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PURPOSE: The objective of this randomized controlled trial was to investigate the impact of manual therapy (friction massage) and pelvic floor muscle (PFM) training on erectile dysfunction (ED), pelvic floor muscle thickness, and blood flow in the penile arteries and veins in men who have undergone prostatic adenectomy (PA). MATERIALS AND METHODS: This study employed a randomized, double-blinded, controlled trial design. Forty patients participated and were divided into two groups: intervention and control (n=20 per group). The intervention group received 10 sessions of pelvic floor muscle training and manual therapy, while the control group solely underwent pelvic floor muscle training. The recovery rate was measured using the International Index of Erectile Function 15 (IIEF-15) questionnaire and Erection Hardness Score (EHS). Sonographic factors were assessed using simple and Doppler ultrasound. RESULTS: The intervention group exhibited significantly higher erectile function scores (F(1,37)=158.04, P<0.001, η2P=0.810) and a higher average total (IIEF-15) score (20.52) (F(1,37)=136.76, P<0.001, η2P=0.787) compared to the control group in the post-test assessment. Comparison between the two groups revealed an increase in ultrasonic parameters such as the thickness of the ischiocavernosus and bulbospongiosus muscles, maximum systolic velocity, and minimum diastolic velocity of the cavernosal artery in the intervention group. However, the maximum blood flow velocity in the posterior vein decreased. CONCLUSION: PFM training and friction massage play a significant role in managing ED following PA, positioning them as the primary treatment approach for men experiencing ED post-prostatectomy.

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Fatigue and balance disorders are common challenges experienced by Multiple Sclerosis (MS) individuals. The purpose of this study was to compare the concurrent effects of cerebellar and prefrontal anodal trans-cranial direct current stimulation (a-tDCS) with postural training on balance and fatigue in MS patients. 51 patients were evaluated to randomly allocation to a-tDCS over cerebellum, a-tDCS over dorsolateral prefrontal cortex (DLPFC) and sham group. 46 individuals (n = 16 in experimental groups and n = 14 in control group) followed treatment. All the groups received 10 sessions of postural training. The experimental groups underwent a-tDCS with a current of 1.5 mA for a period of 20 min. While, in the sham group, tDCS was only activated for 30 s and then turned off. The treatment included 10 sessions for four weeks. Before and after intervention, fatigue and balance were assessed using Fatigue Severity Scale (FSS), Timed Up and Go (TUG) test and Berg Balance Score (BBS), respectively. There was found a significant reduction in fatigue in the group receiving a-tDCS over the prefrontal cortex with postural training compared to the other two groups (P < 0.001). Additionally, a significant improvement was found in balance in the group receiving a-tDCS over the cerebellum concurrent with postural training in comparison to the other two groups (P < 0.001). Besides, in the sham group, the significant results were not reported in the variables. (P > 0.001). The results demonstrated that a-tDCS enhances the effects of postural training on balance and fatigue in MS patients.

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OBJECTIVE: To explore effect of cupping and Kinesio-taping techniques on clinical and ultrasound outcomes of carpal tunnel syndrome (CTS) during pregnancy. METHODS: Thirty pregnant women suffering from CTS were randomly assigned into Kinesio-taping (n = 15) and cupping (n = 15) groups. In Kinesio-taping group, individuals underwent Kinesio-taping for three days, one day with no treatment, and three days with Kinesio-taping, continuing this procedure for four weeks. In cupping group, cupping was moved for 5 min with pressure of 50 mm-Hg on the carpal tunnel area. This procedure continued longitudinally in forearm area for 2 min. The therapeutic intervention of cupping group continued with eight sessions, two days a week for 4 weeks. Ultrasound outcomes including median nerve cross-sectional area through ultrasonography, and clinical outcomes including pain through visual analog scale and severity of symptoms and functional status through Boston questionnaire were measured in both groups before and after therapeutic program. RESULTS: In both groups, a significant reduction was observed in all variables after treatment compared to pre-treatment (P < 0.001). In inter-group comparison, a significant improvement was found in outcomes of Boston questionnaire and ultrasound results about median nerve cross-sectional area at pisiform and hook of hamate in cupping group compared to Kinesio-taping at end of four weeks (P < 0.001). CONCLUSION: Both cupping and Kinesio-taping improved clinical and ultrasound outcomes of CTS. However, efficacy of cupping compared to Kinesio-taping was better in improvement of median nerve cross-sectional area at hamate hook and pisiform levels, symptoms severity scale, and functional status scale, which makes the results clinically more applicable.

