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OBJECTIVE: Low back pain (LBP) is relatively common among the musician population. Few studies have looked at the usefulness of a core stability exercise program in musicians suffering from LBP. The aim of this study was to investigate the effectiveness of a core stability exercise program on pain and improvement of function in musicians with LBP. METHODS: A total of 41 university-level instrumental musicians with nonspecific LBP who played piano, violin, or cello were randomly allocated to one of two groups in a randomized controlled trial. One person from the control group was lost to follow-up. Thus, 40 participants (23 females and 17 males) completed the study. The intervention group received education and a 12-week core stability exercise program. The control group only received an educational brochure. A visual analogue scale (VAS) and the Oswestry Disability Index (ODI) were used to determine the severity of pain and functional status, respectively. Data were collected by an independent, blinded evaluator at baseline and at 12 and 24 weeks after baseline. RESULTS: The intervention group showed a significant improvement in pain severity on the VAS and functional status on the ODI during all times of follow up, whereas the scores of pain and function worsened in the control group at 24 weeks. Between-group analysis showed significant difference in pain intensity at both weeks 12 and 24 of follow-up. However, for functional status, the difference was only significant after 12 weeks. CONCLUSIONS: A structured core stability exercise program supplemented with an educational brochure was effective to manage LBP in musicians.

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BACKGROUND: There is limited evidence regarding the efficacy of different treatment options in patients with carpal tunnel syndrome (CTS). This study aimed at assessing the effectiveness of nerve and tendon gliding exercises in the treatment of patients with mild CTS. METHODS: The current prospective, randomized trial with pretest-posttest design was conducted on 80 patients with mild CTS randomly assigned to 2 groups. The treatment group was instructed to perform gliding exercises in addition to the wrist splint use. The control group only used the wrist splint. All the patients were instructed to use the splint at night and during the day if required. Patients were evaluated in terms of clinical parameters (ie, grip and pinch strength). The severity of symptoms and functional status was also determined using the Boston Carpal Tunnel Syndrome Questionnaire. The subjects were followed up for 6 weeks. RESULTS: There were no significant differences in all parameters between groups. The pretest-posttest analysis showed a statistically significant improvement in subjective and objective parameters in the treatment group. However, in the control group, only a significant improvement was observed in grip strength. Wrist splint use led to a significant change in the severity of symptoms only over the second week. CONCLUSIONS: Both gliding exercise and wrist splint groups showed some improvement in the severity of symptoms and functional status scores. However, the gliding exercises did not offer additional benefit compared with wrist splint alone.

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Background: Carpal tunnel syndrome (CTS) or median nerve neuropathy is among the causes of numbness, paresthesia, and sensory and motor dysfunction in the affected hand. The objective of this study was to compare open and endoscopic carpal tunnel release (ECTR) methods. Methods: A multicenter, historical cohort study was performed on 47 hands in 46 patients with a clinical diagnosis of CTS and a failed trial of conservative treatment. Samples were divided into two groups consisting of 23 patients receiving open carpal tunnel release (OCTR) and ECTR. Outcome measurements had been carried out six weeks after the operation and included handgrip strength, post-op pain, and missing job days. Results: Patients in both groups were comparable regarding baseline characteristics such as age, gender, and handgrip strength. Both methods significantly improved handgrip strength. No significant difference was detected between the two groups concerning handgrip strength improvement (P=0.700) and sick leave days (P=0.564). Open carpal tunnel release resulted in more significant post-op pain (mean 5.91±1.24 compared to 2.43±0.73 after endoscopic release), which was significant (P=0.000). No complications were reported with any technique. Conclusion: This study revealed that apart from post-op pain, other investigated endpoints were similar in both groups. Although the small sample size has limited our ability to draw a conclusive statement, these data suggest that there is no need to utilize the endoscopic technique for the optimum result, especially when this method requires more advanced equipment and could increase surgery costs. Therefore, both approaches can result in good clinical outcomes.

