Search Results (403)

Background: Non-specific neck pain is associated with altered muscle mechanical properties, including increased stiffness. Radial extracorporeal shockwave therapy (rESWT) and orthopedic manual therapy (OMT) are commonly used interventions, although their combined effects on cervical muscle stiffness remain unclear. This study aimed to evaluate the short-term and within-session effects of adding rESWT to OMT on cervical muscle stiffness measured by means of shear wave elastography (SWE) in individuals with non-specific neck pain. Methods: A randomized controlled trial was conducted including 24 participants (mean age 34.36 years) allocated to an intervention group (IG, n = 12) or a control group (CG, n = 12). The IG received a combined protocol of rESWT (1500 impulses per point at 10 Hz, 2–4 bar) and OMT based on the Maitland concept, while the CG received OMT alone. Primary outcomes included cervical muscle stiffness assessed via SWE expressed in meters per second (m/s) and kilopascals (kPa). Secondary outcomes were pain intensity (VAS), pressure pain threshold (PPT), cervical range of motion (ROM), and shoulder elevation strength (SES). Treatment effects were estimated using ANCOVA adjusted for baseline values. Results: The combined intervention was associated with greater reductions in cervical muscle stiffness compared with the control group, with significant decreases in SWE values (m/s: β = −1.27, p < 0.001; kPa: β = −27.97, p < 0.001). Pain intensity was also reduced (β = −2.12, p = 0.012), while PPT increased (β = 18.84, p = 0.024). Improvements were observed in cervical extension ROM (β = 10.30, p = 0.014) and right SES (β = 3.85, p = 0.044). No significant differences were found for other ROM variables or left SES. Conclusions: The addition of rESWT to OMT was associated with greater short-term improvements in cervical muscle stiffness, pain intensity, and mechanical sensitivity compared with OMT alone in individuals with non-specific neck pain. However, these findings should be interpreted with caution due to the study limitations. Full article

Background and Objectives: Brachial plexus birth injury (BPBI) is a peripheral nerve injury occurring during birth that may result in upper-extremity weakness and functional impairment. This systematic review aimed to evaluate the effects of neuromuscular electrical stimulation (NMES) on motor function, muscle strength, range of motion, and upper-extremity function in children with BPBI. Materials and Methods: This systematic review was conducted according to PRISMA guidelines and registered in PROSPERO. PubMed, CINAHL, Scopus, Web of Science, PEDro, and the Cochrane Library were searched from inception to 5 May 2026. Only randomized controlled trials were included. Methodological quality was assessed using the PEDro scale, and risk of bias was evaluated using the RoB 2 tool. Results: Seven randomized controlled trials involving 197 participants were included. Several studies reported improvements in shoulder abduction, elbow flexion, wrist extension, muscle strength, and motor function following NMES compared with conventional therapy. The combination of NMES and constraint-induced movement therapy demonstrated favorable outcomes in functional performance. However, substantial heterogeneity was observed across studies regarding participant characteristics, NMES parameters, treatment duration, and outcome measures. The certainty of evidence ranged from low to very low. Conclusions: Current evidence suggests that NMES may serve as a potential adjunct to conventional rehabilitation in children with BPBI. However, given the low to very low certainty of the evidence, high risk of bias, and substantial clinical and methodological heterogeneity among the included studies, definitive clinical recommendations cannot currently be made. Future well-designed randomized controlled trials using standardized protocols, consistent outcome measures, and longer follow-up periods are warranted. Full article