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Background: The long-term effects of aerobic exercise on the cardiorespiratory system have been studied extensively. This study aimed to evaluate the effects of aerobic exercise with and without external loads on blood glucose, cardiovascular, respiratory, and body temperature indices in patients with type II diabetes. Methods: The present randomized control trial recruited participants from the Diabetes Center of Hamadan University through advertisement. Thirty individuals were selected and divided into an aerobic exercise group and a weighted vest group via block randomization. The intervention protocol included aerobic exercise on the treadmill (0 slopes) with an intensity of 50% to 70% of the maximum heart rate. The exercise program for the weighted vest group was identical to that of the aerobic group, except that the subjects wore a weighted vest. Results: The mean age of the study population was 46.77±5.11 years in the aerobic group and 48±5.95 years in the weighted vest group. After the intervention, blood glucose in the aerobic group (167.07±72.48 mg/dL; P<0.001) and the weighted vest group (167.75±61.53 mg/dL; P<0.001) was decreased. Additionally, resting heart rate (aerobic: 96.83±11.86 bpm and vest: 94.92±13.65 bpm) and body temperature (aerobic: 36.20±0.83 °C and vest: 35.48±0.46 °C) were increased (P<0.001). Decreased systolic (aerobic: 117.92±19.27 mmHg and vest: 120.91±12.04 mmHg) and diastolic (aerobic: 77.38±7.54 mmHg and vest: 82.5±11.32 mmHg) blood pressure and increased respiration rate (aerobic: 23.07±5.45 breath/min and vest: 22±3.19 breath/min) were seen in both groups but were not statistically significant. Conclusion: One aerobic exercise session with and without external loads reduced blood glucose levels and systolic and diastolic blood pressure in our 2 study groups.

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This systematic review aimed to evaluate custom-made 3D printed insoles for people with flatfeet. PubMed, Embase, ISI web of knowledge, ProQuest, Scopus, and Cochrane databases, were searched from inception until January 2022. The quality assessment of included studies was performed through the Downs and Black checklist. A narrative analysis was performed since a meta-analysis could not be conducted. Ten studies including 225 subjects with flexible flatfeet were chosen for final evaluation. Although the evidence from selected literature was generally weak, using insoles with 3D printing technology may positively affect pain (comfort score) and foot function, with no significant change in vertical loading rate during walking or running. There were discrepancies among studies for plantar pressures, center of pressure trajectories, 3D ankle joint kinematics and kinetics of gait while wearing these insoles. Dose-response effects of medial posting on 3D printed insoles suggested beneficial effects on lower limb gait biomechanics in people with flatfeet. There was insufficient evidence to conclude the comparison between 3D printed insoles and other types of insoles. In conclusion, using a 3D printed insole may improve comfort score and foot function in people with flatfeet.

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Objectives: This study aimed to investigate the effect of Tecar therapy on neuropathy symptoms and tibial nerve conduction velocity in individuals with diabetes. Patients and methods: The single-blind, randomized, sham-controlled clinical trial was conducted between January 2019 and October 2019. Twenty-four type 2 diabetics (8 males, 16 females; mean age: 60.4±8.9 years; range, 40 to 78 years) with peripheral neuropathy were randomly allocated to control (n=12) and study (n=12) groups. The study group received the capacitive Tecar therapy with 10 to 30% intensity and infrared radiation in 10 sessions. The controls received the same protocol with zero intensity. The neuropathy symptoms and nerve conduction velocity were evaluated at baseline, after 10 sessions, and six weeks after the end of sessions. Results: There were no significant differences in variables (p>0.05). In this way, the homogeneity of the data variables was confirmed. Moreover, the results of two-way mixed analysis of variance showed that improvement of neuropathy symptoms in the study group was significantly more than controls in all stages (p<0.001). After 10 sessions, the results of post hoc analysis showed that the neuropathy symptoms and tibial nerve conduction velocity were significantly improved in both groups (p<0.05). However, there was no change in these outcomes after six weeks in the control group (p>0.05). Conclusion: Tecar therapy could improve neuropathy symptoms and tibial nerve conduction velocity in diabetic individuals with peripheral neuropathy. Therefore, the use of this method to control the symptoms of diabetic patients can be recommended.

