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Background. Anterior cruciate ligament (ACL) injuries are among the most common injuries in wrestling. Even though there are several studies available in the literature about the changes in gait kinematics following ACL injury and ACL reconstruction surgery, none of these studies investigated the changes in gait kinematics following nonoperative rehabilitation protocol. So, this study is aimed at investigating the changes in gait kinematic following a supervised ACL rehabilitation protocol among wrestlers following a grade II ACL injury. Methods. Fifteen male professional wrestlers with recent grade II ACL injury with mean age: 19.93 ± 2.01 years, weight: 72.33 ± 7.46 kg , and height: 173 ± 4.95 cm volunteered for this single-arm pretest-posttest study. Kinematic parameters during walking pre- and postrehabilitation were examined by two-dimensional (2D) video graphic analysis. Paired sample t -test and Cohen’s d were used to determine significant differences and effect size of segmental angle, cadence, step length, stride length, etc. Results. Injured wrestlers after the rehabilitation program walked significantly faster and had a 10.13% higher cadence, a 10.89% faster gait velocity, a 05% greater step length, and a 4.69% longer stride length, compared with a prerehabilitation program of injured wrestlers. Furthermore, joint angles at the hip, knee, and ankle were significantly different between pre- and postrehabilitation. Conclusion. Research findings suggest that rehabilitation programs significantly impact the gait pattern of injured wrestlers. A 19-week supervised rehabilitation protocol can increase gait velocity and related parameters in ACL injured wrestlers.

Athletes such as long-distance runners, sprinters, hockey, and/or football players may have proximal hamstring tendinopathy (PHT). Laser therapy has been shown to be effective in tendinopathies. High power laser therapy (HPLT) is used for the treatment of several musculoskeletal conditions; however, its efficacy on PHT has not been investigated. This study is aimed at examining the effects of HPLT on pain and isokinetic peak torque (IPT) in athletes with PHT. The two-arm comparative pretest-posttest experimental design was used with random allocation of 36 athletes aged 18-35 years into two groups (experimental and conventional group). The experimental group included the application of HPLT for 3 weeks. The conventional group included treatment with a conventional physiotherapy program including ultrasound therapy, moist heat pack, and home exercises for a total of 3 weeks. Pain and IPT of the hamstring muscle were measured before and after the application of the intervention. Pain score decreased, and IPT increased significantly ( p < 0.05 ) after application of HPLT, by 61.26% and 13.18%, respectively. In the conventional group, a significant difference ( p < 0.05 ) was observed in pain scores only, which decreased by 41.14%. No significant difference ( p > 0.05 ) was observed in IPT in the conventional group. When HPLT was compared with conventional physiotherapy, a significant difference was found in pain scores only. HPLT for 3 weeks was found to be effective in improving pain in athletes with PHT. However, no significant difference was found between HPLT and conventional physiotherapy (US, moist heat, and home exercises) in improving the IPT of the hamstring muscle.

Purpose. This study is aimed at determining the impact of work-related low back pain (LBP) on functional performance and physical capabilities. Methods. This cross-sectional study included women ( n = 25 , mean age, 38.12 ± 4.59 ) and men ( n = 25 , mean age, 37.20 ± 5.38 ) with a history of work-related mechanical chronic LBP who visited our university hospital’s outpatient department. All participants were assessed for primary outcomes, including the severity of LBP on rest and on activity, functional performance, and physical capabilities using a numeric pain rating scale (NPRS), Roland-Morris disability questionnaire (RDQ), five-time sit-to-stand test (FTSST), and fifty-foot walk test (FFWT), respectively. Independent t -tests compared the scores of the outcomes between groups while Pearson’s correlation coefficient identified the correlation between the outcomes’ measures at a significance level of 0.05. Results. With a response rate of 63.29%, a total of fifty participant’s data were obtained for the analysis. A comparison between women and men groups highlighted a significant difference in the scores of the FTSST and FFWT; however, there were insignificant differences in the scores of the NPRS at rest, NPRS on activity, and RDQ. The bivariate correlation revealed a highly significant, positive, and moderate correlation between the scores of NPRS at rest and FTSST, NPRS on activity and FTSST, NPRS at rest and FFWT, NPRS on activity and FFWT, FTSST and RDQ, and FFWT and RDQ in the women group. Similarly, there was a significant, positive, and low correlation between the scores of FTSST and RDQ and FFWT and RDQ in the men group. Conclusion. Work-related chronic LBP affected the physical capabilities of women more than those of men. However, it equally affected the functional performance of all participants in the study. Furthermore, work-related chronic LBP affected the physical capabilities (FTSST and FFWT) and functional performance (RDQ) of women more than those of men.