Background: Upper-limb strength characteristics are considered important determinants of shooting stability in precision sports; however, the specific relationships between upper-limb strength variables and shooting performance in elite air pistol athletes remain insufficiently understood. Therefore, this study aimed to investigate the associations between upper-limb-specific strength characteristics and shooting performance in elite air pistol shooters. Methods: A prospective observational cohort study was conducted using a purposive total population sample from an elite training camp. Isometric peak force and rate of force development of nine upper-limb muscle actions, including handgrip, elbow flexion and extension, and shoulder joint movements, were assessed using a Vald Dynamo handheld dynamometer. Official scores from an international selection competition were used as indicators of shooting performance. Ridge regression analysis was applied to examine the relationships between strength variables and shooting performance while addressing multicollinearity among predictors. Results: Twenty-four elite air pistol athletes at national master level or above were recruited. Ridge regression revealed distinct coefficient patterns between upper-limb task-specific strength characteristics and total shooting score. After within-sex standardization of strength predictors, larger positive ridge coefficients were observed for handgrip RFD, elbow flexion peak force, shoulder external rotation RFD, elbow extension peak force, and selected shoulder variables, whereas negative coefficients were observed for shoulder internal rotation RFD, handgrip peak force, shoulder extension RFD, elbow extension RFD, and selected shoulder variables. These findings suggest that shooting performance is associated with the balance and coordination of task-specific upper-limb strength characteristics rather than maximal strength alone. Conclusions: These findings suggest that coordinated upper-limb task-specific strength balance is associated with shooting performance in elite air pistol athletes. These findings may help inform individualized conditioning and monitoring strategies; however, longitudinal intervention studies are needed to determine whether modifying upper-limb strength balance can improve shooting outcomes. Full article

Background: Rifle shooting performance depends on precise postural control, rifle stability, and coordinated upper-limb force production. Although previous studies have examined postural balance and aiming stability in rifle shooters, the role of upper-limb inter-limb strength asymmetry across different shooting positions remains unclear. This study explored the association between joint-specific upper-limb strength asymmetry and rifle shooting performance in elite athletes across prone, kneeling, and standing positions. Methods: Thirteen elite rifle shooters completed a 20-shot series in each position according to ISSF rules. Bilateral maximal isokinetic strength of the wrist, elbow, and shoulder was assessed at 60°/s using a Biodex System 4 dynamometer, and handgrip strength was measured with a handheld dynamometer. Inter-limb asymmetry indices were calculated for each joint action. Position-specific shooting scores and good-10 hits (≥10.0) were recorded. Associations between asymmetry indices and performance outcomes were examined using Spearman correlation analyses and simple linear regression models. Results: In exploratory analyses, greater asymmetry in selected shoulder actions showed large negative associations with lower prone, kneeling, and standing scores, and standing performance also showed a negative association with wrist flexion asymmetry. Good-10 hits were negatively associated with selected shoulder and wrist asymmetry indices. Exploratory regression models showed large apparent proportions of explained variance for selected position-specific associations, but these estimates should be interpreted cautiously because of the small sample size and the absence of validation. Conclusions: Position-specific upper-limb strength asymmetry, particularly at the shoulder and wrist, was associated with rifle shooting performance and may represent a relevant consideration for training and monitoring in elite rifle athletes. Full article

Background: Preseason screening is widely used in handball to identify athletes at increased risk of injury, yet the prognostic value of different screening approaches remains unclear. The aim of this study was to systematically review the evidence on preseason screening tests and physical assessments in relation to subsequent injury outcomes in handball players. Methods: A systematic review was conducted according to PRISMA guidelines. PubMed, MEDLINE, CINAHL, and Scopus were searched on 14 March 2026. The first 100 results from Google Scholar were also screened, and backward citation searching was performed. Eligible studies included handball players and examined preseason or baseline screening, functional, musculoskeletal, or physical performance assessments in relation to prospectively recorded injury outcomes. Two independent reviewers performed study selection, data extraction, and risk-of-bias assessment using the QUIPS tool. Due to substantial heterogeneity in screening tools, injury outcomes, and follow-up procedures, meta-analysis was not performed. Results: Eight studies were included. Most were prospective cohorts involving adolescent, youth elite, or elite adult handball players. Shoulder-specific screening variables, particularly external rotation strength, strength imbalances, total rotational motion, and selected rotational adaptations, showed more consistent associations with subsequent shoulder-related outcomes. In contrast, broader movement-screening tools, including the Functional Movement Screen, the 9+ screening battery, and the upper quarter Y-Balance Test, generally showed limited associations with overall injury outcomes. Conclusions: Shoulder-specific preseason assessments may be more closely associated with subsequent shoulder-related outcomes than broader movement-screening tools, although the available evidence remains limited, heterogeneous, and derived exclusively from observational studies. Full article

