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Background/Objectives: Hamstring muscle (HM) flexibility is frequently compromised in people with chronic low back pain (CLBP), contributing to disability and leading to a less favorable recovery. In a previous article, we presented the results of a study on the immediate effect of passive HM stretching on flexibility in 90 people with CLBP. There was considerable variability in the changes after stretching. The objective of this supplementary analysis was to compare the clinical characteristics of individuals who experienced a significant improvement in flexibility with those who did not. Methods: We fixed a threshold of 7° to indicate an improvement in passive Straight Leg Raise (SLR) angle and differentiate between 'Responders' and 'Non-responders' regarding passive HM stretching. Results: Only body mass index differed between groups; it was significantly smaller in Responders (p = 0.007). The majority of Non-responders experienced workplace accidents, but this was of marginal difference compared to Responders (p = 0.056). Conclusions: Further studies should consider a broader clinical analysis with a larger sample size to understand which factors influence the HM stretching response in CLBP patients. [ABSTRACT FROM AUTHOR]

There is no consensus on treatment for adhesive capsulitis of the shoulder. Physiotherapy is often used to increase range of motion but individuals may experience pain during mobilisation. The objective of this study was to determine whether rehabilitation under N 2 O for shoulder AC improved pain and function more than rehabilitation alone (with placebo gas). A randomised, 1:1 parallel arm, double-blind study in 4 university hospital outpatient centres. Adults with adhesive capsulitis for at least 3 months with intact cartilage were included. Participants were randomised in blocks of 4 and stratified by centre to receive 20 sessions of intensive physiotherapy over 10 days; the 10 morning sessions were performed with either nitrous oxide (intervention) or sham gas (placebo). Primary outcome: improvement in shoulder function at day 14 (D14) (Constant-Murley score). Seventy-five participants were included, and data from 69 were analysed: 37 in the placebo group and 32 in the intervention group. Improvements occurred in both groups after the intervention. No significant difference in the Constant-Murley score was found between groups at D14 (median score increase of 12.0, IQR 5.6; 19.5 points in placebo group vs. 13.7, 5.2; 18.2 in the N20 group, p = 0.78). Pain score during sessions reduced in the intervention group from the first to final session (−11.6, p = 0.053) but not for the placebo group (−4.2, p = 0.414). Seven serious adverse events were recorded, 4 in the intervention group and 3 in the placebo group, with 11 minor adverse events only in the intervention group (mostly shortness of breath). Nitrous oxide gas associated with intensive physiotherapy for shoulder adhesive capsulitis did not improve function, pain or quality of life more than physiotherapy alone. zHowever, pain experienced during physiotherapy sessions appeared lower. Clinical Trial registration number NCT01087229. [ABSTRACT FROM AUTHOR]

We report a longitudinal survey of a 53-year-old man suffering from right knee osteoarthritis who has undergone total knee replacement (TKR). We aimed at evaluating the effect of a short preoperative isokinetic strengthening program on the functional status, pain, and quadriceps and hamstrings strength before and after TKR. The patient performed a 4-week (6 sessions) preoperative isokinetic strengthening program of the quadriceps and hamstrings. The findings for the concentric strength at 60 ∘ /s, 6-minute walk test (6MWT), and Knee injury and Osteoarthritis Outcome Score (KOOS) were recorded. At baseline the patient presented with an overall KOOS score of 44%, a 6MWT of 444 m, a 63% and 21% strength deficits of the quadriceps and hamstrings, respectively. Following the strengthening program, the quadriceps strength of the operated limb improved (+ 121 Nm; + 83%), but the function as reflected by the KOOS score remained unchanged. Following the TKR, the concentric isokinetic strength of the quadriceps reappeared altered (63% of deficit) despite pain and functional improvements. This case report underlines the importance of functional evaluation rather than the maximal strength to assess the effectiveness of TKR. However, further studies are necessary to conceptualize the meaning of maximal strength measurement and the impact of associated deficits, if any. [ABSTRACT FROM AUTHOR]

