1 W/cm2 are required, since the dosage maintained a temperature increase for more than 5 min.

Immersion Ultrasound Therapy in Combination with Manual Therapy in the Treatment of Ischemic Digital Ulcers in Systemic Sclerosis

Background and Objectives: Digital ulcers (DUs) are the most common complication in patients with Systemic Sclerosis (SSc). They cause pain with hand dysfunction and negatively impact activities of daily and working life. Our study aims to evaluate the efficacy of a combined treatment of manual therapy and ultrasound therapy in SSc patients with ischemic DU (IDU) compared to manual therapy alone. Materials and Methods: We conducted a before-and-after study (non-randomized study). We enrolled a consecutive series of IDU patients undergoing rehabilitation treatment and divided them into two groups: a treatment group consisting of patients undergoing a combination of manual therapy and US water immersion and a standard care group consisting of patients subjected to manual therapy alone. At the time of the first visit (T0) and at the end of the 4-week rehabilitation period (T1), we evaluated functional capacity, pain intensity, ulcer evolution, and quality of life. Results: In the treatment group, we observed a statistically significant improvement in the functional capacity of the hand (DHI: 28.15 ± 11.0 vs. 19.05 ± 8.83; p < 0.05), pain (NRS: 5.55 ± 1.2 vs. 2.9 ± 1.09; p < 0.05), and PSST score (24.4 ± 4.0 vs. 16.2 ± 2.36; p < 0.05). In the standard care group, we observed a statistically significant improvement only for the functional capacity of the hand (DHI: 28.85 ± 9.72 vs. 22.7 ± 7.68; p < 0.05). Finally, from the comparison between the treatment group and the standard care group, we observed statistically significant improvements in pain (2.9 ± 1.09 vs. 4.5 ± 1.07; p < 0.05) and in the PSST scale (16.2 ± 2.36 vs. 20.4 ± 4.02; p < 0.05). Furthermore, at the end of treatment in the treatment group, 15 ulcers (62.5%) were completely healed, while in the standard care group, only 3 ulcers were completely healed (14.3%). Conclusions: Combined treatment with manual therapy and ultrasound therapy appears to be useful in the management of IDU in patients with scleroderma.

Physiotherapy Efficiency in Post-stroke Upper Extremity Spasticity: TENS vs. Ultrasound vs. Paraffin

BACKGROUND/AIM

Post-stroke spasticity is a significant debilitating condition with negative consequences on individual functional independence and quality of life. This study aimed to identify the differences between transcutaneous electrical stimulation (TENS), ultrasound therapy and paraffin procedures on post-stroke upper extremity spasticity and dexterity.

PATIENTS AND METHODS

Twenty-six patients were enrolled in the study, divided into three therapy groups: TENS (n=9), paraffin (n=10) and ultrasound therapy (n=7). For 10 days, the patients received specific group therapy and conventional physical therapy exercises for upper extremities. Modified Ashworth Scale, Functional Independence Measure, Functional Coefficient, Stroke Specific Quality of Life Scale, Activities of Daily Living score and ABILHAND questionnaire were used to assess the participants before and after therapy.

RESULTS

The results of the group comparisons by analysis of variance showed no significant difference between outcomes by the applied treatments. In contrast, one-way analysis of variance suggested significant improvements in patients in all three groups after therapy. Step-wise regression results on functional independence measure and quality-of-life scales suggested that functional range of motion values for elbow and wrist influence individual independence and quality of life.

CONCLUSION

TENS, ultrasound, and paraffin therapy bring equal benefits in the management of post-stroke spasticity.

Radial Extracorporeal Shockwave Therapy versus Ultrasound Therapy in Adult Patients with Idiopathic Scoliosis

BACKGROUND

This study aimed to compare the effectiveness of radial extracorporeal shockwave and ultrasound therapies in adult patients with idiopathic scoliosis in terms of pain, disability, and quality of life.