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Introduction. The aim of the present study was to compare static and dynamic balance among professional athletes in football and basketball. Methods. In this cross-sectional study, 47 professional, male football and basketball players from Pro League in Iran participated. They were divided into 3 groups. Group 1 included 16 participants with history of grade 1 or 2 single ankle sprain within the past 6 months. Group 2 included 17 participants with recurrent ankle sprain. Group 3 included 14 participants without history of ankle sprain. Static and dynamic balance were measured by the Balance Error Scoring System (BESS) and modified Star Excursion Balance Test (SEBT), respectively. Results. For the single-leg stance on a firm surface, group 2 scored errors with a high mean value of 3.94 compared with the other 2 groups, and the difference was statistically significant (P = .03). Significant differences in BESS scores are observed on both surfaces across the tandem limb between groups 2 and 3. Conclusion. The measures from the SEBTs may not reflect the balance performance especially in well-trained athletes who have a better balance when performing sport-related skills. However, BESS includes static postures, and it may reflect postural deficits better than dynamic tests in the more experienced athlete. Level of Evidence: Diagnostic, Level IV.

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INTRODUCTION: The Cumberland Ankle Instability Tool (CAIT) is a valid instrument for determining the presence and severity of functional ankle instability. This questionnaire was recently cross-culturally adapted into Persian; however, the reliability of the Persian version has not been examined in athletes. CAIT has also been used with various independently-selected cut-off scores to determine instability. OBJECTIVE: The present study was conducted to evaluate the psychometric properties of the Persian version of CAIT and to determine its optimal cut-off score in athletic populations. METHOD: One-hundred and sixteen athletes (volleyball, basketball and track and field players) over 18 years old both with and without ankle instability completed the Persian version of the CAIT. The internal consistency, test-retest reliability and discriminative ability of the tool were assessed. A receiver operating characteristic (ROC) curve was drawn to confirm the cut-off point of the Persian version of CAIT using the Youden index. RESULTS: The average CAIT score was 25.14±4.98 for the right and 25.76±4.94 for the left ankle. The Persian version of CAIT had a good internal consistency (Cronbach's α of 0.78 for the right ankle and 0.79 for the left ankle) and substantial reliability (ICC2, 1 = 0.88; 95% CI: 0.86 - 0.90) in athletes. No ceiling or floor effects were observed. The optimal cut-off score for discriminating between athletes with and without FAI was 24. CONCLUSION: The Persian version of CAIT was shown to be a reliable tool for assessing functional ankle instability among Iranian athletes.

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INTRODUCTION: Analysis of in-shoe pressure distribution during sport-specific movements may provide a clue to improve shoe design and prevent injuries. This study compared the mean and the peak pressures over the whole foot and ten separate areas of the foot, wearing different shoes during specific movements. METHODS: Nine male adult recreational futsal players performed three trials of three sport-specific movements (shuffle, sprint and penalty kick), while they were wearing three brands of futsal shoes (Adidas, Lotto and Tiger). Plantar pressures on dominant feet were collected using the F-SCAN system. Peak and mean pressures for whole foot and each separate area were extracted. For statistical analysis, the mean differences in outcome variables between different shoes and movements were estimated using random-effects regression model using STATA ver.10. RESULTS: In the average calculation of the three movements, the peak pressure on the whole foot in Adidas shoe was less than Lotto [8.8% (CI95%: 4.1-13.6%)] and Tiger shoes [11.8% (CI95%:7-16.7%)], (P<0.001). Also, the recorded peak pressure on the whole foot in penalty kick was 61.1% (CI95%: 56.3-65.9%) and 57.6% (CI95%: 52.8-62.3%) less than Shuffle and Sprint tests, respectively (P<0.001). CONCLUSION: Areas with the highest peak pressure during all 3 movements were not different between all shoes. This area was medial forefoot in cases of shuffle and sprint movements and medial heel in case of penalty kick.

