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Background and Objective: Patello femoral pain syndrome is one of the most common orthopeadics complains, which effect athletes, militaries and ordinary people. The symptoms is idiopathic disease, but one of the most important reason for this disease can be the structural problem of lower limb and one of the efficient method of conservative treatment of patients with patello femoral pain syndrome can be using neoprene palumbo and geno direxa stable orthoses, but there is only a few experimental researches supporting the effects of these orthoses. This study was designed to determine the effects of neoprene palumbo and geno direxa stable on pain and daily activity of patients with patello femoral pain syndrome. Materials and Methods: In this clinical trial study 30 male patients (18-40 years old) with patello femoral pain syndrome randomly were divided in 2 groups of 15 patients. Which were placed in Neoprene palumbo and Geno direxa stable orthoses groups respectively. The pain intensity and activity of daily living joint rigidity were assessed before, during and 3 weeks after treatment by visual analogue scale (VAS) and KOOS questionnaire. Following both orthoses application data were analyzed using pair and independent t-test. Results: In both groups the mean of pain intensity decreased and daily physical activity increased after treatment (P<0.05), but there was not significant difference between neoprene palumbo and geno direxa stable methods, on pain and daily physical activities. Conclusion: This study indicated that Neoprene palumbo and geno direxa stable orthoses improved the sign of patello femoral pain syndrome including pain intensity and daily life, activity.

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Background and Objective: Several studies have demonstrated the importance of a coordinated, synchronized action of a scapular and glenohumeral muscles. Minimal alteration in performance and coordination of these muscles have the potential to lead to joint dysfunction. The impingement syndrome is the most common diagnosis of shoulder pain. The purpose of this study was to determine whether strength deficits could be detected in patients with shoulder impingement. Materials and Methods: This case – control study was done on 15 patients with impingement syndrome and 15 healthy matched persons by nonprobability sampling in Tehran, Iran during 2008. Strength of glenohumeral and scapulothoracic muscles was tested with a hand held dynamometer. Independent and paired t-test were used to statistically analyze between and within groups differences. Results: Compared to non impaired subjects, those with impingement syndrome demonstrated a significantly lower strength of shoulder muscles (P<0.05). The strength deficit between involved and noninvolved sides of patients was determined (P<0.05). In impingement syndrome patients, the external-to-internal rotator muscles strength ratio was significantly lower than on the control group (P<0.05). Conclusion: The result of this study suggest that strength deficit of shoulder muscles may be an important aspect of the impingement syndrome. Muscular strength assessment should be considered in evaluation and effective treatment of a patient. Physical therapy treatment should be emphasize strengthening of weak muscles.

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Background and Objective: Constraint induced movement therapy is an approach that with limitation of the healthy upper limb movement of a person with hemiplegia obligate to use the affected limb. This study was done to determine the modified constraint induced movement therapy on quality of upper extremity skills in affected limb in children with hemiplegic cerebral palsy. Materials and Methods: This single blind randomized clinical trial was carried out on 21 children with hemiplegic cerebral palsy referred to rehabilitation centers in Tehran-Iran during 2008. Samples randomly were divided into experimental (n=11) and control (n=10). Common therapeutic physical practice was carried out for 6 weeks in both groups equally. In treatment group intervention was practiced by constrain induced movement therapy methods for 3 hours daily. Quality of upper extremity skills pre and post intervention based on the quality of upper extremity skills test (QUEST) was evaluated. Data were analyzed by SPSS-16 software, Kolmogrov-Smirnoff, chi-square, T student and repeated measurement tests. Results: Mean age of children in the experimental group (7 girls, 4 boys) and control group children (5 female, 5 male) were 46.55±17.5 and 48.10±19.2 months respectively. Internal analysis of all items in interventional group were significant after 6 weeks of treatment (P<0.05). but in control group only grasp item was significant (P<0.05). Analysis between two groups did not show any significant difference in total and subtitle score including dissociated movement, weight bearing and protective extension. But only grasp subtitle showed significant difference between two groups (P<0.05). Conclusion: This study showed that modified constraint induced movement therapy only affect in quality of grasp.

