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Purpose The aim of this prospective, randomized, controlled, double-blind clinical trial was to compare the outcomes, including knee strength, balance, coordination, proprioception and response time, of Nintendo Wii Fit with those of conventional rehabilitation on the subjects with anterior cruciate ligament reconstruction. Methods Thirty volunteer subjects were enrolled in either Wii Fit ( n  = 15; mean age, 29 ± 7 years) or conventional rehabilitation ( n  = 15; mean age, 29 ± 6 years) programmes from the first week up to 12th weeks of the operation. Endoscopic reconstruction of a completely ruptured ACL was performed by using graft harvested from hamstrings. Each subject underwent an individual therapeutic programme. Functional examinations included the measurements of the balance using modified star excursion balance test, coordination, proprioception and response time using functional squat system and strength of flexor and extensor muscles of the involved and uninvolved leg using an isokinetic machine. Results There was no significant difference between Wii Fit and conventional group in terms of isokinetic knee strength at 12th week, and dynamic balance, and functional squat tests including coordination, proprioception and response time at first, 8th and 12th weeks of the rehabilitation. Conclusion Two different 12-week-physiotherapy programmes following ACL reconstruction have the same affect on muscle strength, dynamic balance and functional performance values in both groups. We considered that the practice of Wii Fit activities like conventional rehabilitation could also address physical therapy goals, which included improving visual–perceptual processing, coordination, proprioception and functional mobility. Level of evidence Randomized, controlled trials with adequate statistical power, Level I.

Purpose To evaluate muscle torque, lower extremity coordination, and knee laxity after ACL reconstruction comparing patients operated on with semitendinosus graft (ST) and patients with combined semitendinosus and gracilis (STGR) grafts. Methods Forty-six subjects who underwent ST ( n  = 23) or STGR harvest ( n  = 23) ACL reconstruction participated in this study. Quadriceps and hamstring torque were recorded using an isokinetic dynamometer. The anterior tibial translation was measured using the Kneelax 3 Arthrometer. The eccentric and concentric motor coordination was tested by multi-joint lower-limb tracking-trajectory test. All measurements were taken 12 months after surgery. Side-to-side differences were determined for all subjects. Results Side-to-side differences in extensor peak torque at 180°/s and 60°/s did not differ between semitendinosus (ST) and semitendinosus + gracilis (STGR) groups (n.s.). However, side-to-side differences in flexor peak torque were significantly higher at 60°/s for the STGR group than the ST group ( P  = 0.002). Side-to-side differences in eccentric and concentric parts of tracking-trajectory test and anterior tibial translation did not differ between the STGR and the ST groups (n.s.). Conclusion The outcomes of this study suggested that additional harvest of gracilis did not influence lower extremity motor control, quadriceps muscle torque, and anterior tibial translation; however, it affected knee flexion isokinetic torque negatively at low angular velocity. This finding could be important for functional activity or sports with high demands on hamstring muscle strength. It is recommended that gracilis muscle should be preserved as possible during ACL reconstruction. Level of evidence Prospective comparative study, Level II.

Purpose To evaluate the sonographic characteristics, functional aspects and life quality of a group of adolescent patients 2 years after having been diagnosed with Osgood–Schlatter disease and compare them with an age-matched healthy control group. Methods The study was conducted on eighteen Osgood–Schlatter patients with unilateral involvement and 14 age-matched healthy controls. The Flaviis classification and patellar tendon characteristics were observed using a GE Logiq 9 scanner. Broad and vertical jump tests were used for jumping performance. The coordination, proprioception, strength and endurance functions were assessed with the Functional Squat System. For the quality of life, the SF-36 questionnaire was used. The Wilcoxon test for the patients’ initial and second-year assessment and Mann–Whitney U test for the comparison between the patient and control groups were used. Results By the end of second year, 38.9 % of the patients had totally recovered. The patellar tendon lengthened, distal diameter and distal area of the tendon had lessened, and no significant difference was observed between patient and control groups (n.s). Improvements were detected for the bilateral broad jump test scores, the quality of life and coordination of the patients after 2 years ( p  < 0.05). The average power of endurance and the total work of strength were significantly higher in control group ( p  < 0.05). Conclusions According to the sonography results 2 years after diagnosis, nearly half of the patients had totally recovered. Coordination was the only parameter that improved over the 2-year period. The patient group strength and endurance function remained lower than the control group. Level of evidence III.