METHODS

Forty-eight patients with idiopathic scoliosis were randomly divided into three groups of 16: shockwave, ultrasound, and control. The patients were evaluated at admission (day one) and at discharge (day 14) for pain, by using the visual analogue scale; for disability, by using the Oswestry disability index; and for the quality of life, with short form-36.

RESULTS

Radial extracorporeal shockwave therapy was more effective than ultrasound in reducing pain (p = 0.004) and increasing quality of life, bringing extra vitality (p = 0.003) and emotional comfort (p = 0.007) to the patient. Both shockwave therapy (p = 0.001) and ultrasound therapy (p = 0.003) were effective in reducing pain. In terms of disability, both treatments had similar effects (p = 0.439).

CONCLUSION

Radial shockwave was significantly more effective than ultrasound in reducing pain and increasing the quality of life, bringing additional vitality and emotional comfort to the patient with idiopathic scoliosis. In terms of disability, both treatments had similar effects when associated with kinesitherapy.

Protocol based management of common sports injuries by integrated approach of Sandhi Marmabhighata - An open labeled clinical trial

Background

Sports injuries are the second most common type of accident after domestic (3.7%) and occupational accidents (3.1%). There is an average annual estimate of 8.6 million sports and recreational related injury incidents with an age-adjusted rate of 34.1 per 1000 populations. Common sports injuries are musculoskeletal injuries i.e. Sprains, Strains, Joint injuries, soft tissue injury (STI). The sports injury in Ayurveda can be co-related within dissimilar facets of trauma related ailments.

Objective

To evaluate the efficacy of a protocol-based management of common sports injuries using an integrated approach.

Materials and methods

Integration of Ayurveda and Physiotherapy procedures was done and phase wise treatment was framed. Total 30 patients of age between 10 and 60 years ful-filling the inclusion criteria were selected for the present study. The patients were treated with Phase wise protocol consisting of three phase’s i.e. Inflammatory (1–5 days), Stabilization and recovery (6–10 days), Muscle strengthening (11–17 days). Assessments were done through various variables like pain, tenderness, swelling, local temperature, manual muscle testing (MMT) and range of motion (ROM) at different time points.

Statistical analysis

Wilcoxon matched pair test was used to assess within group results for subjective parameters and paired t-test (Dependent t-test) was used to assess for objective parameters.

Result

The study showed that integrated treatment approach has given significant results in the parameters like pain, loss of function, tenderness, local temperature, MMT and ROM.

Conclusion

Phase wise management through integrated protocol is effective in the management of common sports injuries.

Effect of Neurodynamics Nerve Flossing on Femoral Neuropathy in Haemophilic Patients: A randomized controlled study

OBJECTIVE

Heamophilia is considered a disorder in both children and adolescents which may affect their quality of life seriously than their normal peers; this study investigated the impact of the Neurodynamics Nerve Flossing Technique (NFT) on femoral neuropathy in patients with haemophilia.

METHOD

Thirty haemophilic children with Femoral Neuropathy were randomly allocated into two equivalent groups; the study group which received Neurodynamics NFT of the femoral nerve and conventional therapy program, and the control group which received only the conventional therapy program, three sessions/week for 12 weeks. Femoral nerve motor conduction velocity (MCV) and level of pain sensation according to the Visual Analogue Scale (VAS), were assessed pre and post interventions.

RESULTS

post-treatment comparison between both groups revealed that there was a significant increase in femoral nerve MCV and reduction of pain sensation of the study group compared to the control group (p<0.05).

CONCLUSION

Neurodynamics Nerve flossing had a clear effect in the treatment of femoral neuropathy in children with haemophilia.

Shoulder joint mobility in patients with primary adhesive capsulitis after treatment with continuous mode of ultrasound: A systematic review of randomized controlled trials

Background: Although the continuous mode of ultrasound therapy improves joint mobility, its role in primary adhesive capsulitis (AC) remains unclear. Therefore, this systematic review aims to address this evidence gap.