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Background and Objective: Osteoarthritis is the most common joint disease and associated with degeneration of the joint cartilage. Its high prevalence, particulary in the elderly, and the high rate of disability related to disease make it a leading cause of disability. The symptoms of osteoarthritis are pain, morning stiffness and joint limited motion. This study was carired out to compare the effects of physical modalities and home based exercise training on symptoms and function of knee osteoarthritis. Materials and Methods: In this randomized clinical trial study, fourty patients with knee osteoarthritis according to the American college of rheumatology (ACR) criteria randomly divided into two treatment groups. The physical modality group (A) received TENS, US and Hot pack at pain areas. The exercise group (B) received isometric exercise of the knee. Each group received 3 treatment sessions per week for 4 weeks. Evaluating measuring tools were pain intensity (based on Visual Analogue Scale: VAS) and function was measured with koos questionnare. Results: Improvement in pain, quality of life, symptoms, sports and reduction, in pain intensity on VAS in the physical modality group after treatment were seen (P<0.05). Also significant improvement in symptoms and quality of life observed in the exercise group. Improvement in activity of daily life found in the physical modality group in comparison with exercise group (P<0.05). Conclusion: This study showed that physical modality and exercise training reduce pain and improve quality of life, activity of daily life and sport in patients with the same rate. While activity of daily life improve more in physical modality method.

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Background and Objective: There has been considerable debate regarding the best treatment of the Achilles tendon rupture. One of the nonoperative treatment method for Achilles tendon rupture is using the functional brace. The aim of this study was to evaluate the effect of the functional brace with/without patellar tendon bearing on treatment of patients with Achilles tendon rupture. Materials and Methods: In this semi expremental study, 17 patients with Achilles tendon rupture were recruited and randomly allocated into 2 groups: functional brace with patellar tendon bearing and functional brace without patellar tendon bearing. Pain, plantar and dorsi flexion strength and the required time for progressively increased dorsi flexion position in orthoses to reach the neutral position were measured. Data analyzed with SPSS-13, independent t-test and Smironov-Kolomogrov. Results: Three patients were excluded during follow up and finally this study was done on 14 patients. The difference of the pain intensity and the plantar and dorsi flexion, in each group, before and after the intervention was significant (P<0.05), but the difference between two groups after intervention in all variables was not significant. Conclusion: This study showed that both brace with/without patellar tendon bearing are effective on improvement of pain and the plantar flexion and dorsi flexion strength and also are effective in required time to reach the neutral position.

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Background and Objective: Spasticity is common problem in stroke patients. Spasticity couse dysfunction and restricted activity. The most of patients have hand dysfunction due to stroke. This study was done to determine the effect of adjustable wrist hand splint on upper limb spasticity in post stroke patients.

Materials and Methods: This randomized clinical trial study was carried out on 15 patients with stroke referred to rehabilitation centers in Tehran-Iran during 2009. Patients randomly were divided into interventional (4 female, 3 men) and control (5 female, 3 men) groups. Common occupational therapy practice was carried out for 4 weeks for both groups equally. In treatment group intervention was based on the use of adjustable wrist hand splint moreover common occupational therapy practice. Upper limb spasticity pre and post intervention based on the Modified Ashworth Scale was evaluated. Data were analyzed by SPPS-17 software, pair-t-test and independent  t-test.

Results: Mean age of patients in interventional and control groups were 61.37±4.10 and 58.85±5.01 years respectively. After 4 weeks of treatment, the mean of spasticity was not significant between interventional and control groups, but internal analysis of spasticity were significant in interventional and control groups (P<0.05).

Conclusion: This study showed that the adjustable wrist hand splint is not useful in reduction of upper limb spasticity in post stroke patients.

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Background and Objective: Anterior Cruciate Ligament (ACL) tear is One of the most common injuries at knee joint. Threshold of motion sense included inputs that are received by mechanical receptors at dynamic position. The objection of present study was to find the effect of functional brace on the Kinesthesia motion sense in patients with ACL rupture.

