Introduction to the Physiotherapy Assessment of Musculoskeletal Diseases

Vasiliki Sakellari

Traditional ?ready made recipes? in the Physiotherapeutic plan tend to become easily adopted, especially in the area of Musculoskeletal Diseases. These are obstacles to the application of the assessment procedure and lead to insufficient, unilateral approaches, negligence and errors, at the expense of the patient. It is essential that Physiotherapy assessment takes into consideration the international guidelines, models and terminology implemented for assessment, rehabilitation and research. Evidence Based Practice is a means by which clinical decisions are utilising research outcomes. Other models of extracting and managing assessment elements are the clinical reasoning methods, the disability models, the ergonomic, multifactorial and holistic approaches. At the same time, the existing techniques of collection, recording, and evaluation, regarding the development of the musculoskeletal disorder, should be taken under consideration as they differentiate and reset the priorities and the approach of the Physiotherapeutic interventions. Similarly, the techniques of analysis of the disorder effect on the functional ability, the postural control and safety. Moreover, we need outcome measures that are conceptually distinct, based on modern models and are derived from the application of modern methods of measurement. The interpretation and the application of the above require an informed clinical Physiotherapist, who is open to the numeral choices available for Physiotherapy evaluation. He/she should also have the necessary clinical judgement and critical mind in order to make the best choices and intervention for the interest and the needs of the patient. The systematic clinical observation, the organised re-assessment as well as the evaluation and followup of the rehabilitation outcome, forms the basis for exploiting the best available resources, time, and financial, social, and individual reserves.


The chronic Effects of Exercise on Rate-Pressure Product in Healthy Subjects. A Review of Experimental Studies

Athanasios Mandilaris, Dimitrios Soukos

The objective of this review is to explore the evidence for the effectiveness of exercise on myocardial oxygen consumption in healthy subjects. Myocardial oxygen consumption can be very well estimated by measurement of the double product or rate-pressure product (RPP). The method of choice included the review of Pubmed, Science Direct, Medscape and Physiotherapy Evidence Database (PEDro) from 1980 to 2009. Studies that were considered eligible for further evaluation included only humans, healthy or mildly hypertensive, athletes or non athletes, men or women of every age. In addition, in eligible studies baseline values of RPP and values of subsequent measurements of RPP, during exercise or at the end of it, had to be reported. Twenty (20) studies fulfilled the inclusion criteria for being reviewed. Two reviewers independently evaluated the methodological quality of the included studies using the validated Pedro scale, and subsequently analyzed the findings concerning the change of the value of RPP after the end of exercise programmes with specific duration. Ten (10) studies of moderate quality and four (4) studies of high quality presented statistically significant decreases of RPP, thus improvement on myocardial oxygen consumption. Only four (4) studies of moderate quality and two (2) studies of high quality presented either increase of RPP or no change of it. Better improvement was presented after aerobic exercise with 2 to16 weeks duration. Future research must replicate the results of the current review in an explicit, rigorous and systematic way. Also, it will be useful if future research explore the influence of intensity and frequency of exercise to any change in RPP, not only in healthy subjects but mostly in cardiovascular patients.


Are Eccentric Strength Asymmetries Connected with Increased Risk for Muscle Injuries in the Thigh Muscles of Professional Soccer Players?

Konstantinos Fousekis, Elias Τsepis, George Βagenas

Introduction. The purpose of this prospective study was to statistically evaluate the relation between isokinetic strength asymmetries and risk of non-contact muscle strains in soccer.
Methods. One hundred professional soccer players (age 23.4±4.8 years, height 178±6.7 cm, body mass 74.2±7.6 kg) were tested for isokinetic concentric and eccentric strength during the extension and flexion of the knee and ankle joint. Isokinetic testing was carried-out concentrically at 60o /sec. 180o/sec & 300o/sec and eccentrically at 60o/sec & 180o/sec for the knee joint. The ankle joint was tested at 60o/sec for both the concentric and eccentric mode of action. Each players? non-contact muscle strains resulting in missing at least one practise session or game were recorded during one competition season.
Results. Analysis of the composite muscle strength asymmetries showed a significantly high relative risk of injury for players with eccentric strength asymmetries greater than 15% (RR=5.10; 95% CI: 1.29-20.17). Τhe majority of muscle strains involved 16% the hamstrings and 7% the quadriceps. The relative risk for strains in knee extensors strains was significantly increased in players with eccentric muscle asymmetries >15% (RR=1.93, 95% CI: 0.81- 4.56) and approximated statistical significance in the case of knee flexors strains (RR=1.82, 95% CI: 0.86-3.87). No significant relationship was found between concentric muscle strength asymmetries and muscle strains.
Conclusions. Players with eccentric isokinetic strength asymmetries higher than 15% were more prone to injure their lower extremities. Preseason eccentric isokinetic assessment is required for the identification of soccer players being at high risk of thigh muscle strain and for the prevention of potential muscle strains via individualized exercise protocols.


Mulligan?s ?SNAG? Mobilization Techniques: A Clinical Approach for non-specific Low Back Pain

Evdokia Billis

Mulligan?s mobilizations techniques rest within the Manual Therapy field and constitute a remarkable, functional, safe and practical therapeutic method for treating non-specific low back pain. The most important and popular mobilisation technique of the lumbar spine is the SNAG, where SNAG is the acronym for «Sustained Natural Apophyseal Glides». Its scope is in the assessment and location of ?symptomatic? spinal segments, the restoration of the physiological and smooth spinal motion, as well as the reduction or alleviation of patients? pain and associated symptoms. The SNAG techniques are considered pioneer gliding mobilisations because they combine the application of the passive mobilisation (glide) in the lumbar spinal segments with concurrent active movement from the patient. The aim of the present review is to analytically describe the aims, characteristics, effectiveness, clinical indications and contraindications of these techniques in order to fully understand their proper use. In addition, emphasis will be given to the up to date mechanisms of action of these techniques based on the most current literature search, as well as propose some future research directions relating to these techniques.