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Objectives This study was performed to investigate whether exercise and quercetin have an effect on muscle energy charge in the metabolic syndrome (MetS) model of rats. Methods Male Sprague-Dawley rats consisting of Control, Fructose, Quercetin, Exercise, Fructose + Exercise, Fructose + Quercetin, Fructose + Quercetin + Exercise groups were randomly divided into seven groups, six rats in each group. Consequently, it was determined that the 20% fructose supplement for 10 weeks with drinking water let to metabolic syndrome in the animals depending on the increase of systolic blood pressure, serum triglyceride, serum insulin and high HOMA-IR scores. MetS criteria were successfully established by oral fructose administration. Results ATP and AMP levels were higher in fructose and exercise groups, and ADP levels were lower. The energy charge increased in quercetin treated groups. We found that regular aerobic exercise and quercetin application might be beneficial in the fructose-mediated MetS in accordance with previous studies. However it was found that quercetin was more effective than exercise in muscle. Conclusions Consequently, it is thought that the regular aerobic exercise alone is a preventive method for the MetS and also it can be used together with quercetin as a beneficial treatment.

Background: Pelvic girdle dysfunction is a common musculoskeletal disorder among pregnant women. It is a disabling condition affecting the ability of a pregnant woman to perform her daily functional activities. The scope of digital health in delivering rehabilitation services is growing exponentially, especially in the present COVID -19 pandemic crisis.Case description: A 29-year-old primigravida, at 32 weeks of gestation with severe pelvic girdle pain during bed transitions, sought physiotherapy consultation via video call, as she expressed difficulty in accessing Physiotherapy services due to the present pandemic crisis. Physiotherapy consultation was provided in 4 weekly sessions using a real-time video-based telerehabilitation program and the patient performed unsupervised exercise sessions for 30 minutes for 5 days per week for 4 weeks. The plan of care included muscle energy techniques, pelvic cloth belt, strengthening, stabilization exercises and stretching.Outcomes: The patient completed four sessions including evaluation and treatment and there was a reduction of pain scores for bed transitions from NPRS 8/10 during session one to NPRS 0/10 during session four. The Pelvic girdle dysfunction questionnaire showed a decrease in percentage scores from 54.6 to 4 at the end of physiotherapy sessions.Conclusion: Telerehabilitation was successfully used to manage a pregnant woman with pelvic girdle dysfunction.

ContextPrevious literature has demonstrated the prevalence and socioeconomic impact of postoperative pain in surgery patients. Somatic dysfunction has been demonstrated as a cause, but literature documenting osteopathic manipulative treatment (OMT) in surgery patients is lacking.ObjectiveTo describe typical patterns of and common treatments for somatic dysfunction in patients following laparoscopic cholecystectomy.MethodsThe authors retrospectively reviewed the billing records of all patients over 18 years of age who underwent laparoscopic cholecystectomy by a single surgeon and had postoperative outpatient OMT for right-side pain linked to somatic dysfunction between 2006 and 2018 at a community hospital in Grand Rapids, Michigan. Patients who underwent open cholecystectomy, who did not have documented somatic dysfunction, or had somatic dysfunction unrelated to their biliary disease were excluded.ResultsNine patients were selected for inclusion in this retrospective case series. All patients in the study demonstrated anterior right lower rib pain corresponding to posterior lower rib dysfunctions and rotated right and side-bent left thoracic spine dysfunctions between T5 and T11. Pain was successfully managed with muscle energy, high-velocity, low-amplitude, or soft tissue OMT.ConclusionPostoperative pain following laparoscopic cholecystectomy can be related to right-sided thoracic and rib dysfunctions. This is important for early diagnosis of surgical patients with somatic dysfunction and initiation of appropriate OMT to decrease morbidity related to pain, functional status, and quality of life.