Materials and Methods: In this Quasi- experimental study, 20 patients with ACL tear, with aging range between 18 to 44 years old were recruited. Patients were selected in a simple non probability sampling manner. Using Continuous passive motion for testing the Kinesthesia motion sense, as a dependent variable. Data was analyzed with Paired t-test and Colmogrof-Smirnof tests.

Results: Threshold of motion sense at affected knee before and after bracing was 3.93±1.67, 4.45±1.86 in open eyes and 3.82±1.61, 4.13±1.96 in closed eyes (P<0.05).

Conclusion: This study showed that the functional brace did not play in important role in the improvement of threshold of motion sense in patients with ACL tear.

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Background and Objective: Carpal tunnel syndrome (CTS) is one of the most common disease among the entrapment neuropathies. The purposes of this study was to compare the efficacy of a new dorsal wrist splinting versus common palmar splinting for CTS based on sensory nerve conduction measurements. Materials and Methods: This single blind randomized control trial study was carried out on 22 idiopathic CTS patients. Subjects were randomly divided in two groups: Dorsal splint group (n=12) and palmar splint group (n=10). Both groups used splints for 4 weeks. Sensory conduction study of median nerve were done initially for having baseline and after 4 weeks follow up. SPSS-16 and Kolmogorov–Smirnov, independent T, and paired T tests were used for analysis of Data Results: After four weeks median nerve sensory distal latency and conduction velocity improved significantly in both groups (P<0.05). There was significant difference between both groups due to electro-diagnostic improvement. Conclusion: This study showed that based on electro-diagnostic method, dorsal wrist splint is more effective than cockup splint in carpal tunnel syndrome.

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Background and Objective: Anterior cruciate ligament (ACL) tear is one of the most common injuries at knee joint. This study was done to evalute the effect of reconstruction surgery on hamstring reflex in patients with ACL tear. Materials and Methods: In this Quasi- experimental study, 30 patients (16 males, 14 females) with ACL tear, with mean age of 26.52±8.72 years old were recruited during 2007. Patients were selected in a non probability sampling manner. The Kinsiological Electromyography and trauma mechanism were used for testing the hamstring reflex. Muscle activity were measured as a dependent variable. Data were analyzed with Paired T-Test, ICC, SEM and K-S tests. Results: Hamstring reflex in affected knee and after reconstruction surgery was 73.25±3.22 and 47.35±3.85, respectively. This difference was significant (P<0.05). Conclusion: Reconstruction surgery in patients with ACL tear at acute phase is effective in improvement of hamstring reflex.

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Background and Objective: The reduction of shoe heel height can increase abdominal muscles activity. This study was conducted to evaluate the effect of low shoe heel height on the trunk muscle activity in young healthy females. Materials and Methods: In this quasi- experimental (Pre-post ) study, 48 healthy females were evaluated at University of social welfare and rehabilitation at 2009-2010. Females were selected in a non probability sampling manner and divided randomly into two groups. Subjects in the first group (12 females) were used low heel height shoes(less than 3.4 cm) for six months. The second group (12 female) was used standard heel shoes height (3.5-5 cm) for six months. After the end of the first step of study, females in first group were used standard heel shoes height (3.5-5 cm) for six months. The Kinsiologic Electromyography instrument was used to test the Electromyography magnitude of rectus abdominal and external oblique activity. Data was analyzed with Paired and independent T student and Kolmogorrov-Smirnov tests. Results: Muscle activity in first and second groups at external oblique was 9.72±3.15 μν and 7.87±2.47 μν and at rectus abdominal was 11.60±3.58 μν and 9.81±3.46 μν respectively. Muscle activity before and after using standard shoe heel height was significant (p<0.05). Conclusion: It seems that using lower heel shoes height increase the trunk muscle activity.

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Background and Objective: Patellofemoral is a pain syndrome, common among athletes and the theraputic regiment based on the improvement of muscle involved in this disorder. This study was done to compare electromyography activity of the vastus medialis obliques and vastus lateralis longus during squat with isometric hip adduction in athletes with patellofemoral pain syndrome and healthy athletes.