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Objectives: This study aimed to compare the effect of flexi-bar and stabilization exercises on static and dynamic postural control in patients with chronic nonspecific low back pain. Patients and methods: In this randomized controlled study conducted between November 2019 and March 2020, 38 patients (19 males, 19 females; mean age: 33.8±6.2 years; range, 20 to 45 years) were randomly assigned into flexi-bar (n=19) and stabilization (n=19) groups. Both groups received general physiotherapy for three sessions per week, a total of 10 sessions. Besides, the flexi-bar group received flexi-bar exercises, and the stabilization group received stabilization exercises. Postural sway was assessed with a force platform in three difficult conditions, including open eye, close eye, and one-leg standing and dynamic posture with the modified Star Excursion Balance Test. Results: After the intervention, both groups showed a significant improvement in static and dynamic postural control (p<0.05). However, no significant differences were found between groups after treatment, while only the phase-plane portrait of opened eyes condition was significantly improved (p=0.03), in the flexi-bar group compared to the stabilization group. Conclusion: Both flexi-bar and stabilization exercises effectively improved static and dynamic postural control, but none of the exercises was superior to the other. Flexi-bar is recommended as an effective tool in low back pain rehabilitation.

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Background: Peripheral sensory and motor nerves are often affected in people with diabetes mellitus (DM), and balance problems are widespread. Diabetic peripheral neuropathy is common. This study investigated the impact of exercise treatment on balance parameters in diabetic peripheral neuropathy patients. Method: Electronic databases, such as PubMed, Web of Science, and Science Direct, were used to perform a search of accessible papers. The search strategy was (exercise therapy OR physical activity) AND (balance OR equilibrium OR postural control OR fall OR fall risk OR static balance OR dynamic balance OR functional balance) AND diabetic peripheral neuropathy. The Physiotherapy Evidence Database (PEDro) scale was used to rate the research in this review for its quality and reliability. Scores ranged from 5 to 9 on the PEDro scale. Result: According to databases, about 9,103 articles were found in August 2021 from March 1984 to February 2020. From 9103 articles, 3872 were deleted for different reasons, including duplicate, non-randomized controlled trial (RCT) articles and after reviewing the title and abstract. About 5,231 articles were found in free full text. In the end, 12 submissions were approved. These studies investigated the effects of exercise treatment on static, dynamic, and functional balance parameters in diabetic peripheral neuropathy patients. Conclusions: This study showed the positive effects of balance and strengthening exercise on static balance indices in patients with diabetic peripheral neuropathy. Supplementary Information: The online version contains supplementary material available at 10.1007/s40200-022-01077-1.

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Forward Head Posture (FHP) results in spine malalignment, muscle imbalance and cervical proprioception sensory input impairment. Subjective description of FHP is interpreted differently by clinicians and therefore the FHP is classified as slight, moderate and sever. This study aimed to evaluate balance disorder in individuals with severe forward head posture (FHP). Twenty individuals with severe FHP and 20 controls were enrolled. Dynamic postural stability was assessed in all participants using the Biodex Balance System (BBS) in semi dynamic position with eye open/eye closed conditions. Based on the findings, dynamic postural stability in the sagittal plane was different between the groups (P<0.05). It can be concluded that impairment of dynamic postural stability occurs in individuals with severe FHP. The findings suggest that clinicians take into account the importance of dynamic postural stability assessment in FHP subjects and consider the application of intervention programs for improvement of the dynamic balance.