Purpose: Shoulder and cervical pain, reduced mobility and disability are some of the major complications associated with surgeries of head and neck cancers affecting several domains of quality of life. In the present study we aimed to compare the effectiveness of Muscle Ener-gy Techniques (METS) and Active Range of Motion Exercises in reducing pain, improving shoulder mobility and function in patients post Modified Radical Neck Dissection (MRND). Methods: Forty eight subjects were randomly assigned to two groups. Group A received active range of motion (AROM) exercises and group B received Muscle energy techniques (METS). Both the groups were treated for a period of 10 consecutive days starting from the 3rd to 5th postoperative day. Data was collected on the 1st and 10th day of intervention. Results: Both groups showed highly significant improvements in shoulder range of motion , decrease in pain and better Global Rating Change cores(GRCS) (p=0.005). GRCS and shoul-der abduction showed significant improvement in group B when compared to group A, sug-gesting better clinical outcomes in those treated with Muscle Energy Techniques. Conclusion: This study showed that both METs and AROM exercises were effective in im-proving shoulder range of motion, function and reducing pain in patients post MRND but-Muscle Energy Techniques were more effective when compared to AROM exercises.

Context Colleges of osteopathic medicine (COMs) are required to provide hands-on osteopathic manipulative medicine (OMM) training during clerkship years, but this can be challenging given that students are in a variety of clinical sites and often train with allopathic physicians. Objective To identify student OMM practice patterns documented on required OMM practice logs detailing 10 OMM treatments each semester as part of a 3-semester third- and fourth-year clerkship curriculum and to determine whether these practice patterns varied by supervisor type (osteopathic vs allopathic) and semester. Methods The OMM practice logs from 2 class years were retrospectively reviewed for patient and supervisor characteristics and OMM treatment details. Semesters included 2 third-year semesters and an extended fourth-year semester. Results Between July 2015 and March 2018, 1018 OMM practice logs were submitted detailing 10,150 treatments involving 4655 clinical (45.9%) and 5474 volunteer (53.9%) patients. Logs contained up to 10 treatments per log; 26.0% included only clinical patients, 17.4% included only volunteer patients, and 56.6% included both. Significantly more clinical patients (1708 [36.7%]) were treated during the first semester of the third year than the other 2 semesters (PP=.34). Neuromusculoskeletal complaints accounted for 10,847 (90.7%) chief complaints, and nonneuromusculoskeletal complaints accounted for 1115 (9.3%). The most commonly treated body regions were the thoracic (6255 [61.4%]), cervical (4932 [48.4%]), and lumbar (4249 [41.7%]). More body regions were treated on clinical patients than on volunteer patients (mean, 2.7 vs 2.6, respectively; P=.04). Commonly used techniques were muscle energy (6570 [64.5%]); high-velocity, low-amplitude (4054 [39.8%]); soft tissue (3615 [35.5%]); balanced ligamentous tension/indirect techniques (2700 [26.5%]); and myofascial release (1944 [19.2%]). Conclusion More than 80% of students documented OMM practice on clinical patients for their required OMM practice logs. Both osteopathic and allopathic physicians provided supervision. Chief complaints and types of osteopathic manipulative treatment used were consistent with current clinical practice. Areas identified for enhanced didactic education included OMM for nonneuromusculoskeletal complaints.

Purpose of review Skeletal muscle wasting during critical illness is the result of disturbed metabolism. No proven effective interventions targeting skeletal muscle mass and function during critical illness currently exist. This review summarizes recent advances regarding the complexity of metabolic factors involved and the challenge of establishing the clinical effects of metabolic interventions targeting the muscle. Recent findings Although the catabolic state is limited to the acute phase of critical illness, its subsequent impact on muscle mass and function persists long after ICU discharge. Immobilization, inflammation and disturbed muscle energy and nutrient metabolism are key drivers of muscle protein loss. Current research focuses on the effects of enhanced protein provision, specific substrate delivery and physical exercise. Whilst some interventions have been successful at improving muscle mass, these effects do not always carry over into muscle function or strength. Summary Increased understanding of metabolic derangements during critical illness provides new potential targets for treatment. The potential of dietary protein to attenuate the muscle protein catabolic state has yet to be established in clinical trials. Basic research should focus on ways to further improve the anabolic potential of nutrition by unravelling mechanisms that regulate anabolic and catabolic pathways and energy metabolism.