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Patellofemoral pain (PFP) is a very common problem in athletes who participate in jumping, cutting and pivoting sports. Several risk factors may play a part in the pathogenesis of PFP. Overuse, trauma and intrinsic risk factors are particularly important among athletes. Physical examination has a key role in PFP diagnosis. Furthermore, common risk factors should be investigated, such as hip muscle dysfunction, poor core muscle endurance, muscular tightness, excessive foot pronation and patellar malalignment. Imaging is seldom needed in special cases. Many possible interventions are recommended for PFP management. Due to the multifactorial nature of PFP, the clinical approach should be individualized, and the contribution of different factors should be considered and managed accordingly. In most cases, activity modification and rehabilitation should be tried before any surgical interventions.

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BACKGROUND: Lateral ankle sprains (LAS) are among the most common sports- related injuries and the reinjury rate is very high. OBJECTIVES: This study aimed to evaluate the prevalence of some intrinsic risk factors among professional football and basketball players with or without history of acute or recurrent ankle sprain. PATIENTS AND METHODS: One hundred and six professional football and basketball players who were referred for pre-participation examinations were recruited in this study. Prepared checklist was completed for each participant. Athletes were asked for any history of previous ankle sprain and the severity (based of self-description of signs and symptoms by the athlete), level and number of injuries in the last two years. All players were assessed for measures of foot posture index- 6, foot length and width, Beighton generalized joint laxity score, anterior drawer and talar tilt tests, star excursion and single leg balance tests and goniometric assessment of ankle plantarflexion, ankle dorsiflexion and first metatarsophalangeal dorsiflexion. RESULTS: Forty eight basketball players (45.3%) and 58 football players (54.7%) with mean (SD) age of 19.8 (4.5) years participated. About 58.5% and 14.2% of athletes had a history of ankle sprain and recurrent sprain in at least one extremity, respectively. Sprains were more prevalent in basketball players and in dominant leg. There was no significant difference in assessed risk factors between athletes with and without history of ankle sprain, except for positive single leg balance test which was more prevalent in athletes with history of ankle sprain and also for positive talar tilt test and decreased ankle plantarflexion range of motion in acute and recurrent injury of left ankle. CONCLUSIONS: Some intrinsic risk factors including lateral ankle ligaments laxity, balance and ankle plantarflexion seem to be related to acute or recurrent LAS in athletes. Further research is needed to reveal the role of different arthrokinematics following lateral ankle sprain.

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OBJECTIVE: The aim of this study is to assess different parameters of cardiopulmonary exercise testing that can predict the development of myocardial ischaemia in patients with suspected coronary artery disease (CAD) and to identify the parameters which have more correlation with myocardial ischaemia. STUDY DESIGN: Cross-sectional study. METHODS: In this study, a total of 31 men (mean age 57.23±11.09 years) with suggestive symptoms of CAD underwent an exercise stress test with breath-by-breath gas exchange analysis, followed by coronary angiography as the gold standard for diagnosing CAD. RESULTS: The ventilation versus CO2 output (VE/VCO2) peak was significantly different between patients with negative and positive angiography results. Receiver operator characteristic analysis showed an area under the curve of 0.73 for VE/VCO2 peak with diagnostic threshold equal to 35 (95% CI 0.54 to 0.9; p=0.05). Exercise stress testing had sensitivity and specificity of 75% and 40%, respectively. CONCLUSIONS: A change in ventilatory efficiency assessed using the VE/VCO2 peak has the predictive ability to identify exercise-induced myocardial ischaemia. The present study has provided additional evidence of the potential clinical value of cardiopulmonary exercise testing in the diagnosis of CAD.

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Flatfoot constitutes the major cause of clinic visits for pediatric foot problems. The reported prevalence of flatfoot varies widely due to numerous factors. It can be divided into flexible and rigid flatfoot. Diagnosis and management of pediatric flatfoot has long been the matter of controversy. Common assessment tools include visual inspection, anthropometric values, footprint parameters and radiographic evaluation. Most flexible flatfeet are physiologic, asymptomatic, and require no treatment. Otherwise, the physician should treat symptomatic flexible flatfeet. Initial treatment options include activity modification, proper shoe and orthoses, exercises and medication. Furthermore, comorbidities such as obesity and ligamenous laxity should be identified and managed, if applicable. When all nonsurgical treatment options faile, surgery can be considered. Our purpose in this article is to present a clinical algorithmic approach to pediatric flatfoot.