Search Results (394)

Current rehabilitation protocols for transitioning patients to late-stage recovery, evaluating return-to-play (RTP) clearance, and assessing tendon characteristics exhibit significant heterogeneity. Clinicians frequently interpret and apply research findings based on individual philosophies, resulting in varied RTP criteria and performance expectations. Despite medical clearance, patients recovering from Achilles tendon (AT) injuries often exhibit persistent impairments in muscle volume, tendon structure, and force-generating capacity. Inconsistencies in assessment frameworks, compounded by a lack of quantitative data and the utilization of specific metrics to quantify certain strength characteristics (endurance, maximal, explosive, etc.) and standardized protocols, hinder optimal functional recovery of the plantar flexors during the final stages of rehabilitation and RTP. With this in mind, the aim of this integrative review was to provide an overview of AT rehabilitation, with particular critique around mid-stage strengthening and the use of the heel-raise assessment in milestoning rehabilitation progress. From this critique, new perspectives in mid-stage strengthening are suggested and future research directions identified. Full article

Introduction: Hip abductor strength is essential for pelvic stability, lower limb alignment, and injury prevention. Weaknesses of the gluteus medius and minimus contribute to various musculoskeletal conditions. Lateral band walks and monster walks are elastic resistance exercises commonly used to target the hip abductors and external rotators in functional, weight-bearing tasks. Therefore, the aim was to summarize the current evidence on the biomechanics, muscle activation, and clinical applications of lateral and monster band walks. Methods: This narrative review was conducted following the SANRA guideline. A comprehensive literature search was performed across PubMed, Scopus, Web of Science, and SPORTDiscus up to April 2025. Studies on the biomechanics, electromyography, and clinical applications of lateral band walks and monster walks were included, alongside relevant evidence on hip abductor strengthening. Results: A total of 13 studies were included in the review, of which 4 specifically investigated lateral band walk and/or monster walk exercises. Lateral and monster walks elicit moderate to high activation of the gluteus medius and maximus, especially when performed with the band at the ankles or forefeet and in a semi-squat posture. This technique minimizes compensation from the tensor fasciae latae and promotes selective gluteal recruitment. Proper execution requires control of the trunk and pelvis, optimal squat depth, and consistent band tension. Anatomical factors (e.g., femoral torsion), sex differences, and postural variations may influence movement quality and necessitate tailored instruction. Full article

Background/Objectives: Urinary incontinence (UI), defined as the involuntary loss of urine, is common among female athletes. As more women engage in competitive sports, numerous studies have explored UI in young, nulliparous, and physically active women. The objectives of this study were (i) to analyze the prevalence, severity, and characteristics of UI in professional nulliparous female soccer players and (ii) to compare the status of the pelvic floor muscles (PFMs) between professional soccer players and physically active young women. Methods: This descriptive cross-sectional study included professional soccer players (n = 18) and physically active women (n = 14). UI was assessed using the ICIQ-SF questionnaire, and PFM function was evaluated through intracavitary examination using the PERFECT method. Additional data were collected on body composition and on urinary, bowel, and sexual health. Results: UI affected 35.7% of physically active women and 50% of professional soccer players. Stress urinary incontinence (SUI) was the most common type, present in 100% of affected soccer players and 60% of affected active women. The severity of UI was mostly mild, with no significant differences between groups. PFM assessment revealed deficiencies in control, relaxation, endurance, and rapid contractions, as well as difficulties performing an effective perineal locking (PL) maneuver during increased intra-abdominal pressure. Conclusions: These findings highlight the need for targeted programs focused on strengthening and educating athletes about their PFMs, aiming to prevent UI and improve both performance and quality of life. The study reinforces the importance of preventive strategies for pelvic floor health in sports. Full article