Background: Elbow is a very functional joint. Elbow stiffness is a significant cause of disability hampering the function of the upper extremity as a whole. Muscle Energy Techniques (METs) are relatively pain-free techniques used in clinical practice for restricted range of motion (ROM). Objective: To study the effects of MET on pain, ROM and function given early in the rehabilitation in post-surgical elbow stiffness. Methods: An RCT was conducted on 30 patients post elbow fracture fixation. Group 1 was given MET immediately post removal of immobilization while Group 2 received MET 1 week later along with the rehabilitation protocol. Pain (Visual Analogue Scale), ROM (goniometry) and function (Disability of Arm, Shoulder and Hand questionnaire) were assessed pre and post 3 weeks. Results: Group 1 showed greater improvement than Group 2, mean flexion and extension change between groups being [Formula: see text], 95%CI(5.9,17.4) and [Formula: see text], 95%CI(4.4,12.7), respectively. VAS and DASH scores improved better in Group 1, mean change being [Formula: see text], 95%CI(0.6,1.8) and [Formula: see text], 95%CI(13.5,22.8) for VAS and DASH scores, respectively. Conclusion: MET can be used as an adjunct to the rehabilitation protocol to treat elbow stiffness and can be given safely in the early stages of post elbow fracture rehabilitation managed surgically with open reduction and rigid internal fixation.

Background/Aims: Chronic low back dysfunction is a serious health problem affecting people at some time in their life; it impedes the mobility of the lumbar spine and adjacent joints leading to functional disabilities. Muscle Energy Techniques aim to normalise soft tissue structures, such as shortened or tight muscles, with no direct implication to the joint associated with these soft tissues. Kinesio taping supports damaged structures without restriction of mobility and at the same time may influence some of the mechanisms associated with muscle fatigue, such as blood flow and proprioception. The aim of this study was to investigate the effect of Muscle Energy Techniques and kinesio taping on pain level and spinal mobility in patients with chronic low back dysfunction. Methods: A total of 90 patients with chronic low back dysfunction were selected. All participants were randomly allocated into three groups; group A received cross (X) technique kinesio taping and conventional therapy, Group B received cross (X) technique kinesio taping, Muscle Energy Techniques and conventional therapy, Group C received Muscle Energy Techniques and conventional therapy. A visual analogue scale for pain severity and inclinometer for trunk range of motion were used to measure the results. Results: Results showed that there was no statistically significant difference between the post-treatment measurements of the three groups. Conclusions: A combination between Muscle Energy Techniques and kinesio taping with conventional therapy appears to improve pain and trunk range of motion in patients with chronic low back dysfunction.

Research Topic: To study and compare the effectiveness of active release technique and muscle energytechnique in subjects with hamstring tightness.Method: 60 normal healthy subjects (30 in each group) were recruited in the study under simple randomizationmethod. Group A received single session of Active Release Technique and Group B received single sessionof Muscle Energy Technique for hamstring tightness. Active knee extension test (90-90 test) were measuredpre-intervention and post-intervention. Data was analyzed using t-test.Results: Statically there is significant (p

Objective: The aim was to verify if manual lymphatic drainage (MLD) and muscular energy techniques (MET) helps on pain control and amplitude of mouth opening, in patients submitted to bilateral third molars surgeries. Methods: Thirty consecutive patients, aged between 18 and 45 years, 53.7% males, were randomized in two groups: physical therapy group (PG), treated with MLD and MET on one random side of the mouth, being the other side, the control (CG). Additionally, for CG, paracetamol and dexamethasone were prescribed. The control of pain and inflammation in the PG was performed using manual therapy techniques (MLD and MET) and paracetamol. Postoperative pain was evaluated through visual analogue scale (VAS) and maximum active mouth opening by using a digital caliper. Results: On the 8th postoperative day the VAS were 2.13 ± 1.84 in the CG and 0.33 ± 1.45 in the PG (p

Tension-type headaches, associated with young age, poor health, sleep disturbances, anxiety, stress, and poor posture, account for 90% of all headaches diagnosed by healthcare professionals. Diagnosis and treatment of the various headache subtypes are often aimed at determining the underlying cause but commonly involve over-the-counter pain medication. Because recurrence is common in tension-type headaches, with a subsequent refractory response to over-the-counter medications, adjunctive and alternative treatment modalities should be further studied. Here we present a case of tension headache initially non-responsive to pain medication but resolved with osteopathic manipulative treatment and lifestyle modifications. Osteopathic considerations and literature are also reviewed in the broader context of headache management.