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Purpose: Patients with diabetic neuropathy usually suffer from impaired balance, pain, and decreased sole-foot sensation. The present research was designed to appraise the relic of whole-body vibration (WBV) on balance, pain, and sole-foot sensation in diabetic neuropathy patients. Methods: Present study was a single-blind randomized controlled clinical trial. Thirty-four patients with type 2 diabetic neuropathy were randomly divided into intervention groups (n=17) and control (n=17). The therapeutic program in the intervention group included standing on the platform of the WBV device, and in the control group included using the device in off mode. Dynamic balance (including overall, anterior-posterior, and medial-lateral stability indices) was measured using Biodex device, functional balance with timed up and go (TUG) test, pain using the visual analog scale (VAS), and sole-foot sensation of both feet with a monofilament. The outcomes were measured in both groups before and after the interventions. Results: Sixteen people in each group were analyzed. Intra-group comparison showed a significant improvement in the mean pain (P = 0.000), functional balance (P = 0.011), right and left sole-foot sensation (P = 0.001), and overall (P = 0.000), anterior-posterior (P = 0.000) and medial-lateral (P = 0.000) stability indices for the intervention group in post-intervention compared to pre-intervention. However, changes in the control group were not statistically significant. Results of inter-group comparison indicated a significant improvement in all parameters in the intervention group, except for functional balance. Conclusion: WBV can be effective in reducing pain and improving the sole-foot sensation and dynamic balance.

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Objective: Forward head posture (FHP) is a common abnormal posture in neck disorders. FHP causes an alteration of the strength in the cervical muscles. Since both muscle quantity and quality impress the muscle strength, this study aimed to compare the echo intensity of cervical muscles (index of muscle quality) between women with and without FHP.Method: Echo intensity of cervical muscles was measured by Adobe Photoshop software and compared between two groups.Results: The findings of the current study indicate the insignificant difference between two groups regarding the echo intensity of cervical muscles.Conclusion: Evaluation of echo intensity of cervical muscles may expand knowledge about the muscle quality and function.

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An acceptable reliability is needed for each scale and a valid decision-making process. Ultrasonography is a simple, cost-effective, and accessible tool compared to magnetic resonance imaging (MRI) to assess echo intensity (EI) as a biomarker of muscle function in neck musculoskeletal problems. However, no evidence is available regarding the reliability of neck muscle echogenicity according to rehabilitative ultrasonography in clinical studies on forward head posture (FHP). We determined the reliability of neck muscles EI in individuals with and without FHP. Transverse images of deep neck flexors (Longus Coli) and suboccipital (Rectus capitis posterior minor) muscles were acquired from 20 individuals with FHP and 20 controls in one session. The intraclass correlation coefficient (ICC), minimum detectable change (MDC), and standard error of measurement (SEM) for EI were measured in this study. The ICC, SEM, and MDC ranges were 0.50 - 0.51, 2.73 - 3.41, and 7.56 - 9.46 for the Longus colli muscle and 0.48 - 0.49, 3.29 - 4.98, and 9.13 - 13.81 for the rectus capitis posterior minor (RCPm) muscle, respectively. Based on the present findings, EI showed acceptable reliability; therefore, it can be used for assessment of neck muscle morphology.

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PURPOSE: Diabetic peripheral neuropathy (DPN) leads to decreased sole sensation and balance disorder, all of which increase the risk of falls and socioeconomic costs. Since the physiotherapists do not use the same manner to lessen the complications of this problem. Therefore, this review study was directed to appraise physiotherapy intervention efficiencies in diminishing DPN's symptoms and complications. METHOD: A database search of Pubmed, Elsevier, Google Scholar, and Embase was performed to determine DPN's published documents. Finally, studies of DPN and treatments available in this field, particularly physiotherapy that included electrotherapy, exercise therapy, and other therapies, were identified. RESULT: According to a database search on August 1, 2019, from 1989 to 2019, in the last 30 years, about 968 articles were found, 345 of which were free full text available, and finally, 19 articles were approved. These articles examined the effects of physiotherapy interventions, including exercise therapy, electrotherapy, and other treatment techniques on DPN patients. CONCLUSIONS: The results showed that most diabetic peripheral neuropathy patients suffer from muscle weakness, pain, loss of balance, and lower limb dysfunction. As a result, their daily activity and Life satisfaction are gradually impaired. Exercise therapy, electrotherapy, and other physiotherapy methods have been used to reduce the mentioned cases. Among these interventions, exercise therapy has been the most effective. Although there was little evidence of aerobic exercise in these patients, further studies should be done on other therapies' effects.