Methods: The literature search included databases (SCOPUS, CINAHL, EMBASE, and PubMed) and in-text references of articles read full-text. Randomized controlled trials (RCT) on primary AC patients (published in the English language between 1979-2019) comparing the ROM changes (in degrees) mainly between continuous mode of US therapy with any other non-electrotherapeutic treatment were eligible for inclusion. The trials were reviewed narratively along with an assessment of the risk of bias.

Results: Out of 174 search results, two eligible single-center trials comprising of 100 participants compared ROM in four separate directions at the 10th session and after three months post-intervention. The risk of selection bias, performance bias, and attrition bias was unclear among the trials. While in both the trials ROM (in all directions) improved in the respective intervention groups at follow up, most of these changes varied between the intervention groups in one trial. However, in the latter trial, participants in the treatment group had the worst ROM values at baseline with poor compliance to the adjunct exercise therapy.

Conclusion: The contemporary evidence in the context remains inconclusive due to a lack of large multicentric well-conducted RCTs.

Efficacy of continuous and pulsed therapeutic ultrasound combined with exercises for knee osteoarthritis: a randomized controlled trial

OBJECTIVES

To compare the effects of continuous and pulsed therapeutic ultrasound combined with strengthening exercises.

DESIGN

This is a double-blind randomized controlled trial.

SETTING

Pontifical Catholic University.

SUBJECTS

One hundred participants with Grade 2-4 knee osteoarthritis and both genders were involved.

INTERVENTION

Participants were randomized into five groups: Group I (n = 20; in the first month, continuous ultrasound was applied), Group II (n = 20; in the first month, pulsed ultrasound was applied), Group III (n = 20; in the first and second months, continuous ultrasound was applied), Group IV (n = 20; in the first and second months, pulsed ultrasound was applied) and Group V (n = 20; patients received only exercise sessions for eight weeks). All patients in the groups that received ultrasound application performed exercises in the second month of treatment. The sessions occurred three times a week.

MAIN MEASURES

Pain was assessed using the visual analogical scale, functionality was assessed using the Lequesne questionnaire, range of motion was assessed using a universal goniometer, muscular strength was assessed using a dynamometer, mobility was assessed using the Timed Up and Go test and 8-meter walk test and the activity level was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire.

RESULTS

Statistically significant differences (P < 0.05) were presented by Group III in the variables pain during activities of daily living (ADLs) 5.89 (2.18), mobility assessed by 8-meter test 2.68 (2.56), in pain 10.65 (4.40), function 25.50 (10.87) and total 38.65 (15.29) of WOMAC and functionality 9.10 (5.15).

CONCLUSION

Prolonged applications of continuous ultrasound combined with exercises are effective in providing pain, mobility, functionality and activity in subjects with knee osteoarthritis.

Simplified Theoretical Model for Temperature Evaluation in Tissue–Implant–Bone Systems during Ultrasound Diathermy

Deep heating procedures are helpful in treating joint contractures that frequently occur with fractures and joint diseases involving surgical implants and artificial joint prostheses. This study uses a one-dimensional composite medium model consisting of parallel slabs as a simplified approach to shed light on the influences of implants during ultrasound diathermy. Analytical solutions for the one-dimensional transient heat generation and conduction problem were derived using the orthogonal expansion technique and a Green’s function approach. The analytical solutions provided deep insight into the temperature profile by therapeutic ultrasound heating in the composite system. The effects of the implant material type, tissue thickness, and ultrasound operation frequency on temperature distribution were studied for clinical application. In addition, sensitivity analyses were carried out to investigate the influences of material properties on the temperature distribution during ultrasound diathermy. Based on the derived analytical solutions, the numerical simulations indicate that materials with high density, high specific heat, and low thermal conductivity may be optimal implant materials. Among available implant materials, a tantalum implant, which can achieve a lower temperature rise within the tissue (hydrogel) and bone layers during ultrasound diathermy, is a better choice thanks to its thermodynamics.