Objectives: To show the superiority of eccentric versus concentric strengthening in terms of improving quadriceps strength in knee osteoarthritis (OA), a randomized controlled study was conducted to perform 12 sessions of either eccentric or concentric isokinetic muscle strengthening over 6 weeks. Methods: We recruited males and females, aged between 40 and 70 years, with predominantly unilateral femorotibial OA. Exclusion criteria were having a prosthesis, inflammatory arthritis or flare-up of OA, symptomatic patellofemoral OA, cardiovascular or pulmonary disease that could be a contraindication to the study treatment, and any pathology that could cause muscle weakness. The primary endpoint was the between-group difference in change in maximum concentric isokinetic knee extension peak torque (PT) at 60°/s on the OA side at 6 weeks. Secondary endpoints were between-group difference in change in concentric hamstring PT at 60°/s; eccentric quadriceps and hamstring PT at 30°/s; 10 m and 200 m walking speeds; pain and functional status (WOMAC score) at 6 weeks and 6 months. Results: The sample consisted of 11 females and 27 males, with a mean age of 57.7 ± 7.52 years and a body mass index (BMI) of 25.95 ± 3.93 kg/m2. Quadriceps strength increased more at 6 weeks in the concentric than the eccentric group with no statistical difference. There was a rate of 25% major adverse events in the eccentric group. Conclusions: Eccentric training resulted in a smaller improvement in quadriceps strength than concentric training and was associated with a high risk of muscle injury, particularly to the hamstring muscles. [ABSTRACT FROM AUTHOR]

Objective The Star Excursion Balance Test (SEBT) has been lately used in the anterior cruciate ligament (ACL) deficient patients but its measurement properties are still unknown in this population. The purpose of this study was to estimate: the intrarater reliability, agreement, the construct validity of the SEBT, versus the one leg hop test (OLHT) and the self-reported function. Patients and methods The ACL-deficient patients ( n = 18) performed three trials of the SEBT in the anterior (A), posteromedial (PM) and posterolateral (PL) direction and three trials of the OLHT bilaterally. The self-reported function was evaluated with the Lysholm score and the International Knee Documentation Form (IKDC 2000). Results The intrarater reliability was excellent for the SEBT (ICC: 0.94–0.99) with acceptable agreement (MDC: 1.39–6.00). Significant correlations ( P < 0.05) were found for the injured limb: SEBT-PM vs. Lysholm score ( r = 0.56), SEBT composite score vs. Lysholm score ( r = 0.50), SEBT-A vs. OLHT ( r = −0.56) and for the non-injured limb: SEBT-PM and OLHT ( r = 0.64), SEBT-PM vs. Lysholm score ( r = 0.54), SEBT-PL vs. Lysholm score ( r = 0.53), SEBT composite score vs. Lysholm score ( r = 0.57). Discussion/Conclusion The excellent reliability and agreement of the SEBT are in concordance with the results obtained in healthy subjects, indicating that the SEBT can be reliably employed in ACL-deficient patients. Moderate positives correlations found between the SEBT parameters and the Lysholm score reveal good construct validity of the SEBT. However, moderate negative correlation found between SEBT-A and OLHT suggest that these two parameters seem evaluate different construct. [ABSTRACT FROM AUTHOR]

Highlights • The best way to treat adhesive capsulitis is not known. • Intensive physical therapy may improve range of motion but may increase pain. • The use of analgesic gas during rehabilitation may help with the treatment. • A multicentre randomized clinical trial is designed to test the effectiveness of gas associated with rehabilitation for adhesive capsulitis. Abstract Background There is little evidence regarding the best way to treat adhesive capsulitis. Physical therapy can reduce pain and improve function and range of motion. However, we lack clear indications on the regimen, techniques or intensity of physical therapy to achieve better results. Intensive physical therapy seems to be confined to the later stages of adhesive capsulitis (chronic stage) given that rehabilitation-induced pain could worsen the outcomes. Here we describe a protocol for a study comparing the efficacy of a standardized program of intensive mobilization under analgesic gas to a similar program under placebo gas and questioning the impact of pain. Method/Design A randomized, double-blind, multicenter study — the MEOPA Trial — was designed to include adults with strictly defined clinical adhesive capsulitis for a 14-day intensive physical rehabilitation program under an equimolar mixture of oxygen and nitrous oxide or sham gas administration. Efficacy will be assessed by the Constant-Murley score. Data for secondary criteria including pain, disability, quality of life and perceived efficacy by the patient or physiotherapist will be collected over 6 months. Discussion This randomized controlled trial has been designed to test the effectiveness of intensive physical therapy under a simple and safe analgesic method. This study will also address the effect of pain during rehabilitation in adhesive capsulitis. Furthermore, results from the 6-month multidimensional follow-up of painful mobilization for this condition could be extrapolated to other musculoskeletal conditions. Trial registration ClinicalTrials.gov No. NCT01087229. [ABSTRACT FROM AUTHOR]