Context Osteopathic manipulative medicine (OMM) is an adjunctive treatment approach available to geriatric patients, but few studies provide details about presenting conditions, treatments, and response to osteopathic manipulative treatment (OMT) in that patient population. Objectives To provide descriptive data on the presentation and management of geriatric patients receiving OMT at an outpatient osteopathic neuromusculoskeletal medicine (ONMM) clinic. Methods Data were retrospectively collected from electronic health records (EHR) at a single outpatient clinic for clinical encounters with patients over 60 years of age who were treated with OMT between July 1, 2016, and June 30, 2019. Records were reviewed for demographic information, insurance type, presenting concerns, assessments, regions treated, OMT techniques used, and treatment response. Results There were 9,155 total clinical encounters with 1,238 unique patients found during the study period. More women than men were represented for overall encounters (6,910 [75.4%] vs. 2,254 [24.6%]) and unique patients (850 [68.7%] vs. 388 [31.3%]; both p Conclusions Our results showed that geriatric patients receiving OMT at our clinic were predominately presenting for neuromusculoskeletal concerns associated with back, neck, and extremity conditions, consistent with national epidemiological data for this population. The most common OMT techniques were also consistent with those used nationally by osteopathic medical students and practicing physicians. Future longitudinal studies are needed to determine the length of time improvement persists and the overall health impact experienced by geriatric patients receiving OMT.

Context Diagnosis of somatic dysfunction is based on subjective palpatory osteopathic assessments. This subjectivity has posed a challenge for researchers in studying osteopathic medicine. The development and use of radiological imaging techniques to objectively confirm or quantify muscle tissue stiffness associated with somatic dysfunction could be of benefit in osteopathic clinical practice, training, and further research. Objectives To investigate the feasibility of ultrasound shear wave elastography (SWE) to quantify muscle tissue stiffness in somatic dysfunction before and after osteopathic manipulative treatment (OMT). Methods In this prospective study, we assessed lumbar spine somatic dysfunction in 20 adult patients before and after a single OMT session using standard osteopathic palpatory assessments by osteopathic physician faculty members in the Department of Osteopathic Principle and Practice at Rocky Vista University College of Osteopathic Medicine (Utah campus). Shear wave velocity (SWV, m/s) was measured in lumbar paraspinal muscle tissue using a commercial ultrasonography scanner on all participants immediately before and after OMT. In this study, OMT techniques targeted the iliocostalis lumborum and included the articulatory technique, balanced ligamentous tension, facilitated positional release, high-velocity, low-amplitude technique, muscle energy, myofascial release, and the Still technique at the discretion of the osteopathic physician. The difference in SWV between muscle tissues with and without dysfunction, and differences in SWV of dysfunctional tissue before and after OMT were examined using unpaired and paired t tests, as appropriate. The correlation between SWV measurements and osteopathic assessments was examined by the Spearman rank correlation. Intra- and interobserver reliability was analyzed using intraclass correlation coefficient. Results The difference in SWV between muscle tissues with and without somatic dysfunction was significant before OMT (mean [SD], 1.93 [0.44] vs 1.69 [0.19]; P=.03) and was not significant after OMT (mean [SD], 1.69 [0.19] vs 1.53 [0.31]; P=.05). The difference in SWV in the same tissue with somatic dysfunction before and after OMT was significant (mean [SD], 1.93 [0.44] vs 1.52 [0.3]; Pr=0.72). Intra- and interobserver reliability for performing SWE in somatic dysfunction was good (intraclass correlation coefficient >0.80). Conclusions The results of this study show that ultrasound SWE can objectively assess muscle tissue stiffness for diagnosis of somatic dysfunctions and for muscle tissue stiffness changes after OMT.