Background: While exercise is critical for breast cancer survivors, identifying prescriptions that promote long-term adherence is a challenge. This study evaluated whether survivors could maintain fitness gains during a 6-month self-managed phase following two distinct 12-week supervised programs. Specifically, we compared whether transitioning from one-on-one training to either individualized (Ind) or group-based (Gr) sessions influenced a participant’s ability to sustain improvements in strength, range of motion (ROM), and cardiorespiratory endurance (VO₂peak). Methods: Thirty breast cancer patients from diverse backgrounds completed an initial 12-week supervised individual training program. They were then randomized into either Ind (n = 13) or Gr (n = 17) supervised sessions for a second 12-week phase. Fitness assessments were conducted at baseline, 3 months (post-initial training), and 1 year (after the 6-month self-managed phase). Data were analyzed using generalized estimating equations to evaluate the effects of time and training format. Results: Significant improvements were observed across all fitness categories over time. Muscular strength (bench press, plank, and squats) and VO₂peak increased significantly by 3 months and were successfully maintained at the 1-year follow-up mark. Shoulder ROM also showed significant improvement at 1 year. Notably, the training format (group vs. individual) had no significant impact on these outcomes, with the exception of one ROM metric. Conclusions: Initial supervised exercise leads to significant fitness gains that breast cancer survivors can successfully maintain for at least six months through self-management. These gains are sustained regardless of whether the preceding supervised training was delivered in a group or individual format, suggesting flexibility in clinical exercise prescriptions. Full article

Fused deposition modeling (FDM) of polylactic acid (PLA) produces parts whose weak interlayer bonding and low as-printed crystallinity limit their tensile performance. This work used a Taguchi L9 orthogonal array with five replicates per cell (n = 5; N = 45 annealed specimens plus five non-annealed controls) to study how annealing temperature (70, 80, and 90 °C) and holding time (40, 60, and 80 min) change the tensile response of a commercial PLA grade (eSUN PLA+) printed on a desktop FDM machine. Differential scanning calorimetry (DSC) and X-ray diffraction (XRD) were used in parallel to measure total crystallinity, and XRD was deconvoluted to estimate the α′/α polymorph fractions; the DSC α′→α exothermic shoulder was used as an independent cross-check. Every annealed condition exceeded the non-annealed baseline ultimate tensile stress (UTS) of 39.75 ± 1.28 MPa. The optimum, 47.00 ± 0.97 MPa at 70 °C/60 min, gave an 18.2% gain. Total crystallinity rose from 8.6% (DSC baseline) to 41.8% (DSC, 90 °C/80 min), with DSC and XRD ranking the conditions consistently. ANOVA confirmed both temperature (30.0% contribution) and time (24.2%) as significant at α = 0.05. The new contribution is a combined strength–crystallinity–polymorph map for desktop FDM-printed PLA: the best-performing specimens are dominated by the disordered α′ form, while the stiffer but weaker high-temperature specimens shift toward α. A partial least squares regression on all 50 specimens supports the polymorph-composition role beyond what total crystallinity alone explains. The practical conclusion is that moderate annealing just above the glass transition gives the best balance of crystal content, polymorph character, and geometric stability for FDM-printed PLA. Full article