Materials and Methods: This case – control study was carried out on 16 national team male athletes (volleyball, handball and taekwondo) aged 30-18 years with patellofemoral pain syndrome and 16 healthy male athletes. Subjects were matched based on weight, height, age, dominant of lower extremity and voluntarily participated. Electromyography activity of vastus medialis obliques and vastus lateralis longus muscles recorded by surface electrodes at 15, 30 and 45 knee flexion degrees. Paired t test was used to compare electromyography activities in each group and One-way ANOVA and Tukey post hoc test was used to compare each muscle in different angles.

Results: There was significant differences in the activity of vastus medialis obliques and vastus lateralis longus muscles in athletes with patellofemoral pain syndrome at 45 knee flexion degree (P<0.05). There were no significant differences between the muscle activities in healthy athletes at none of the knee flexion degrees. There were significant differences in the activity of vastus medialis obliques (P<0.05) and vastus lateralis longus (P<0.05) muscles at 45 degrees in comparison with muscle activities in each group in knee flexion degrees.

Conclusion: Electromyography activity of the vastus medialis obliques in healthy athletes during squat with isometric hip adduction at 45 knee flextion is greater than other degrees and in athletes with patellofemoral pain syndrome is greater than healthy athletes.

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Background and Objective: Neuropathy is a diabetic burden which can causes traumedous complications on affected indivitals. This study was done to compare the speed of walking, balance and proprioception of knee and ankle joints between type 2 diabetes and healthy subjects. Materials and Methods: This case – contorl study was carried out on 22 diabetic and 22 healthy subjects in Shiraz, Iran during 2010. Speed of walking, repositioning of some angles in knee and ankle joints and balance time (Tandem position) were measured for all subjects. Sensory neuropathy tested using neuropathy total symptom score-6 (NTSS-6). Results: There is no significant difference between two groups due to speed of walking, but mean time of balance in diabetic patients (32.01±38.03) was significantly less than healthy subjects (71.18±65.15). The average error in repositioning of joint angles in diabetic patients was more than healthy subjects (P<0.05). Conclusion: Balance time and walking speed is lower in diabetic patients which can be due to neuropathy.

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Background and Objective: The first carpometacarpal joint osteoarthritis reduced the ability of upper limb in elderly with subsequent disability in physical activities. This study was carried out to determine the effect of prefabricated and custom-made splints on quality of life in the first carpometacarpal joint osteoarthritis. Materials and Methods: This quasi-experimental study was done on 24 elderly (>60 years of age) patients with the first carpometacarpal joint osteoarthritis and 12 matched healthy subjects in Tehran rehabilitation University during 2010-11. Patients assigned randomly in two groups with 8 weeks treatment period, prefabricated thumb and custom-made splints. Persian version of The Short Form 36 quastioner (SF36) was used to assess the quality of life. Data were analyzed using SPSS-16 and paired t-test. Results: There were significant differences between osteoarthritis patients and healthy subjects in the quality of life according to SF36 score physical health problem (P<0.05), general health (P<0.05), limitations of activities (P<0.05), emotional health problem (P<0.05), social activities (P<0.05), pain (P<0.05), energy and emotions (P<0.05). Using splints significantly improved the quality of life of patients, but there was no significant difference between two splints in improving the quality of life. Conclusion: Prefabricated and custom-made

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Low back pain (LBP) is a common and complicated disorder which is influenced by a number of factors, among them is the lack of spinal stability provided by muscle contraction. One of the most important muscles which has a role in spinal stability is musculus transversus abdominis. A literature search for the period of 2000-11 was performed in PubMed, ProQuest, Science Direct, Thomson, EMBASE, OVID, CINAHL and MEDLINE databases using musculus Transversus Abdominis, ultrasonography, chronic nonspecific low back pain as keywords. Nineteen articles were selected according to the inclusion criteria of the study. Evidences demonstrated that thickness of transversus abdominis reduces in patients with chronic nonspecific low back pain (LBP) and ultrasonography seemed to be a valid and highly reliable instrument for measuring thickness of transversus abdominis in patients with LBP and healthy subjects on different positions and states. Studies demonstrated that there are adequate evidences to confirm the merit of ultrasonography in the assessment of musculus transversus abdominis in patients with chronic LBP and healthy subjects.