Context Under the Accreditation for Graduate Medical Education (ACGME) single accreditation system, there is likely to be increasing interest and opportunity for teaching osteopathic manipulative treatment (OMT) to allopathic residents and residency faculty. When learning OMT, allopathic physicians (MDs) have distinct needs compared with osteopathic medical students. For example, MDs already have a foundation in anatomy and medical vocabulary, but incorporating an osteopathic approach to patient care may require a paradigm shift. Thus, a unique approach to osteopathic education for MDs in residency programs with osteopathic recognition (OR) is needed. Objectives To create a longitudinal OMT elective for allopathic residents and residency faculty and assess its impact on attitudes and confidence regarding osteopathic principles and treatment. Methods Drawing from standard texts used during preclinical osteopathic education, a blended online and in-person laboratory modular curriculum for the OMT elective course was developed by osteopathic residents and faculty within the Department of Family Medicine and Community Health at the University of Wisconsin in Madison. The modalities of muscle energy, counterstrain, myofascial release, and soft tissue were included; the curriculum also reviewed autonomic physiology, somatovisceral, and viscerosomatic reflexes. A quality improvement study of the course was conducted via pre- and postcourse surveys to assess its impact on perceptions and confidence regarding the theory and practice, referral, and use of OMT. A precourse survey was distributed before the first module to obtain background information and assess participants’ prior OMT exposure, among other things. Nine months after the course ended, a corresponding postcourse survey was distributed. Pre- and postcourse surveys were individually matched to improve statistical analysis, using unique identifiers. Also, following each laboratory, a postlaboratory survey was collected about the participant’s experience for that lecture and for laboratory-specific quality improvement purposes. Two years after course completion, graduates were reached via phone or email for informal interviews to assess the perceived long-term impact from the elective. Results Eleven MDs from a total potential pool of 26 residents and approximately 120 attending physicians enrolled in the course; eight (72.7%) completed all modules and pre- and postcourse evaluations. Participants reported statistically significant gains in attitudes and confidence regarding OMT (“knowledgeable regarding OMT principles”: precourse mean, 2.50 [0.76], vs. postcourse mean, 3.37 [0.52]; p=0.021; “know how to treat using OMT”: precourse mean, 2.25 [1.39], vs. postcourse mean, 3.12 [1.25]; p=0.041). Several participants (five; 62.5%) had completed prior OMT training. There was an increase, albeit nonsignificant, in the use of OMT, with more providers using OMT (precourse mean, five, vs. postcourse mean, six; p=0.171), and providers using OMT more often (precourse OMT use monthly or more often, three, vs. postcourse OMT use monthly or more often, six; p=0.131). Conclusions Implementing a longitudinal elective curriculum is a feasible way to improve attitudes and confidence in OMT for MDs involved in a family medicine residency. Whether our elective leads to competency in OMT for allopathic residents and faculty remains to be formally evaluated. Our pilot established the feasibility and led to a revision of our curriculum; the elective continues to occur yearly. Future analyses will focus on competency assessment.

Neck is one of the most common site of musculoskeletal symptom manifestations. An impaired spinal curvature is a common finding in patients with mechanical neck pain. A pre-post quasi experimental pilot study was conducted at Fauji Foundation Hospital from January- March 2017,in which 12 patients with mechanical neck pain and straightening of the cervical spine were included and treated for 7 consecutive sessions consisting of muscle energy techniques (MET) in combination with facet joint mobilization. The objective of this study was to determine the effects of MET and facet joint mobilization on spinal curvature and functional outcomes in patients with neck pain. Outcome measurement tools that were included comprised of pain severity, neck disability index (NDI), cervical lordosis which was measured via x-ray based posterior tangential method, goniometry for cervical range of motion (ROM) and modified sphygmomanometer dynamometry (MSD) for isometric muscle strength. A significant difference was observed in pre and post treatment scores for all outcomes (p

Metabolic myopathy is referred to a rare group of inherited muscle diseases caused by specific enzymatic defects that lead to muscle energy defect and subsequently muscle dysfunction. They are divided into disorders of carbohydrate metabolism, disorders of lipid metabolism and mitochondrial disorders. Examples of the common metabolic myopathies are Pompe disease, McArdle’s disease, beta-oxidation defects and carnitine disorders. A unique clinical presentation should raise the suspicion of such rare muscle disorders specially when the patient has episodic muscle dysfunction and dynamic rather than static symptoms. Premature exertional fatigue and exercise-associated muscle cramps are other clues. However, they occasionally present as progressive muscle weakness mimicking dystrophic muscles disorders or multiorgan involvement. Early diagnosis and implementation of therapeutic strategy will help prevent acute muscle dysfunction, myoglobinurea and rhabdomyolysis. This strategy may include avoiding vigorous exercise and prolonged fasting, eating complex carbohydrates, carnitine and MCT supplementation and enzyme replacement therapy.