Regeneration of Skeletal Muscle After Eccentric Injury

Eccentric-contraction-induced skeletal muscle injuries, included in what is clinically referred to as muscle strains, are among the most common injuries treated in the sports medicine setting. Although patients with mild injuries often fully recover to their preinjury levels, patients who suffer moderate or severe injuries can have a persistent weakness and loss of function that is refractory to rehabilitation exercises and currently available therapeutic interventions. The objectives of this review were to describe the fundamental biophysics of force transmission in muscle and the mechanism of muscle-strain injuries, as well as the cellular and molecular processes that underlie the repair and regeneration of injured muscle tissue. The review also summarizes how commonly used therapeutic modalities affect muscle regeneration and opportunities to further improve our treatment of skeletal muscle strain injuries.

Influence of therapeutic ultrasound on the biomechanical characteristics of the skin

BACKGROUND

Skin function is dependent on its biomechanical characteristics, resistance, malleability, and elasticity. Therapeutic ultrasound may increase cutaneous malleability thus and optimize the rehabilitation process on specific diseases. The aim of this study is to evaluate possible alterations of biomechanical characteristics of the normal skin after therapeutic ultrasound application.

METHODS

Thirty-one volunteers took part of the study, and the average age was 31.61 ± 8.37 years old. Biomechanical characteristics evaluation of the skin was performed with the Cutometer MPA 580 (Courage + Khazaka Electronic-Köln, Germany) of 2-mm probe hole and 500-mbar vacuum. Skin characteristics were analyzed before and after therapeutic ultrasound application, and the variables R0 (distensibility), R2 (gross elasticity), and R6 (viscoelasticity) were used for the study. Areas of therapeutic ultrasound application (continuous, 3 MHz, 1 W/cm(2) SATA) were defined at the upper limbs and standardized using a neoprene template. Sociodemographic data of volunteers were analyzed using SPSS 15.0. To analyze the distribution of the data, the Shapiro-Wilk test was used, which showed the normal distribution for R0 values, R2 and R6. For this procedure, the PROC TTEST from SAS® 9.0 software and Minitab 16 software, with significance, was set at the 0.05 level.

RESULTS

In relation to R0, a significant increase (p = 0.001) was observed for the distensibility, when compared to values of pre- (0.3273 mm) and immediately post- (0.3795 mm) resource application which feature a greater distensibility. Related to R2 values, a significant increase (p = .001) of the gross elasticity at pre- (0.8419) and post- (0.8884) therapeutic ultrasound application was found.

CONCLUSIONS

Therapeutic ultrasound promotes significant alterations of the biomechanical characteristics of the skin.

TRIAL REGISTRATION

ClinicalTrials.gov, 1111-1146-7342.

Immediate effect of stretching and ultrasound on hamstring flexibility and proprioception

[Purpose] This research explored the positive effects of self-myofascial release on hamstring muscular flexibility and proprioception and investigated the effectiveness of the stretch combined with therapeutic ultrasound. [Subjects and Methods] This study included 30 healthy university students with no history of pain in the Achilles tendon or hamstring within the recent 6 months. Each participant completed two experiments. In the first experiment (MS), they completed self-myofascial stretching using a foam roller for 7 days. In the second experiment (MSU), the same participants performed the self-myofascial stretching after the 15-minute application of ultrasound. This study involved a pre- and post-test on hamstring muscle flexibility and hip joint proprioception. [Results] The use of self-myofascial stretching in the MS experiment had a significant effect on hamstring muscle flexibility and hip joint proprioception. However, the addition of ultrasound in the MSU experiment had no additive effect. [Conclusion] Self-myofascial stretching immediately increased hamstring muscle flexibility and improved hip joint proprioception, but the addition of pre-stretch ultra sound provided no further benefit.