Background/Objectives: Arthroscopic shoulder surgery is associated with postoperative pain and loss of function. Percutaneous electrical nerve stimulation (PENS) may serve as an effective adjunct to postoperative rehabilitation. This randomized clinical trial examined whether adding ultrasound-guided PENS to a multimodal rehabilitation program improves pain, disability, pressure pain sensitivity, shoulder range of motion, and muscle strength in individuals with postoperative pain following shoulder arthroscopy. Methods: A randomized, parallel-group clinical trial (registry: NCT06331871) was conducted. Seventy patients who had undergone shoulder arthroscopy were randomized to receive manual therapy/exercise alone (n = 35) or manual therapy/exercise/PENS (n = 35). All participants received the multimodal program including manual therapy and exercises four weeks after surgery for a duration of 12 weeks (five sessions/week). Those allocated to the PENS group also received two sessions (once per week) of ultrasound-guided PENS targeting the suprascapular and axillary nerves. Pain intensity (Numeric Pain Rating Scale (NPRS)) and disability (Disabilities of the Arm, Shoulder and Hand (DASH)) were the primary outcomes, whereas function (Shoulder Pain and Disability Index (SPADI)), pressure pain threshold (PPT), isometric strength, and shoulder range of motion (ROM) were secondary outcomes. Pain, PPT, strength, and ROM were assessed before and after treatment, and at 1 and 3 months. Disability and function were assessed at baseline and 3 months after treatment. Results: Patients receiving PENS showed greater improvements in shoulder pain (F_{2.72, 182.32} = 7.76, p = 0.007, η²p = 0.10), disability (F_{1, 68} = 5.63, p = 0.020, η²p = 0.08), function (F_{1, 68} = 4.15, p = 0.046, η²p = 0.02) and PPT over the infraspinatus muscle (F_{3.20, 217.28} = 2.93, p = 0.032, η²p = 0.04) than those receiving manual therapy/exercise alone. No between-group differences were observed for PPT at the deltoid or tibialis anterior muscles. The PENS group also showed greater improvements in some, but not all, measures of shoulder strength and range of motion; however, the effect sizes were small and the clinical relevance of these differences remains uncertain. Conclusions: Adding ultrasound-guided PENS targeting the suprascapular and axillary nerves to a multimodal physical therapy program resulted in greater improvements in pain, disability, and shoulder-specific function, with limited additional benefits for some measures of strength and range of motion, compared with physical therapy alone, in individuals with postoperative shoulder pain. However, many of the lower-bound estimates of the 95% confidence interval did not surpass the minimal clinically important difference. Therefore, the clinical relevance of the results should be considered with caution. Full article

Background/Objectives: Mind–muscle connection (MMC) refers to a strategy in which an individual intentionally focuses attention on specific muscles to enhance the neural activation of those muscles. The purpose of this study was to examine the acute effects of MMC directed toward a specific muscle during a machine-based shoulder press exercise on the muscle activity of untrained individuals. Methods: Thirty-one healthy young adults with no athletic or resistance training experience participated in this single-session study. Participants performed machine-based shoulder presses at 40% of one-repetition maximum intensity under three MMC conditions. The three conditions were: no-focus condition, deltoid (DT)-focused condition, and triceps brachii (TB)-focused condition. Muscle activities of the DT, TB, and upper trapezius (UT) were measured during exercise under each MMC condition. Differences in muscle activity across conditions were analyzed using a two-way repeated-measures analysis of variance. Results: A total of 31 participants were included in the final analysis. A significant interaction between muscle and MMC condition was observed (p < 0.001). Post hoc analysis showed that DT activity was higher in the DT-focused condition, whereas TB activity was higher in the TB-focused condition (p < 0.001). UT activity did not differ across conditions (p > 0.05). Conclusions: MMC selectively enhanced target muscle activity without changing non-target muscle activity, indicating its potential for selective neuromuscular recruitment. These findings suggest that MMC may serve as a practical strategy for selective muscle activation during machine-based resistance training. Further study is needed to determine whether these findings translate into long-term improvements in muscle strength and functional performance. Full article

Background/Objectives: Breast cancer survivors differ from non-cancer populations in that cancer treatment commonly induces declines in physical fitness (PF) that are relevant to treatment tolerance, recovery, and survivorship outcomes. However, PF assessment methods vary widely across interventional studies. This scoping review aimed to map and characterize objective PF assessments used in interventional research among breast cancer survivors. Methods: Following PRISMA-ScR guidelines, PubMed, MEDLINE, EMBASE, Web of Science, KoreaMed, KCI, ClinicalTrials.gov, and Google Scholar were searched through November 2024. Interventional studies enrolling adult female breast cancer survivors and reporting at least one objectively measured PF outcome were included. Results: Of 9697 records identified, 316 studies met the inclusion criteria. Most interventions were exercise-based (83.2%) and conducted in the post-treatment phase (56.4%). Across the 316 studies, 557 PF domain records were identified because a single study could report more than one PF domain. Muscular strength accounted for the largest proportion of PF domain records (n = 222, 39.9%), followed by cardiorespiratory fitness (n = 190, 34.1%), flexibility (n = 100, 18.0%) and physical function (n = 45, 8.0%). Assessment method records showed that field-based walking test, strength test, shoulder range of motion test and balance tests were commonly used within their respective domain. Substantial heterogeneity in protocols, timing, and reporting limited comparability across studies. Conclusions: PF assessments are widely used in interventional breast cancer survivorship research but remain unevenly distributed across domains and treatment phases. More standardized and clearly reported PF assessment methods are needed to improve comparability and support future survivorship research. Full article