Background. Cellular miRNAs are expressed in tissue fluids with sufficient amounts and were identified as potential molecular targets for studying the physiological mechanisms and correlations with many human diseases particularly diabetes. However, molecular-based changes among older adults with diabetes mellitus (DM) are rarely fully elucidated. Aim. This study is aimed at identifying circulating miRNAs, which hold the potential to serve as biomarkers for the immune-inflammatory changes in older T2D patients with moderate and poor glycemic control status. In addition, the association of both myokines and osteopontin (OPN) levels with circulating miRNAs was identified. Methods. A total of 80 subjects aged 20–80 years were invited during the period of October 2017–May 2018 to participate in this descriptive cross-sectional study. All subjects were diagnosed with T2D for more than 5 years. Subjects were grouped based on glycemic control (HbA1c values) into two groups: moderate glycemic control (>7-8% HbA1c, no = 30 ) and poor glycemic control (>8% HbA1c, no = 50 ), respectively. Diabetic control parameters, fasting blood sugar (FS), HbA1c, fasting insulin (IF), insulin resistance (IR), HOMA-IR, inflammatory cytokines (IL-6, IL-8, IL-18, IL-23, TNF-α, and CRP), osteopontin, and myokines (adropin and irisin) were estimated by colorimetric and immune ELISA assays, respectively. In addition, real-time RT-PCR analysis was performed to evaluate the expression of circulating miRNAs, miR-146a and miR-144, in the serum of all diabetic subjects. Results. In this study, T2D patients with poor glycemic control showed a significant increase in the serum levels of IL-6, IL-8, IL-18, IL-23, TNF-α, CRP, and OPN and a reduction in the levels of myokines, adropin and irisin, compared to patients with moderate glycemic control. The results obtained are significantly correlated with the severity of diabetes measured by HbA1c, FS, IF, and HOMA-IR. In addition, baseline expression of miR-146a is significantly reduced and miR-144 is significantly increased in T2D patients with poor glycemic control compared to those with moderate glycemic control. In all diabetic groups, the expression of miR-146a and miR-144 is significantly correlated with diabetic controls, inflammatory cytokines, myokines, and serum levels of OPN. Respective of gender, women with T2D showed more significant change in the expressed miRNAs, inflammatory cytokines, OPN, and serum myokine markers compared to men. ROC analysis identified AUC cutoff values of miR-146a, miR-144, adropin, irisin, and OPN expression levels with considerable specificity and sensitivity which recommends the potential use of adropin, irisin, and OPN as diagnostic biomarkers for diabetes with varying glycemic control status. Conclusion. In this study, molecular expression of certain microRNA species, such as miR-146a and miR-144, was identified and significantly associated with parameters of disease severity, HbA1c, inflammatory cytokines, myokines, and serum osteopontin in T2D patients with moderate and poor glycemic control. The AUC cutoff values of circulating miRNAs, miR-146a and miR-144; myokines, adropin and irisin; and serum OPN were significantly identified by ROC analysis which additionally recommends the potential use of these biomarkers, miR-146a, miR-144, adropin, irisin, and OPN, as diagnostic biomarkers with considerable specificity and sensitivity for diabetes in patients with varying glycemic control status.