In this study, we explored the dose-dependent effects of neutral sodium humate (NSH) on the growth performance, slaughter traits, antioxidant capacity, and intestinal health of yellow-feathered broilers. A total of 240 one-day-old male yellow-feathered broilers were randomly allocated into three groups, with each group consisting of four replicates containing 20 birds per replicate. The control group (Blank) received a basal diet, while the NSH-L and NSH-H groups were provided with the same basal diet included with neutral sodium humate at concentrations of 0.15% and 0.3%, respectively. The results indicate that dietary inclusion of neutral sodium humate at both low (NSH-L) and high (NSH-H) doses significantly increased the body weight and leg muscle yield of yellow-feathered broilers and improved meat quality (p < 0.05). Furthermore, NSH inclusion effectively reduced serum total cholesterol levels and elevated total protein concentration (p < 0.05). In addition, NSH significantly improved duodenal and ileal morphology (e.g., increased villus height and reduced crypt depth), strengthened intestinal barrier integrity (p < 0.05), and enhanced antioxidant capacity (p < 0.05). Notably, the high-dose NSH group (NSH-H) demonstrated significantly greater enhancements in intestinal and barrier integrity compared to the low-dose group (NSH-L). Microbiome analysis revealed that, compared to the Blank group, both the NSH-L and NSH-H groups exhibited significant shifts in cecal microbiota composition, including increased abundance of Bacteroidota and Rikenellaceae_RC9_gut_group and reduced abundance of Euryarchaeota and Methanobrevibacter. Collectively, these findings demonstrate that neutral sodium humate acts as a multifunctional feed additive in yellow-feathered broilers, enhancing productivity and gut health. The study provides a theoretical foundation for the scientific application of neutral sodium humate in broiler production. Full article

Respiratory muscle training (RMT) has been proposed as a supportive strategy for adults receiving invasive mechanical ventilation; however, the way RMT is prescribed—mode, intensity, frequency, and volume—remains highly heterogeneous. Objectives: This study aimed to describe the current evidence regarding the prescription of respiratory muscle strengthening in terms of frequency, intensity, method, and volume in adult patients under mechanical ventilation in intensive care units. Methods: A scoping review was conducted following the PRISMA-ScR guidelines based on searches in electronic databases including Scopus, SciELO, ScienceDirect, PubMed, LILACS, Springer, Web of Science, Google Scholar, PEDro, Dialnet, and Cochrane. Results: Seven studies met the established inclusion criteria and described prescription protocols for respiratory muscle strengthening in adult patients under mechanical ventilation in intensive care units. Conclusions: The most frequently reported protocol involved threshold load training at 40–50% of maximal inspiratory pressure, administered twice daily, every day of the week, with a volume of 30 repetitions. This intervention showed promising results in improving inspiratory muscle strength, with potential additional benefits in weaning success and pulmonary function. Full article

Background and Objectives: Arthrogenic muscle inhibition (AMI) is a key neurophysiological barrier to effective rehabilitation in individuals with chronic ankle instability (CAI). The primary objective of this narrative review is to explore the role of arthrogenic muscle inhibition (AMI) in chronic ankle instability (CAI) and to critically appraise neurophysiological and rehabilitative strategies targeting its resolution. Although peripheral strengthening remains a cornerstone of treatment, the roles of spinal and cortical modulation are increasingly recognised. Materials and Methods: A narrative review was conducted to examine recent clinical trials targeting AMI in CAI populations. A structured search of MEDLINE, Web of Science, Scopus, Cochrane Central, and PEDro was performed. Five studies were included, encompassing peripheral, spinal, and cortical interventions. The outcomes were grouped and analysed according to neurophysiological and functional domains. Results: Manual therapy combined with exercise improved pain, strength, and functional mobility. Fibular reposition taping transiently enhanced spinal reflex excitability, while transcranial direct current stimulation (tDCS) over the primary motor cortex significantly modulated corticospinal excitability and voluntary muscle activation. Improvements in subjective stability, dynamic balance, and neuromuscular responsiveness were observed in the majority of the five included studies, although methodological heterogeneity and short-term follow-ups limit generalisability. Conclusions: Multimodal interventions targeting different levels of the neuromotor system appear to be more effective than isolated approaches. Integrating manual therapy, sensorimotor training, and neuromodulation may optimise outcomes in CAI rehabilitation. Future trials should focus on standardised outcome measures and long-term efficacy. Full article

The Inverted Swallow (IS) is a rare isometric upper-body skill in artistic gymnastics. Athletes use Preconditioning Strengthening Exercises (PSEs) to develop the strength necessary to hold the IS at competition rings. However, the specific muscle excitation and synergies typical of the IS and its PSEs remain unexplored. Thus, this study analyzed muscle excitations and synergies during the IS and its five common PSEs. Muscle excitation was recorded from the pectoralis major, latissimus dorsi, triceps brachii, infraspinatus, trapezius, serratus anterior, biceps brachii and posterior deltoid muscles in six elite calisthenics athletes (age: 24.5 ± 3.0 years; height: 168.6 ± 5.8 cm; body mass: 65.0 ± 4.7 kg). Non-Negative Matrix Factorization was used to extract synergies. The results showed a predominant role of the posterior deltoid and triceps brachii during the IS. Significant differences were observed in the muscle excitation of the triceps brachii between the IS and its PSEs (p ≤ 0.001; W = 0.765), and in the posterior deltoid (p = 0.002; W = 0.629). Muscle synergy patterns also differed in simultaneous muscle activation between the IS and its PSEs. These findings provide the first detailed evidence of the characteristics of the IS element, providing insights for optimizing strength training and gymnastics performance. Full article