Background and Clinical Significance: This case highlights the management of chronic extensor carpi ulnaris (ECU) tenosynovitis in a patient exposed to non-traditional wrist-loading activities. Exercise therapy rehabilitation is well established in shoulder and knee tendinopathies, although it remains less well described for wrist tendinopathies beyond De Quervain’s disease. Moreover, the patient’s active engagement in non-traditional, wrist-intensive sports such as handstands, slacklining, and yoga may have contributed to the development and persistence of chronic extensor carpi ulnaris (ECU) tenosynovitis. Unlike more common ECU injuries observed in tennis or golf players, this case demonstrates how ECU tenosynovitis can develop in less conventional sports. It adds to the scientific literature by showing that chronic ECU tenosynovitis can be effectively managed through non-surgical rehabilitation tailored to the specific needs of the patient, in particular by using exercise therapy. Case Presentation: The patient presented with chronic left wrist pain, especially during ulnar deviation and resisted ECU testing, following two traumatic events. Examination revealed limited range of motion caused by pain, particularly in flexion, extension, and both ulnar and radial deviations. Ultrasound imaging confirmed ECU tenosynovitis with mild inflammation of other wrist tendons and a small synovial cyst on radio-scapho-lunate level. ECU stability during forearm rotation was confirmed both clinically and by ultrasound.  The diagnosis of chronic ECU tenosynovitis was managed conservatively with a targeted rehabilitation program focused on isometric strengthening and progressive resistance exercises. Over one month, the patient demonstrated marked improvement in wrist strength, pain reduction, and functional capacity, allowing for a gradual return to sporting activities. Conclusions: The main takeaway from this case is that chronic ECU tenosynovitis can be successfully managed through individualized, conservative treatment based on exercise therapy. Early intervention, patient adherence, and rehabilitation tailored to the athlete’s specific demands are crucial for recovery, even in chronic cases, without the need for surgical intervention. Full article

Crossfit^® is a high-intensity interval training modality that combines weightlifting, aerobic exercises, and gymnastics. Although it has gained widespread popularity, it also presents a considerable injury rate without clarity on the extent to which experience categories exhibit distinct temporal patterns. This study identifies the most common injuries and their progression across CrossFit^® categories over 12 months. We defined injury as any Crossfit-related event requiring healthcare consultation and interrupting an athlete’s activity. An observational, longitudinal study was conducted with 102 participants categorized into three groups (n = 34): beginner, scale, and rx. An adapted injury index questionnaire was applied, and descriptive statistics were performed. Results showed that the most frequent injuries affected the shoulder and knee, with variations across the different athlete categories. Beginners exhibited the highest injury rates: knee (56%) and shoulder (35%). The scale group presented a greater concentration of shoulder injuries, whereas rx demonstrated the lowest injury incidence overall. Over the 12-month follow-up, 135 injuries were reported at baseline, decreasing to 116 at six months and 101 at the final evaluation. Dropout rates were 35% among beginners, 12% in the scale group, and 0% in the rx group. Crossfit-related injuries primarily affect the shoulders and knees, with a higher incidence in beginners. Future studies should investigate movement technique, strength, mobility, and limb dominance considering the overhead demands and the associated injury risk, in addition studies should examine training programming too Full article