Chronic obstructive pulmonary disease (COPD) is primarily a disease of the lungs; however, extrapulmonary comorbidities like rib cage stiffness, decreased thoracic spine mobility, postural changes, and skeletal muscle dysfunctions also coexist. Muscle energy technique (MET) and joint manipulation (JM) may help alleviate these musculoskeletal problems. This study was aimed at evaluating the effectiveness of MET and JM on pulmonary functions, dyspnea, chest wall mobility, disease exacerbations, and health-related quality of life in COPD patients. A total of 16 patients (7 women and 9 men) suffering from COPD between the ages of 35 and 65 years participated in the study. Pretest-posttest quasiexperimental design was used. MET was applied to the sternocleidomastoid, anterior scalene, pectoralis major muscles, and at the C4-C6 level of the cervical spine. Maitland JM was performed in the thoracic region at the intervertebral, costovertebral, and costotransverse joints. The treatment intervention lasted for 3 weeks. FEV1/FVC, maximum inspiratory pressure (MIP), SpO2, modified Borg dyspnea scale (MBDS), COPD assessment test (CAT), mMRC dyspnea scale, BODE index, right and left hemidiaphragm excursion, and chest wall expansion at T4 and T10 levels were the outcome measures. Significant improvement ( p < 0.05 ) was observed in FEV1/FVC, MIP, SpO2, MBDS, CAT, mMRC dyspnea scale, BODE index, and chest expansion at T4 and T10 levels. Only for the hemidiaphragm excursion, no significant ( p > 0.05 ) improvement was observed. Combined application of MET to accessory respiratory muscles and cervical spine and JM to thoracic spine improved pulmonary functions, chest wall mobility, and health-related quality of life and reduced dyspnea and disease exacerbations in patients with mild to moderate COPD.

Purpose. There may be a strong association among stress urinary incontinence (SUI), low back pain (LBP), and core muscle endurance (CME) in married women. This study is aimed at evaluating the prevalence and clinical association between SUI, CME, and LBP among married women in Saudi Arabia. Methods. The study was based on a case-control research design, conducted among 143 women with LBP (mean age, 32 ± 7.4 years) and 160 healthy women (mean age, 31.7 ± 6.7 years). SUI, CME, and functional disability were assessed using the international consultation on the Incontinence Questionnaire-Short Form (ICIQ-SF), prone plank test (PP), and Oswestry Disability Index for LBP-United Arab Emirates edition (ODI-UAE). Results. The prevalence of SUI was found to be 60% in the LBP group while 20% in the control group. CME revealed a stronger negative correlation with SUI in the LBP group ( r s = − 0.75 ) than in the control group ( r s = − 0.63 ). Conclusions. The prevalence of SUI was observed higher in women with LBP than healthy women. CME exhibited a stronger association with SUI than LBP among women with LBP compared to healthy women in Saudi Arabia. Therefore, the role of CME in SUI development or vice versa among married women with LBP may be subjected to further research.

