Manual therapy
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Upper Limb Neurodynamic Test 1 (ULNT1) is commonly used within clinical practice. However, the existing evidence regarding its reliability is conflicting and raises methodological questions. Therefore, the aim of this study was to investigate how reliable and precise physiotherapists are at recording both intra and inter-rater measurements of ULNT1 on an asymptomatic population. ⋯ Precision was acceptable for both intra-rater (SEM 2.59° Rater 1; SEM 0.97° Rater 2; SDD 7.16° Rater 1; SDD 2.68° Rater 2), and inter-rater (SEM 3.83°; SDD 10.58°) measurements. These findings demonstrate that physiotherapists can use ULNT1 reliably and with precision for intra and inter-rater measurements of asymptomatic subjects in conditions that replicate clinical practice. The reproduction of this study on a population of symptomatic subjects is now warranted.
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Randomized Controlled Trial Comparative Study
Effect of pilates mat exercises and conventional exercise programmes on transversus abdominis and obliquus internus abdominis activity: pilot randomised trial.
Pilates training is said to increase Transversus abdominis (TrA) and Obliquus internus (OI) activation during exercise and functional activities. 34 Pain-free health club members with no Pilates experience, mean (SD) age 30(7) years, were randomised to Pilates mat exercises or strength training. Participants exercised unsupervised twice-weekly for eight weeks. TrA and OI thickness (a proxy for muscle activity at the low-medium efforts of our exercises) were measured with ultrasound pre- and post-training during Pilates exercises 'Imprint' (an abdominal drawing-in manoeuvre) and 'Hundreds A' (lying supine, arms slightly raised, hips and knees flexed to 90°) and 'Hundreds B' (as A, with neck flexion) and functional postures sitting and standing. ⋯ There were no changes in muscle thickness at rest or during functional postures. Pilates training appears to increase TrA activity but only when performing Pilates exercises. Further research is required into Pilates in clinical populations and how to increase deep abdominal activation during functional activities.
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A diagnosis of Myofascial Pain Syndrome (MPS) requires palpation for the identification of at least one clinically relevant trigger point (TP). However, few comparable, high quality studies currently exist from which to draw firm conclusions regarding the robustness of TP examination. An inter-observer agreement study was conducted using two experienced and two inexperienced clinicians. ⋯ Inter-observer agreement was not stable with the experienced pairing exhibiting a sharp decline in agreement during the latter portion of the study. Identification of clinically relevant TPs of the upper Trapezius musculature is reproducible when performed by two experienced clinicians, however, a mixed observer pairing can yield acceptable agreement. A protracted period of data collection may be detrimental to inter-observer agreement; more investigation is needed in this regard.