Purpose This study aimed to compare the short-term effects of kinesiotaping and extracorporeal shock wave therapy (ESWT) along with physiotherapy on pain, functionality, and grip strength in patients with newly diagnosed lateral epicondylitis undergoing rehabilitation. Methods Forty-five voluntary patients (mean age 48 years) were randomly assigned to three groups. Patients in all groups received physiotherapy consisting of a cold pack and transcutaneous electrical nerve stimulation five times per week for a total of 15 sessions and a home exercise programme including stretching and eccentric strength exercises. In the second group, patients received kinesiotaping 5 days a week for 3 weeks. In the third group, ESWT was applied three times for 3 weeks. Patients were assessed by visual analogue scale for pain intensity, pain-free grip strength using a hand dynamometer, Cyriax Resisted Muscle Test, and Patient-Rated Tennis Elbow Evaluation Scale. All measurements were collected at baseline and after treatment. Results There were no significant differences in the demographic characteristics of the patients in all groups at baseline. Intra-group analysis revealed that pain intensity decreased, whereas maximum grip strength and functionality increased in all groups at the end of the treatment ( p  < 0.05). Inter-group analysis revealed that the kinesiotaping group yielded better results in decreasing pain intensity than the other groups ( p  < 0.05). The kinesiotaping group ( p  < 0.001) and ESWT group ( p  = 0.002) yielded better results in improving functionality than the physiotherapy group. There were significant differences in recovering pain-free grip strength in the kinesiotaping group ( p  < 0.05). Conclusion Kinesiotaping was found to be effective for decreasing pain intensity, recovering grip strength, and improving functionality in patients with lateral epicondylitis undergoing rehabilitation. Level of evidence Therapeutic study, Level II.

The aim of this prospective, randomized clinical study was to compare the effectiveness of two physical therapy treatment approaches for impingement syndrome, either by joint and soft tissue mobilization techniques or by a self‐training program. Thirty patients (Group 1, n = 15; Group 2, n = 15) with the diagnosis of an outlet impingement syndrome of the shoulder were treated either by strengthening the depressors of the humeral head with a guided self‐training program (Group 1, age 49.5 ± 7.9 years), or by joint and soft tissue mobilization techniques (Group 2, age 48.1 ± 7.5 years). Group 1 was instructed with the active range of motion (ROM), stretching and strengthening exercise program including rotator cuff muscles, rhomboids, levator scapulae and serratus anterior with an elastic band at home at least seven times a week for 10–15 min and Group 2 received a prescription for 12 sessions of joint and soft tissue mobilization techniques, ice application, stretching and strengthening exercise programs and patient education in clinic for three times per week. All patients were tested with visual analog scale (VAS) for pain level, goniometric measurement for ROM and algometry for the pain threshold. Function was measured with a functional assessment questionnaire. The VAS (10 cm) used to measure pain with functional activities and the functional assessment questionnaire (Neer) were also measured 3 months after the initiation of treatment. Subjects in both groups experienced significant decreases in pain and increases in shoulder function, but there was significantly more improvement in the manual therapy group compared to the exercise group. For example, pain in the manual therapy group was reduced from a pre‐treatment mean (±SD) of 6.7 (±0.3) to a post‐treatment mean of 2.0 (±2.0). In contrast, pain in the exercise group was reduced from a pre‐treatment mean of 6.6 (±1.4) to a post‐treatment mean of 3.0 (±1.8). ROM at flexion, abduction and external rotation in the manual therapy group improved significantly while ROM in the exercise group did not. There were statistically differences among the groups in function ( P > 0.05). Group 2 showed significantly greater improvements in the Neer Questionnaire score and shoulder satisfaction score than Group 1. The patients treated with manual physical therapy applied by experienced physical therapists combined with supervised exercise in a brief clinical trial showed improvement of symptoms including increasing strength, decreasing pain and improving function earlier than with exercise program.