Background. Neck pain (NP) is a common work-related disorder, with high prevalence in the profession of teaching. The daily duties of a school teacher involve head-down postures while reading and writing, which expose them to the risk of developing NP. Deep cervical flexor (DCF) muscles have been reported to have lower endurance in patients with cervical impairment, which has additionally been associated with disability. There is limited evidence regarding the efficacy of training of DCF muscles in occupational NP. The objective of this study was to investigate the effects of DCF muscle training on pain, muscle endurance, and functional disability using pressure biofeedback in school teachers with NP. Methods. Sixty-five teachers (age, 25-45 years) with more than 5 years of teaching experience participated in this study. They were randomly divided into two groups: the experimental (E) and control (C) groups. In the E group, the subjects underwent DCF muscle training using pressure biofeedback in addition to conventional exercises for neck pain, while those in the C group underwent conventional exercises only. Pain, muscle endurance, and disability were measured at day 0 (before the treatment) and days 14 and 42 after the treatment. Endurance of DCF muscles was measured by the craniocervical flexion test using pressure biofeedback, pain intensity was measured using the numeric pain rating scale, and functional disability was assessed using the neck disability index questionnaire. This study was performed in accordance with CONSORT guidelines. Results. On day 0, there were no significant differences in the age, pain, muscle endurance, and disability levels between the groups. After initiating the intervention, although there were improvements in both groups, there was a statistically significant improvement in muscle endurance, pain, and disability in subjects who received additional training with pressure biofeedback. Conclusions. Besides increasing muscle endurance, specific training of DCF muscles in addition to conventional exercises can improve neck pain and functional disability. These results should be further correlated clinically. A dedicated time for exercises at school could help prevent the development of NP in teachers. This trial is registered with ClinicalTrials.gov NCT03537300 May 24, 2018 (retrospectively registered).

Background. Teaching is one of the professions where incidence and prevalence of neck pain is high. Prolonged use of computers, which has further increased due to online teaching amid pandemic, is known to cause neck pain and alter posture, while people with forward head posture (FHP) are prone to develop neck pain and related disability. Research has shown that impairment of deep cervical flexor (DCF) muscles leads to insufficiency in coordination, activation, overload, and poor support on cervical structures that further lead to development of neck pain and altered neck posture. The objective of this study was to see the effect of DCF muscle training using pressure biofeedback on pain and FHP in school teachers with neck pain. Methods. This observational study was conducted at medical center in school premises. Fifty-five school teachers aged between 25 and 40 years with experience of more than 5 years were invited to participate in this study. Subjects were divided in two groups. Both the groups received conventional exercises while in experimental group DCF muscle training using pressure biofeedback was given additionally. Pain and FHP were assessed using NPRS and cranio-vertebral angle using digital photograph technique, respectively, at baseline and end of four weeks of treatment. Results. Although pain and FHP improved in both the groups, mean improvement in both the measures was more in the group that also received DCF training using pressure biofeedback. Conclusions. This study shows that although pain and FHP improved following conventional exercises in school teachers with neck pain, mean improvement was more significant among those who received additional DCF muscle training using pressure biofeedback.

In contemporary societies, computer use by children is a necessity and thus highly prevalent. Using computers for long hours is related to a higher risk of computer-related muscular disorders like forward head posture (FHP) and neck pain (NP). Deep cervical flexor (DCF) muscles are important head-on-neck posture stabilizers; thus, their training may lead to an improvement in FHP and NP. The aim of this study was to determine if 4 weeks of DCF training is effective in alleviating NP, improving FHP, and functional status in adolescent children using computers regularly, a pretest-posttest experimental group design was used. Subjects were randomly assigned into the experimental group (receiving DCF training and postural education) and the control group (receiving postural education only). 30 subjects with a mean age of 15.7 ± 1.725 years with NP and FHP using computers regularly participated in the study. Dependent variables were measured on day 1 (at baseline) and after 4 weeks of training. Photographic analysis was used for measuring FHP, visual analog scale for NP intensity, and neck disability index for functional status. Data analysis showed that in both groups, no significant improvement occurred in FHP. In both groups, there was a significant improvement in functional status and NP. There was no significant difference between both groups for FHP and NP. There was a significant improvement in functional status in the experimental group in comparison to the control group. Four weeks of DCF training does not cause a significant improvement in FHP in 13 to 18 years old adolescent children using computers regularly.