Effects of deep heating provided by therapeutic ultrasound on demyelinating nerves

[Purpose] Physiotherapeutic heating agents are classified into two groups: superficial-heating agents and deep-heating agents. Therapeutic ultrasound is a deep-heating agent used to treat various musculosketal disorders. Numerous studies have attempted to determine the impact of ultrasound on healthy nerve conduction parameters. However, the instantaneous effects of deep heating via ultrasound on demyelinating nerves do not appear to have been described previously. The present study aimed to assess and compare the impact of ultrasound on demyelinating nerve and healthy nerve conduction parameters. [Subjects and Methods] Carpal tunnel syndrome was used as a focal demyelination model. Thirty-two hands of 25 participants with carpal tunnel syndrome were enrolled in the study. Ultrasound parameters were 3.3 MHz, 1.0 W/cm², 8 minutes, and continuous wave. Electrodiagnostic studies were performed initially, at the midpoint (4th min), and immediately after (8th min) ultrasound application. [Results] Reduced motor conduction velocity was found in demyelinating nerves at the 4th and 8th minutes. Ulnar nerve onset latency was significantly prolonged in the 8th minute recording, compared to the initial value. There were no significant differences in relative velocity and latency changes between demyelinating and normal nerves. [Conclusion] Deep heating via ultrasound may inversely affect conduction velocity in demyelinating nerves.

Comparison of therapeutic duration of therapeutic ultrasound in patients with knee osteoarthritis

[Purpose] The aim of study was to compare different durations of ultrasound in patients with knee osteoarthritis. [Subjects and Methods] One hundred patients diagnosed with bilateral knee osteoarthritis (OA) were enrolled in this study. Patients were divided into two groups. The first group (G1) received 4 minutes of ultrasound. The second group (G2) received the exact same treatment, but the duration of ultrasound was longer at 8 minutes. Patients in both groups underwent a total of 10 ultrasound over 2 weeks. Following treatment, all patients provided self-evaluations of pain via the Visual Analog Scale (VAS), overall physical function with WOMAC, disability via the Lequesne index (Leq), and depressive symptoms with the Beck Depression Index (BDI). [Results] There were no significant differences in VAS, WOMAC Leq, and BDI values between groups 1 and 2. After treatment, VAS, WOMAC, Leq, and BDI values improved for both treatment groups. However, following treatment, G2 had significantly greater values for WOMAC functional and total scores than G1. No statistically significant differences were observed for VAS scores while inactive, WOMAC pain and stiffness scores, and BDI values after treatment between both groups. VAS pain scores while active and Leq index values were significantly lower in G1 than G2. [Conclusion] Patients in both groups demonstrated improved functionality, pain and psychological status following a consistent, 2-week regimen of 4-minute or 8-minute treatments with ultrasound. Yet, patients that experienced longer treatment durations of 8 minutes demonstrated better outcomes in pain and the ability to carry out activities of daily living.

Comparison of the effects of hamstring stretching using proprioceptive neuromuscular facilitation with prior application of cryotherapy or ultrasound therapy

[Purpose] Stretching using proprioceptive neuromuscular facilitation involve physiological reflex mechanisms through submaximal contraction of agonists which activate Golgi organ, promoting the relaxation reflex. The aim of this study was to evaluate the effects of proprioceptive neuromuscular facilitation alone and with prior application of cryotherapy and thermotherapy on hamstring stretching. [Subjects and Methods] The sample comprised of 32 young subjects with hamstring retraction of the right limb. The subjects were randomly allocated to four groups: the control, flexibility PNF, flexibility PNF associated with cryotherapy, flexibility PNF in association with ultrasound therapy. [Results] After 12 stretching sessions, experimental groups showed significant improvements compared to the control group. Moreover, we did not find any significant differences among the experimental groups indicating PNF stretching alone elicits similar results to PNF stretching with prior administration of cryotherapy or thermotherapy. [Conclusion] PNF without other therapy may be a more practical and less expensive choice for clinical care.