Background/Objectives: Scapular adaptations have been associated with shoulder pain. However, conflicting findings have been reported after scapular-focused interventions. The present study aims to evaluate scapula-related outcomes before and after a scapular therapeutic exercise program. Methods: Eighteen adult volunteers with chronic shoulder pain participated in an 8-week scapular therapeutic exercise program that was personalized according to their pain condition and the presence of scapular dyskinesis. This program included preparation and warm-up, scapular neuromotor control, and strengthening and stretching exercises. Both self-reported (shoulder pain and function, psychosocial factors, and self-impression of change) and performance-based outcomes (scapular muscular stiffness and activity level, tridimensional motion, rhythm, and movement quality, measured while participants drank a bottle of water) were used for analysis. Results: After the intervention, participants presented reduced shoulder pain (p < 0.0001) and pain catastrophizing (p = 0.004) and increased shoulder function (p < 0.0001). Additionally, the participants presented changes in scapular winging (p < 0.0001 to p = 0.043), increased scapular downward rotation (p < 0.0001) and depression (p = 0.038), and decreased global movement smoothness (p = 0.003). These were associated with changes in serratus anterior activity (p = 0.016 to p = 0.035), decreased middle (p < 0.0001 to p = 0.002) and lower trapezius (p < 0.0001) and levator scapulae (p = 0.048) activity levels, and decreased middle trapezius muscle stiffness (p = 0.014). Patients’ self-perception of change was rated favorably. Conclusions: After a scapular therapeutic exercise program, changes were observed in both self-reported and performance-based outcomes. These results need to be confirmed by a randomized controlled trial. Full article

Background: Post-COVID syndrome is characterized by persistent symptoms such as dyspnea, fatigue, and reduced exercise tolerance, which can significantly impair pulmonary function and quality of life. Pulmonary rehabilitation has been proposed as a potential intervention to address these challenges. This study aimed to evaluate the effects of a pulmonary rehabilitation program on pulmonary function, inflammatory markers, and quality of life in patients with post-COVID syndrome. Methods: A prospective, interventional, non-randomized clinical trial was conducted involving 77 participants (mean age 59.4 ± 11.6 years; 39% female) who attended a post-COVID care clinic in Rzeszów, Poland. The intervention included supervised respiratory and aerobic exercises, muscle strengthening, and body balance therapy, alongside motivational breathing therapy. Pulmonary function (spirometry, plethysmography, gasometry), inflammatory markers (CRP, WBC, D-dimer), and quality of life (WHOQOL-BREF) were assessed pre- and post-intervention. Results: Significant improvements were observed in pulmonary function parameters post-rehabilitation, including increases in forced vital capacity (FVC, 75% to 78.4%, p < 0.001), forced expiratory volume in one second (FEV1, 78.2% to 80.5%, p < 0.001), and total lung capacity (TLC, 67.3% to 71%, p < 0.001). The diffusing capacity for carbon monoxide (DLCO) improved by 6.2% (p < 0.001). Arterial oxygen pressure (PaO₂) increased by 7.6 mmHg (p < 0.001). Markers of inflammation, including CRP (8.9 to 1.3 mg/dL, p < 0.001) and d-dimer (1722.2 to 203.4 ng/mL, p < 0.001), showed significant reductions. Quality of life improved across physical, psychological, and environmental domains. Sex, BMI, and baseline inflammatory markers were significant determinants of rehabilitation outcomes. Conclusions: A pulmonary rehabilitation program significantly improved pulmonary function, reduced systemic inflammation, and enhanced quality of life in individuals with post-COVID syndrome. The findings highlight the importance of tailored rehabilitation in mitigating long-term post-COVID sequelae. Future research should explore the long-term effects of rehabilitation and its applicability in diverse populations. Full article