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OBJECTIVES: The Flexi-Bar and Bodyblade are oscillatory tools used in rehabilitation centers worldwide to enhance muscle activity. Because of a lack of reports on the Flexi-Bar, this study focused on erector spinae (ES) muscle activation under different conditions. METHODS: Twelve university students (age 21 ± 2.5 years old) were recruited in this study and were tested while using a loaded Flexi-Bar for 10 seconds. Comparison between muscle activation on the right and left sides in the cervical, thoracic, and lumbar regions was measured by electromyography during two-leg and one-leg (left and right) standing. RESULTS: The results showed that during oscillation using the right hand, the right cervical muscles showed significantly higher activation levels than the left cervical muscles, while the thoracic and lumbar regions showed significantly higher muscle activities on the left side. CONCLUSION: The current study showed that the Flexi-Bar might be used for muscle activation and reeducation, as well as for specific exercise therapy in spinal muscle imbalance.

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BACKGROUND AND PURPOSE: Cupping therapy has been used widely as a safe and common method to tackle soft tissue lesions in most Asian countries, Central Europe, and parts of the United States. In this study, cupping therapy has been used for the treatment of carpal tunnel syndrome (CTS), which is the most common entrapment neuropathy. The aim of this study was to investigate the effect of cupping therapy on the clinical findings of patients with CTS. METHODS: This is a randomized clinical trial. For this research, a total of 56 hands with CTS were studied, aged 18-60 years, and of both genders. The participants were divided into two groups: test and control, regardless of the severity of their CTS. In the control group, 28 were treated with routine physiotherapy (transcutaneous electrical nerve stimulation and ultrasound), and in the test group, the other 28 were treated with routine physiotherapy with cupping therapy. The variables used to determine the effect of cupping were symptom severity scale, functional status scale, distal sensory latency, and distal motor latency. The severity of symptoms and functional status of patients was evaluated with the help of the Boston questionnaire, and the distal latency was evaluated through electromyography. RESULTS: The results of study demonstrated a significant improvement in symptom severity (p = 0.006) and also a significant decrease in distal sensory latency (p = 0.007) of the test group (routine physiotherapy with cupping) as compared with the control group (routine physiotherapy). CONCLUSIONS: The results showed that incorporation of cupping therapy in a routine physical therapy programme can reduce the severity of symptoms and improve the distal sensory disturbance of the median nerve. Therefore, it is suggested that cupping, as a convenient and low-cost method, can be used as a complementary therapy in the treatment of CTS.

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Background: Diabetes is a chronic disease that reduces cardiorespiratory fitness and increases systolic and diastolic blood pressures as well as resting heart rate due to the activity level of the sympathetic nervous system. The aim of this study was to assess the effectiveness of 2 types of aerobic exercise, with and without external loading, on cardiac parameters in diabetic patients. Methods: This randomized controlled trial was carried out on 45 volunteers. These individuals were randomly divided into aerobic, weighted vest, and control groups. The aerobic protocol comprised 24 sessions of aerobic exercise. The exercise program for the weighted vest group was identical to that of the aerobic group, except that the subjects wore a weighted vest. The parameters were measured before and after the 24 sessions. Results: The mean age of the study population was 48.30±5.02 years in the aerobic group, 48.33±5.74 years in the weighted vest group, and 48.60±4.79 years in the control group. Males comprised 7 (53.8%) patients in the aerobic group, 7 (58.3%) in the weighted vest group, and 8 (53.3%) in the control group. After 8 weeks, maximum oxygen consumption in the aerobic group (mean±SD=37.54±8.02 mL/kg/min, 95% CI: 5.48 to 11.60; P<0.001) and the weighted vest group (mean±SD=35.92±3.96 mL/kg/min, 95% CI: 4.36 to 9.64; P<0.001) was increased, similar to metabolic equivalent of task in the aerobic group (mean±SD=11.60±1.62 kcal/kg×h, 95% CI: 1.48 to 2.72; P<0.001) and the weighted vest group (mean±SD=11.21±1.11 kcal/kg×h, 95% CI: 1.23 to 2.28; P<0.001). Furthermore, resting heart rate decreased significantly in the aerobic group (mean ± SD=90.23±8.90 bpm, 95% CI: -13.93 to -1.29; P=0.022) and the weighted vest group (mean±SD=90.58±9.19 bpm, 95% CI: -0.16 to - 12.33; P=0.045). Conclusion: These findings suggest that 24 aerobic exercise sessions might improve cardiac parameters in type 2 diabetes.