Background Diffuse idiopathic skeletal hyperostosis (DISH) syndrome and lumbar epidural lipomatosis are relatively asymptomatic neurological conditions, with findings often seen incidentally on radiological studies. Objective The aim of this paper is to present unique findings of concomitant, symptomatic DISH syndrome and lumbar epidural lipomatosis and to discuss the osteopathic diagnosis and treatment implications. Methods Concomitant, symptomatic variants are rare and present challenges to treatment and management, as seen with a 60-year-old African American woman who presented with worsening disequilibrium and new-onset bilateral fingertip numbness. Past medical history was significant for alcohol abuse disorder, hypertension, hyperlipidemia, and multiple episodes of self-resolving vertigo and lower extremity neuropathy. Results The patient was referred to the neurology department for stroke workup, which was negative. Osteopathic structural exam revealed thoracolumbar and sacral dysfunctions. Magnetic resonance imaging revealed findings consistent with thoracic DISH syndrome and lumbar epidural lipomatosis in the areas of somatic dysfunctions. Conclusions Due to minimal information on osteopathic manipulative treatment in rare neurological diseases, only gentle techniques of myofascial release, balanced ligamentous tension, and muscle energy were performed with resultant minimal improvement, thus highlighting the necessity for better guidelines and further research.

We have recently demonstrated that the triceps surae muscles energy cost (ECTS) represents a substantial portion of the total metabolic cost of running (Erun). Therefore, it seems relevant to evaluate the factors which dictate ECTS, namely the amount and velocity of shortening, since it is likely these factors will dictate Erun. Erun and triceps surae morphological and AT mechanical properties were obtained in 46 trained and elite male and female distance runners using ultrasonography and dynamometry. ECTS (J·stride−1) at the speed of lactate threshold (sLT) was estimated from AT force and crossbridge mechanics and energetics. To estimate the relative impact of these factors on ECTS, mean values for running speed, body mass, resting fascicle length (Lf), Achilles tendon stiffness and moment arm and maximum isometric plantarflexion torque were obtained. ECTS was calculated across a range (mean ± 1 sd) of values for each independent factor. Average sLT was 233 m·min−1. At this speed, ECTS was 255 J·stride−1. Estimated fascicle shortening velocity was 0.08 Vmax and the level of muscle activation was 84.7% of maximum isometric torque. Compared to the ECTS calculated from the lowest range of values obtained for each independent factor, higher AT stiffness was associated with a 39% reduction in ECTS, 81% reduction in fascicle shortening velocity and a 31% reduction in muscle activation. Longer AT moment arms and elevated body masses were associated with an increase in ECTS of 18% and 23%, respectively. These results demonstrate that a low ECTS is achieved primarily from a high AT stiffness and low body mass, which is exemplified in elite distance runners.

Background Increased intramuscular peroxisome proliferator-activated receptor gamma coactivator-1α (PGC-1α) with exercise directly or indirectly affects other tissues, but the effector pathway of PGC-1α has not been clearly elucidated. The purpose of this study was to investigate the effect of exercise and/or dietary change on the protein levels of the soleus muscle energy-sensing network and meteorin-like (Metrnl), and additionally to analyze the detraining and retraining effects in high-fat diet (HFD)-induced obese mice. Methods One hundred male C57BL/6 mice were divided into normal-diet + sedentary (CO, n = 20) and HFD + sedentary (HF, n = 80) groups, and obesity was induced in the HF group through consumption of a 45% HFD for 6 weeks. The HF group was subdivided into HF only (n = 20), HF + training (HFT, n = 20), dietary change + sedentary (HFND, n = 20), and HFND + training (HFNDT, n = 20) groups, and the mice in the training groups underwent a treadmill training for 8 weeks, 5 times per week, 40 min per day. The HFT and HFNDT groups underwent 8-week training, 8-week detraining, and 4-week retraining. Results An 8-week training was effective in increasing the protein levels of soleus muscle AMP-activated protein kinase (AMPK), PGC-1α, and plasma Metrnl in the obese mice (P