Peptides are currently vital components in nutrition with physiological advantages beyond a basic diet. This systematic review aims to explain their significance in metabolic, behavioral, and musculoskeletal health, focusing on their therapeutic benefits, molecular mechanisms, and bioactivities. This systematic review analyzed clinical trials from PubMed and Scopus databases in the time range of 2019 to 2024, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards, that investigated the role of peptides in human nutrition. Eight randomized clinical trials (RCTs) met the predefined metabolic, behavioral, and musculoskeletal health inclusion criteria. Peptides are derived from various sources, including milk, fish, and plants, and show various bioactive characteristics such as anti-inflammatory effect, improved muscle protein synthesis, and immune modulation. Some important findings emphasize their potential to govern metabolic processes, defend against chronic diseases, and enhance gut health. For instance, glucagon-like peptide (GLP-1) controls taste perception and appetite stimulation, and collagen peptides strengthen the musculoskeletal system. Peptides display intriguing potential as nutrients for addressing global health challenges, including behavioral responses, aging, and metabolic syndrome. Future investigations would focus on bioavailability, optimizing dosage, and demographic-specific treatments. Full article

Background and Objectives: Negative-pressure wound therapy (NPWT) expedites tissue repair, yet functional recovery depends on adjunct rehabilitation. Evidence from high-resource settings is difficult to translate to Romanian county hospitals, where advanced devices are scarce. The objective of this study is to determine whether two tiers of low-technology, therapist-delivered exercise improve mobility, oedema resolution, pain and quality-of-life (QoL) beyond NPWT alone in adults with acute lower-limb wounds. Methods: A single-centre, prospective observational study (January 2021–June 2024) enrolled 92 patients and randomised them unevenly into: Group A, NPWT only (n = 39); Group B, NPWT + routine physiotherapy (n = 33); Group C, NPWT + enhanced manual programme (n = 20). All received −125 mmHg continuous suction; rehabilitation started 48 h post-operation. Primary outcomes were ankle dorsiflexion and knee flexion at 12 weeks. Secondary outcomes included calf circumference, ultrasound oedema depth, Manual Muscle Testing (MMT), pain (VAS), analgesic use and SF-36 domains through 24 weeks. Results: Baseline characteristics were similar (p > 0.40). At 12 weeks dorsiflexion reached 20.1 ± 1.8° in Group C, surpassing Group B (18.4 ± 2.1°; p = 0.004) and Group A (16.0 ± 2.3°; p < 0.001). Knee flexion followed the same gradient (140.8 ± 3.2°, 137.6 ± 3.4°, 133.4 ± 3.8° respectively). Oedema depth fell fastest in Group C (0.4 ± 0.2 mm by day 42) versus B (0.6 ± 0.2 mm) and A (0.8 ± 0.3 mm). Week-12 MMT grade ≥ 4.5 was attained by 95% of Group C, 85% of B and 72% of A (χ² = 10.9, p = 0.004). VAS pain fell more steeply with each rehabilitation layer, paralleled by a stepwise decline in daily tramadol. All SF-36 domains were highest in Group C at 24 weeks (Physical Function 88.7 ± 4.8 vs. 85.1 ± 5.4 vs. 78.2 ± 5.9; p < 0.001). Mobility correlated positively with QoL (r = 0.66) and inversely with pain and oedema. Conclusions: In a resource-constrained Romanian setting, adding structured manual physiotherapy to NPWT produced meaningful functional and patient-centred gains, while an “enhanced” programme incorporating daily PNF and elastic-band strengthening delivered the largest observed benefit. These findings justify prioritising therapist-led interventions even where sophisticated equipment is unavailable. Full article

Background: Breast cancer is one of the most prevalent neoplasms among women, often requiring mastectomy, a procedure with a significant impact on functionality, self-esteem, and quality of life. Objective: This study aimed to map the main interventions performed by the Rehabilitation Nursing Specialist in the follow-up care of mastectomised women. Methods: A review was conducted according to the Joanna Briggs Institute methodology. The search included 11 articles published between 2019 and 2024 in Portuguese, English, and Spanish, available on the EBSCO platform (MEDLINE with Full TEXT, CINAHL). The descriptors used were (Mastectomy OR Breast Removal) AND (Rehabilitation Nursing OR Nursing Intervention). Results: The Rehabilitation Nursing Specialist interventions focused on education regarding upper limb mobilisation, medication administration, lymphedema prevention, strategies for performing Daily Life Activities with less effort and pain, implementation of rehabilitation plans with physical exercises, and emotional support in accepting body image changes. Hospital discharge planning and caregiver education also emerged as key elements to ensure continuity of care. Most studies (six) identify performing exercises to strengthen muscles and prevent lymphoedema as a very important intervention for nurses, followed by education on care for upper limb mobilisation and lymphoedema prevention (five) and emotional and social support (four), among other interventions. Conclusions: The Rehabilitation Nursing Specialist interventions are fundamental for promoting functionality, emotional well-being, and quality of life in mastectomised women, reinforcing the importance of a multidisciplinary, person-centred approach supported by scientific evidence. Full article