Subacromial impingement syndrome (SAIS) is a major contributing factor of shoulder pain; and treatment approaches (Kinesio® taping [KT], Exercise [EX], manual therapy [MT], and high-intensity laser therapy [HILT]) have been developed to treat the pain. The key objective of this study was to compare the effects of KT, MT, and HILT on the pain, the range of motion (ROM), and the functioning in patients with SAIS. Seventy patients with SAIS were randomly divided into four groups based on the treatment(s) each group received [EX ( n  = 15), KT + EX ( n  = 20), MT + KT + EX ( n  = 16), and MT + KT + HILT + EX ( n  = 19)]. All the patients were assessed before and at the end of the treatment (15th day). The main outcome assessments included the evaluation of severity of pain by visual analogue scale (VAS) and shoulder flexion, abduction, and external rotation ROM measurements by a universal goniometry. Shoulder pain and disability index (SPADI) was used to measure pain and disability associated with shoulder pathology. Statistically significant differences were found in the treatment results of all parameters in MT + KT + EX and HILT + MT + KT + EX groups ( p  < 0.05). When the means of ROM and SPADI results of three groups were compared, statistically significant differences were found between all the groups ( p  < 0.05). These differences were significant especially between the groups MT + KT + EX and KT + EX ( p  < 0.05) and HILT + MT + KT + EX and KT + EX ( p  < 0.05). HILT and MT were found to be more effective in minimizing pain and disability and increasing ROM in patients with SAIS. Further studies with follow-up periods are required to determine the advantages of these treatments conclusively.

BackgroundBalance and jumping mechanisms are important to prevent injuries in sports such as handball, which require immediately change of direction, jumping and landing strategy. Strong proximal stability is required for accurate jump performance and stability.ObjectiveTo investigate the relationship between gluteus medius strength and static, dynamic balance, horizontal and vertical jump performance.DesignProspective field trial study.SettingElite women handball players in Turkish Handball Super League.Patients (or Participants)Forty-two elite women handball players (Age range:15–40 years, Body Mass Index:22,1±2,2) from Turkish Handball Super League were included in this study.Interventions (or assessment of risk factors)The Lafayette Hand-Held Dynamometer was used to determine the strength of the gluteus medius. Single leg hop (SLH) test was used for horizontal jump and Lafayette Vertimetric device was used for vertical jump (VJ) evaluation. Y Balance Test (YBT) was used for the dynamic balance with direction of anterior, posteriomedial, posteriolateral and Standing Stork Test (SST) with eyes closed for the measurement of static balance.Main outcome measurementsGluteus medius strength with hand dynamometer compared with YBT, SST, VJ and SLH tests.ResultsA statistically significant relationship was found between anterior parameter of YBT and gluteus medius strength (r=0,665 P<0,001). Additionally, a statistically significant relationship was found between gluteus medius strength and VJ (r=0,479 p<0.05). There was no statistically significant relationship between gluteus medius and SST test, posteriomedial and posteriolateral parameters of dynamic balance and SLH test parameters (respectively, r=0,109; r=0,152; r=-0,144; r=-0,182, p>0.05).ConclusionsAccording to this study, a significant relationship was found between the strength of the gluteus medius and anterior parameter of the dynamic balance and VJ. It is recommended to support gluteus medius muscle strength for the quality of vertical jump and dynamic balance, which is necessary for the prevention of injuries.

The scapula plays a critical role in supporting shoulder function. Considering the closed anatomical relationship between the scapula and the thoracic cage, the presence of postural disturbances could be linked to alterations in the scapular position and orientation in adolescent idiopathic scoliosis (AIS). However, currently there is a lack of descriptive research and detailed assessment of scapular kinematics in AIS. The aim of this study was to investigate the three-dimensional scapular kinematics in AIS. Nineteen AIS patients and fourteen healthy controls participated in this study. Bilateral shoulder kinematics were measured with an electromagnetic tracking device during shoulder elevation in the sagittal, scapular, and frontal planes. Data for the scapular orientation were analyzed in the resting position and at 30°, 60°, 90°, and 120° of humerothoracic elevation. Scapular behavior was different in participants with AIS, compared to healthy controls, with different patterns observed on convex and concave sides. While examining all three planes of elevation, the scapula was more internally and anteriorly tilted on the convex side, while the scapula was more externally, downwardly rotated, and posteriorly tilted on the concave side in participants with AIS. Furthermore, there was a decreased peak humerothoracic elevation and altered scapular posterior tilt in participants with AIS in the resting position. These findings increase our knowledge and understanding of scapular alterations and the reported scapular alterations can be considered as adaptive compensation strategies in AIS.