Background: The efficacy of ischemic compression, strain/counterstrain, and muscle energy techniques were supported by literatures to relieve myofascial trigger points. However, no high-level research is available regarding the integrated neuromuscular inhibition technique (INIT). Objective: To document the efficacy of INIT in improving cervical function by reducing the trigger points on upper trapezius muscle over the traditional approach. Methods: Thirty adults in the age group of 18–35 years diagnosed with mechanical neck pain with upper trapezius trigger point were selected by the simple random sampling for two group pretest-posttest design. They were allocated randomly into two equal groups, Group A and Group B, respectively. Group A received hydrocollator pack, INIT, neck strengthening exercises, scapular stabilization exercises, shoulder stabilization exercises, postural correction, and ergonomic advice while Group B received the same treatment except INIT. They were treated for six sessions on alternate days for 2 weeks. Visual analog scale, neck disability index, and tenderness grading scale were noted at baseline, 3rd session, and 6th session after the above treatment on both the groups and analyzed. Results: In all the outcome measures, Group A showed significant (P < 0.05) improvement when compared to Group B. Conclusion: There is a sufficient evidence to prove the efficacy of INIT in improving cervical function by reducing the trigger points on upper trapezius muscle

Goal of research - the study aims to justify the statement that osteopathy is an effective method of diagnostics and treatment.Materials and methods. The study examined 5 000 patients with different clinical symptoms who underwent osteopathic treatment sessions. A variety of osteopathic techniques were used: e. g. soft tissue techniques, articulations, muscle energy techniques and trusts, fascial techniques, strain-counterstrain, visceral techniques on the thoracic and abdominal cavities, cranial techniques, etc. In some cases, the following additional research methods were used: electroencephalography, echocardiogram, Doppler sonography, etc.Results. All the patients showed signifi cant improvement in the condition with complete regression of clinical symptoms and with the improvement of the results of additional research methods.Conclusion. The osteopathic treatment has shown to be highly effective in diagnostics and correction in this group of patients. It corresponds to the basic principles of medicine of the future.

Background and purpose Muscle energy techniques (METs) are used to reduce tension in neck muscles and therefore, can be used together with Swedish massage to enhance its effect. The aim of this study was to assess if using METs combined with massage could improve sleep quality. Materials and methods In this prospective, randomised controlled trial forty patients with chronic cervical spine pain were divided into two equal groups. Both groups attended 10 sessions of Swedish massage, and the study group additionally attended MET-sessions. Sleep disturbances were assessed with the Pittsburgh Sleep Quality Index (PSQI). Results A significant improvement in terms of sleep disturbances was seen in both groups. The MET group demonstrated improvement in all PSQI components. In the control group, the improvement included only 4 components of the index. Conclusion Massage therapy combined with relaxing METs may be more effective than massage therapy alone in this group of patients.

The increasing use of computer in daily life has brought about numerous musculoskeletal problems. Impairments in the head, neck and shoulders are more common compared with the other parts of the body. The aim of this study was to compare the effect of two manual treatments in two separate groups, i.e., active release technique (ART) and muscle energy technique (MET) on the latent trigger points (LTrPs) in the upper trapezius muscle. The set criteria in the study included the active range of cervical lateral flexion, pain intensity on the visual analog scale (VAS), and the upper trapezius muscle thickness.This clinical trial study assessed the outcome measures within and between groups before and after the intervention. The target population were 64 (32 males, 32 females) participants who had been selected from among the staff members and the students of a rehabilitation school, and the employees of an engineering company who had LTrPs in their upper trapezius muscle and were from 18 to 50 years old.The immediate effects of MET and ART on the patients of each groups with LTrPs in their upper trapezius muscle were increased active range of cervical lateral flexion (P 0.001), decreased pain intensity on VAS (P 0.05) and decreased thickness of the upper trapezius muscle (P 0.01).Both manual techniques of ART and MET reduced the symptoms of LTrPs in the upper trapezius in the two groups equally, neither technique being superior to the other.