This study investigated the effects of a 12-week structured aquatic exercise program incorporating multiple immersion depths on muscle strength, postural alignment, and static balance in middle-aged women. Eighteen women in their 40s were randomly allocated to an aquatic exercise group (AG, n = 9) or a control group (CG, n = 9). The AG participated in a 12-week aquatic exercise program twice weekly in an indoor rehabilitation pool with progressively increased intensity (RPE 11–13 for weeks 1–6 and 14–16 for weeks 7–12) and multiple immersion depths (knee, waist, and xiphoid process levels). The CG was instructed to refrain from moderate-to-vigorous physical activity for 12 weeks. Outcomes included dominant handgrip strength, a 60-s abdominal curl-up test, postural alignment (3D posture analysis), and static balance (single-leg stance test). Data were analyzed using two-way mixed ANOVA. Significant group × time interactions were found for handgrip strength (p = 0.003), 60-s abdominal curl-up performance (p < 0.001), pelvic tilt alignment (p = 0.017), and single-leg stance time (p < 0.001). The AG improved handgrip strength (25.62 ± 2.81 to 27.57 ± 2.13 kg), 60-s abdominal curl-up performance (26.89 ± 2.93 to 41.56 ± 3.05 repetitions), pelvic tilt alignment (10.94 ± 3.46 to 7.63 ± 0.17), and single-leg stance time (29.49 ± 2.81 to 34.65 ± 2.60 s), whereas the CG showed no meaningful changes. No significant interaction effects were observed for head displacement, shoulder asymmetry, hip alignment, or knee alignment (all p > 0.05). These preliminary findings suggest that a structured aquatic exercise program incorporating multiple immersion depths may improve muscle strength, trunk muscular endurance, pelvic tilt alignment, and static balance in middle-aged women compared with a non-exercise control group. However, because this study did not include a fixed-depth aquatic exercise comparator, the findings should not be interpreted as evidence that exercise incorporating multiple immersion depths is superior to fixed-depth aquatic exercise. Full article

Overhead sports place high demands on the shoulder complex, making warm-up specificity relevant for acute readiness. This randomized controlled pilot trial compared the immediate effects of a shoulder-specific warm-up with a habitual routine in 24 youth competitive overhead athletes (14–20 years), allocated to an experimental group (EG = 12) and a habitual warm-up group (SWG = 12). The warm-up protocol was administered bilaterally to both shoulders, whereas outcome measurements were collected unilaterally, with each shoulder tested separately. Assessments were performed before and immediately after the warm-up protocol. Outcome measures included shoulder flexion range of motion (ROM), handgrip strength, Closed Kinetic Chain Upper Extremity Stability (CKCUES) performance, and post-warm-up Rating of Perceived Exertion (RPE; Borg CR-10). A significant group-by-time interaction was found for right shoulder flexion ROM (p = 0.003, η²p = 0.346), with a significant increase in the EG from baseline to post-test (p = 0.008). No significant effects were observed for left shoulder flexion ROM, handgrip strength, or CKCUES performance. Post-warm-up RPE was statistically significant in the EG compared to the SWG (p = 0.041). These preliminary findings may suggest the potential practical value of more targeted warm-up strategies in overhead sports, while larger longitudinal studies are needed to confirm their broader functional relevance. Full article

Background and Objectives: Breast cancer survivors often experience long-term physical and psychological impairments that negatively affect quality of life. Exercise-based rehabilitation strategies are increasingly recommended in this population. This study aimed to analyze the physical and psychological benefits of Nordic walking (NW) in breast cancer survivors. Materials and Methods: A systematic review (registered in PROSPERO ref: CRD42024613292) was conducted in accordance with PRISMA guidelines. SPORTDiscus, CINAHL, Cochrane, Embase, Medline Ovid and PubMed were searched from database inception to 30 December 2025, with no restrictions applied regarding the language of the included studies, using the terms “breast cancer”, “walking poles”, “pole walking” and “Nordic walking”. Studies involving adult women (≥18 years) with breast cancer were included. Data on study design, participant characteristics, intervention protocols and outcomes were extracted. Methodological quality was assessed using the Joanna Briggs Institute critical appraisal tools. Results: From 281 records identified, 17 studies were included that evaluated NW alone or in combination with other exercise. Improvements in cardiovascular capacity were reported in five studies (four out of five reported significant improvement after NW), while gains in shoulder range of motion were observed in three out of four studies assessing this outcome, mainly after standalone NW interventions. Positive changes in body posture were significantly reported after NW in all three studies investigating this parameter. Improvements in strength were reported in five studies, while gains in flexibility were observed in one study, within multimodal interventions combining NW with other exercise. Among seven studies evaluating lymphedema, sustained reductions were primarily reported after multiweek programs, especially when NW was combined with the ISA method. Several studies also reported improvements in pain, psychological alterations, and quality of life. Conclusions: NW appears to be an effective, holistic exercise modality for enhancing both physical and psychological aspects for breast cancer survivors. Full article