Postactivation potentiation is referred to as an acute and temporary enhancement of muscle performance resulting from previous muscle contraction. The purpose of this study was to compare the acute effect of plyometric exercise (PLY) and heavy-resistance exercise (RES) on the blood lactate level (BLa) and physical performance. Fourteen male collegiate soccer players were randomized to perform either RES or PLY first and then crossed over to perform the opposite intervention. PLY consisted of 40 jumps, whereas RES comprised ten single repetitions at 90% of one repetition maximum. BLa and physical performance (countermovement jump height and 20-m sprint) were measured before and at 1 and 10 min following the exercise. No significant difference was observed in the BLa for both exercises (PLY and RES). Relative to baseline, countermovement jump (CMJ) height was significantly better for the PLY group after 1 min (P=0.004) and after 10 min (P=0.001) compared to that of the RES group. The 20-m sprint time was significantly better for PLY at 10 min (P=0.003) compared to that of RES. The present study concluded that, compared to RES, PLY causes greater potentiation, which leads to improved physical performance. This trial is registered with NCT03150277.

Objective. The current study aimed to investigate the effects of body position on the level and severity of stuttering in young adults with developmental stuttering. Methods. A total of 24 subjects (male: 17; female: 7; mean age: 24.9 ± 6.2 years) with developmental stuttering participated. The participants were asked to perform oral reading and spontaneous monologue-speaking tasks in different body postures while their speech was recorded. During reading and speaking tasks, the Stuttering Severity Instrument was used to quantify the severity of stuttering. The effects of different body postures on stuttering severity, reading task, and speaking task scores were analyzed. Results. Significant differences in stuttering severity, reading task, and speaking task scores were found for different body postures. Post hoc analyses revealed a significant difference in stuttering severity, reading task, and speaking task scores when subjects were sitting on a chair with no arm support compared to lying down (p Conclusions. Body postures or body segment positions that relax and facilitate the muscles of the neck and shoulders may potentially improve speech fluency in young adults with developmental stuttering.

Objective.To investigate the efficacy of using “Instagram application” with a “home-exercise program” as a motivational stimulus in improving physical activity (PA) adherence levels among female college students.Methods.Fifty-eight female undergraduate students with the mean age20.3±0.96years participated. Participants were divided into two groups: intervention and the control group; both the groups received an exercise program and the intervention group was additionally motivated by “Instagram.” Adherence to PA was measured by using an adherence sheet. The Exercise Motivation Inventory (EMI-2) was used to assess the motivational factors.Results.The most frequent motivational factors were extrinsic as assessed using the EMI-2. “Positive health” was the most frequent factor mentioned of the two types with 47% of the sample. The intervention group adhered with 17% more to the activity program compared to the control group. Moreover, 72% of the participants in the intervention and control groups found the activity program flexible enough to be performed at home; they agreed about its effectiveness on adherence (53%).Conclusions.The use of Instagram with the home exercise program as a motivational modality could be attractive and effective to reinforce adherence and maintain an appropriate PA level.

Objective. The present study compared the effects of upright and slouched sitting postures on the respiratory muscle strength in healthy young males. Methods. A total of 35 adult male subjects aged 18–35 years participated in this study. Respiratory muscle strength was determined by measurement of sniff nasal inspiratory pressure (SNIP) using a MicroRPM device in the upright and slouched sitting positions. The subjects were asked to perform the pulmonary function test including peak expiratory flow (PEF), forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and FEV1/FVC ratio at baseline. Body composition was also determined. Results. There was a significant difference of SNIP score between upright sitting and slouched sitting positions (p=0.04). The mean difference of SNIP score between upright sitting and slouched sitting positions was 8.7 cmH2O. Significant correlations were found between SNIP in upright sitting and FEV1% predicted values [R = .651], SNIP in slouched sitting and FEV1% predicted values [R = .579], and SNIP in upright sitting and SNIP in slouched sitting positions [R = .926] (p<0.05 for all). There were no significant correlations between SNIP scores, demographic variables, and other baseline clinical data (p>0.05). Conclusions. The slouched sitting position had a lower SNIP score compared to upright sitting position suggesting a reduced diaphragm tension and movement as a result of altered body posture.