The abdominal drawing-in maneuver (ADIM) is one of the most valuable exercises for explicitly targeting and strengthening the transversus abdominis (TrA), a key muscle in the deep core. However, using the ADIM for the selective training of the transverse abdominis can be challenging for certain individuals. This study investigated the effects of combining ADIM with blood flow restriction (BFR) training on TrA strengthening in sedentary university students. Forty university students with sedentary lifestyles (mean age: 23.28 ± 2.468 years; range 20–25 years) were randomly assigned to an ADIM+BFR group and a control group (ADIM only). Both groups underwent 25 min ADIM training sessions twice weekly for four weeks. Ultrasound measurements assessed TrA thickness, contraction ratio, and preferential activation. Core stability, strength, and endurance were evaluated using the double leg lowering, abdominal strength, and abdominal static endurance tests. The ADIM+BFR group showed significant improvements in TrA thickness, contraction ratio, and preferential activation compared to the control group following the four-week training intervention (p < 0.05). The ADIM+BFR group demonstrated improved core stability and enhanced abdominal strength and endurance compared to the control group (p < 0.05). The results support the effectiveness of ADIM+BFR training in enhancing TrA contraction and activation in sedentary university students. This approach also improves core stability, strength, and endurance. BFR provides a novel and readily applicable method for promoting TrA activation during ADIM training. Full article

Background/Objectives: This paper analyzes the movement and relationships within the lumbopelvic–hip complex during forward trunk bending in young women with chronic low back pain. Methods: This study involved 24 women aged 20–24 with chronic low back pain. They were randomly divided into two equal-sized groups: Group 1 participated in a 12-week functional training program, and Group 2 was a control without any intervention. The level of perceived pain was assessed using the Visual Analog Scale (VAS). Qualitative motion analysis was performed using the BTS SMART-D system. Custom indicators were developed to evaluate the angular relationships and ranges of motion in the lumbar spine and the lumbopelvic–hip complex. The functional training program consisted of three sections: motor control and stabilization, muscle strengthening, and stretching exercises. Statistical analysis was performed using Statistica 13.3. Results: The therapy resulted in a reduction in perceived pain levels reported by the participants. There was a significant improvement in the quality of the forward trunk bending pattern in women who underwent functional training. Conclusions: Significant modifications in the quality, technique, and angular relationships within the lumbopelvic–hip complex were observed during the forward trunk bending pattern in women undergoing functional training. It has proven to be an effective form of therapy for chronic low back pain. Full article

The number of people suffering from urinary incontinence increases every year. Along this trend, the knowledge of society increases regarding the various methods available for treating this ailment. Both patients and researchers are constantly looking for new treatments for urinary incontinence. One of the new solutions is sonofeedback of the pelvic floor muscles, which may help to strengthen them and thus reduce the problem. The aim of this study was to evaluate the effectiveness of sonofeedback and transvaginal electrostimulation in increasing the bioelectrical activity of pelvic floor muscles in postmenopausal women with stress urinary incontinence. Sixty women with stress urinary incontinence were enrolled in the study. The patients were divided into two groups: A, where sonofeedback was used, and B, where electrostimulation of the pelvic floor muscles was performed with biofeedback training. In patients, the resting bioelectrical activity of the pelvic floor muscles was assessed using an electromyograph. The assessment of the resting bioelectrical activity of the pelvic floor muscles was performed before the therapy, after the 5th training, and after the therapy. It was observed that after the end of the therapy, the average bioelectrical potential increased by 1.1 µV compared with the baseline in group A. It can be suggested that the sonofeedback method is comparatively effective in reducing symptoms that are associated with urinary incontinence as an electrostimulation method with biofeedback training. Full article