Background Self-directed learning is a student-centered approach based on the students’ evaluation about their own learning needs. Self-directed practice is a component of the self-directed learning which focus on achieving manual and practical skills. Given the abundance of manual skills that students need to develop in the osteopathic curriculum, self-directed practice has become an attractive methodology. Most of the Italian osteopathic educational institutions recognize two types of educational curriculum: T1, for students without a healthcare background; and T2 for students who are already healthcare professionals. The aim of the present study is to investigate the attitudes of Italian osteopathic students toward self-directed practice during the summer break highlighting the possible differences between T1 and T2 students. Methods A web-based closed-ended survey was administered to the students attending one of the Italian osteopathic educational institutions which accepted to participate in the research. Results Two hundred sixty-eight students on 2549 participated to the survey. 64.92% of the students reported to have performed self-directed practice during the summer break. The main difficulty encountered by students in approaching self-directed practice was ‘lack of people to exercise with’. Most of the students performed self-directed practice between 1 to 5 h per week. The most common clinical condition encountered was Low Back Pain. The anatomical area most approached was lumbar spine. The most commonly simulated tests were the articular mobility tests. The techniques in which students trained the most were muscle energy techniques. Significant difference was found in self-engagement to the self-directed practice between T1 and T2 students (p = 0.026), and in the reasons to perform self-directed practice (p = 0.027). Conclusions The results of this study could be useful to reveal some aspects of students’ academic education and future clinical practice. Therefore this paper can be a useful tool for the institutions to develop strategies to overcome the reported problems students have towards self-directed practice. For example it should be discussed the possibility for the students to observe some senior osteopaths during their practice or to plan to maintain an open tutored didactic environment during the summer break as an extracurricular activity.

In recent years, there has been increased attention paid to the research of lower extremity walking assistive devices. However, many of them are powered by external energy and require separate actuators with corresponding control modules, which increase the overall quality while reducing the portability and wear-ability. In this paper, through the gait kinetic energy analysis, we summarized the movement rules of each joint in lower extremity to improve the walking efficiency. Considering that ankle joint whose movement rules are apparent has a significant influence on human gait performance, we proposed that there is a negative work stage in dorsiflexion, whereas plantarflexion does positive work by consuming muscle energy to drive the body forward. Therefore, we designed an unpowered walking assistant device, which imitated the normal gait by using the characteristics of energy storage under pressure of torsion spring in dorsiflexion and energy release in plantarflexion. The biodynamic simulation of the proposed design was conducted to verify the function of walking-assistant.

In a conventional view of motor control, the human brain might employ an optimization principle that leads a stereotypical motor behavior which we observe as an averaged behavioral data over subjects. In this scenario, the inter-individual motor variability is considered as an observation noise. Here, we challenged this view. We considered a motor control task where the human participants manipulated arm force by coordinating shoulder and elbow torques and investigated the muscle-tuning function that represents how the brain distributed the ideal joint torques to multiple muscles. In the experimental data, we observed large inter-individual variability in the profile of a muscle-tuning function. This contradicts with a well-established optimization theory that is based on minimization of muscle energy consumption and minimization of motor variability. We then hypothesized the inter-subject differences in the structure of the motor cortical areas might be the source of the across-subjects variability of the motor behavior. This was supported by a voxel-based morphometry analysis of magnetic resonance imaging; The inter-individual variability of the muscle tuning profile was correlated with that of the gray matter volume in the premotor cortex which is ipsilateral to the used arm (i.e., right hemisphere for the right arm). This study suggests that motor individuality may originate from inter-individual variation in the cortical structure.

Skeletal muscle is highly dependent on mitochondrial oxidative phosphorylation for ATP production, the major energy source for prolonged muscle activity. It is obvious that muscle mitochondrial density and oxidative capacity adapt to muscle energy demand. Chronic overfeeding and obesity may be directly responsible for changes in muscle mitochondrial function. Major metabolic anomalies identified in obesity are lower mitochondria density, diminished fat oxidation, and greater dependence on glucose for ATP synthesis; ectopic lipid accumulation in skeletal muscles and low basal ATP concentrations.