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OBJECTIVE: The main objective of the present study was to analyze how supra spinal motor control mechanisms are altered in different directions during anticipatory postural phase of gait initiation in chronic ankle instability patients. It seems that supra spinal pathways modulate anticipatory postural adjustment phase of gait initiation. Yet, there is a dearth of research on the effect of chronic ankle instability on the anticipatory postural adjustment phase of gait initiation in different directions. METHOD: A total of 20 chronic ankle instability participants and 20 healthy individuals initiated gait on a force plate in forward, 30° lateral, and 30° medial directions. RESULTS: According to the results of the present study, the peak lateral center of pressure shift decreased in forward direction compared to that in other directions in both groups. Also, it was found that the peak lateral center of pressure shift and the vertical center of mass velocity decreased significantly in chronic ankle instability patients, as compared with those of the healthy individuals. CONCLUSION: According to the results of the present study, it seems that chronic ankle instability patients modulate the anticipatory postural adjustment phase of gait initiation, compared with healthy control group, in order to maintain postural stability. These changes were observed in different directions, too.

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OBJECTIVE: To investigate the immediate effect of electrical stimulation of the common peroneal nerve on the maximum voluntary activation of the quadriceps muscle in patients with knee osteoarthritis. METHODOLOGY: Fifteen subjects with knee osteoarthritis (mean age: 50.5 ± 13 years) participated in this study. To measure the arthrogenic inhibition ratio of quadriceps, a burst of electrical stimulation was superimposed on the maximum voluntary contraction, and the percentage of change in the force production was computed. The same measurement was also performed with concurrent electrical stimulation of the common peroneal nerve. RESULTS: All the patients with knee osteoarthritis showed significant arthrogenic inhibition of the quadriceps muscle. The stimulation of the common peroneal nerve was able to reduce this inhibition and increase the capacity of the muscle to produce a significantly higher knee extension force (p = 0.028). CONCLUSIONS: Electrical stimulation of the common peroneal nerve concurrent with the maximum voluntary effort can remove the arthrogenic inhibition of the quadriceps muscle in patients with knee osteoarthritis. This finding could have clinical implications in the management of patients with knee disorders.

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OBJECTIVE: Craniocervical (CC) muscles control posture of the CC area. Muscle imbalance at this area induces musculoskeletal disorders. The purpose of this study was to develop a device for measuring isometric force of CC flexor and extensor muscles and to evaluate its intra-rater reliability. METHOD: Isometric force of CC flexor and extensor muscles was measured in 20 women by one examiner on two days with a custom-made device. The intra-class correlation coefficient (ICC), standard error of measurements (SEM), smallest detectable difference (SDD), and Pearson correlation coefficient were computed. RESULTS: The results of this study revealed that this device had excellent reliability (ICC: 0.98, SEM: 2.29 N, SDD: 6.36 N, Pearson correlation coefficient: 0.97 for CC flexor muscles and ICC: 0.97, SEM: 2.13 N, SDD: 5.91 N, Pearson correlation coefficient: 0.94 for CC extensor muscles). DISCUSSION: This new device can improve knowledge about the CC muscle and efficacy of treatments in patients with poor posture.

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