Background.Assessment of hand grip strength is vital for the evaluation of upper limb impairments and effective exercise prescription. Present study primarily aimed to investigate the effect of head-neck positions on the hand grip strength in healthy young adults. Secondarily, the present study compared hand grip strength between left versus right hand in different head-neck positions.Methods.Healthy young adults (age 19 – 30 year; n = 40) participated in this cross-sectional study. Hand grip strength was assessed in three head-neck positions (neutral, rotation left, and rotation right) using the standard adjustable Jamar hand dynamometer.Results. Hand grip strength in both sides (left and right) was greatest in the head-neck neutral position. Hand grip strength measured in head-neck left rotation position displayed the least strength in both sides. There was no significant difference noted between left and right side hand grip strength measured in head-neck neutral and right rotation positions. However, there was a significant difference noted between left and right side hand grip strength measured in head-neck left rotation positions. There was no significant effect of head-neck positions on hand grip strength noted in both sides.Conclusions. Hand grip strength was highest in the head-neck neutral position followed by head-neck rotation to the right. However, head-neck positions did not significantly affect hand grip strength in healthy young adults. Further studies assessing the hand grip strength in different neck positions in patients with neck pain and upper limb dysfunction may have significant implications for the assessment of hand grip strength.

Normal respiration is a very intricate function that comprises mechanical as well as nonmechanical components. It is shown to be affected by various factors including age, lifestyle, disease, and change in posture. With the increased use of hand held devices, everyone is prone to poor sitting postures like forward head posture. The purpose of this study was to evaluate the effect of assumed forward head posture and torticollis on the diaphragm muscle strength. A sample of 15 healthy males, aged 18-35 years, was recruited for this study. All subjects performed spirometry to measure the forced expiratory volume in 1 second (FEV1), the forced vital capacity (FVC), and FEV1/FVC ratio. SNIP was measured during upright sitting, induced forward head posture, and torticollis. Subject’s mean age (SD) was 23(6) years. The SNIP score of the subjects during sitting with FHP was lower as compared to that during upright sitting. It decreased significantly during induced right torticollis position. This is the first study exploring the impact of different head and neck positions on respiratory function. Alteration of head and neck positions had an immediate negative impact on respiratory function. Clinicians should be prompted to assess respiratory function when assessing individuals with mal-posture.

Objectives. This systematic review was conducted to examine the effects of exercise on spinal deformities and quality of life in patients with adolescent idiopathic scoliosis (AIS).Data Sources. Electronic databases, including PubMed, CINAHL, Embase, Scopus, Cochrane Register of Controlled Trials, PEDro, and Web of Science, were searched for research articles published from the earliest available dates up to May 31, 2015, using the key words “exercise,” “postural correction,” “posture,” “postural curve,” “Cobb’s angle,” “quality of life,” and “spinal deformities,” combined with the Medical Subject Heading “scoliosis.”Study Selection. This systematic review was restricted to randomized and nonrandomized controlled trials on AIS published in English language. The quality of selected studies was assessed by the PEDro scale, the Cochrane Collaboration’s tool, and the Grading of Recommendations Assessment, Development, and Evaluation System (GRADE).Data Extraction. Descriptive data were collected from each study. The outcome measures of interest were Cobb angle, trunk rotation, thoracic kyphosis, lumbar kyphosis, vertebral rotation, and quality of life.Data Synthesis. A total of 30 studies were assessed for eligibility. Six of the 9 selected studies reached high methodological quality on the PEDro scale. Meta-analysis revealed moderate-quality evidence that exercise interventions reduce the Cobb angle, angle of trunk rotation, thoracic kyphosis, and lumbar lordosis and low-quality evidence that exercise interventions reduce average lateral deviation. Meta-analysis revealed moderate-quality evidence that exercise interventions improve the quality of life.Conclusions. A supervised exercise program was superior to controls in reducing spinal deformities and improving the quality of life in patients with AIS.