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Background and Objective: Disability of upper extrimity from stroke are often permanent. Despite numerous functional problems, there is less attention to upper exterimity disabilitis than lower limbs. Some new methods of treatment focuses on using the magnetic stimulation as a means brain currents to produce therapeutic effects. This study was done to evalute the effect of low frequency repeatitive transcranial magnetic stimulation to improve motor function and grip force of upper limb in hemiplegic patients. Materials and Methods: This clinical trial study was done on 12 stroke hemiplegic patients in Firoozgar hospital in Tehran, Iran during 2009-10. Patients in group I, recieved rehabilitation program with placebo magnetic stimulation, and patients in group II, received magnetic stimulation with routine rehabilitation program for 10 session, 3 times in week. Pre and post were evaluated by Barthel and Fugl-Meyer indeces and dynamometer. Data were analyzed using SPSS-15, Kolmogorov-Smirnov, paired t-test, independent t-test and Wilcoxon signed tests. Results: According to Barthel and Fugl-Meyer indeces both groups I, II showed significant improvement (P<0.05). Using dynamometer, it was demenstrated that grip force of upper limb in group I was not significant but this index in group II was significant after intervention (P<0.05). Conclusion: This study showed that low frequency repeatitive truscrianial magnetic stimulation has therapuetic effect on grip force of upper limb.

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Background and Objective: Myofascial pain syndrome is one of the painful conditions of the musculoskeletal system. There is controversy about the effectiveness of treatment strategy. This study was done to compare the effects of diclofenac phonophoresis with ergonomic instructions on neck and shoulder pain and disability in women with myofascial trigger points in trapezius muscle. Materials and Methods: This clinical trial study was conducted on thirty female students with trigger points in trapezius muscle in Razmejo-Moghadam Physiotherapy Clinic, Zahedan University of Medical Sciences, Iran during 2009. Patients were randomly assigned to one of three equal groups: diclofenac phonophoresis, ergonomic instructions, and control groups. In phonophoresis group, after applying diclofenac gel, ultrasound with frequency of 1 MHz, continuous mode, intensity 1.5 W/cm2, and duration 4.5 min was used. Ergonomic group received instructions in order to maintain appropriate posture during activity of daily life. Control group received ultrasound without output. A 12 session treatment program, during 4 weeks, 3 sessions per week was performed. Neck pain was assessed before and after intervention with Northwick Park Neck Pain Questionnaire and shoulder pain and disability with Shoulder Pain and Disability Index. Data were analyzed using SPSS-17, Kolmogorov-Smirnov, paired t-test, One-way ANOVA and Tukey tests. Results: Neck pain score decreased from 18±3.5 to 7.6±4.4 in phonophoresis group and from 17.8±3.5 to 10.5±3.4 in ergonomic group (P<0.05). Also, shoulder pain and disability score decreased from 106.2±28.1 to 36.76±30.7 in phonophoresis group and from 103.3±22.9 to 26.2±12.3 in ergonomic group (P<0.05). There was no significant difference between post and pretreatment results in control group. After treatment, there was no significant difference between two treatment groups regarding neck, shoulder pain and disability. However, after treatment there was significant difference between two treatment groups and control group regarding pain (P<0.05). Conclusion: This study showed that diclofenac phonophoresis and ergonomic instructions are effective in decreasing neck and shoulder pain and disability in patients with myofascial trigger points in trapezius muscle. None of both treatment strategy was superior to other.

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Background and Objective: Improving the ability to walk is often a key target for the treatment of abnormal gait in children with spastic diplegic cerebral palsy (CP). One of the goals of orthotic rehabilitation is to improve walking in this field. The aims of this study was to design and manufacture the dynamic neoprene orthoses and evaluate its impact on the gait parameters in children with cerebral palsy. Materials and Methods: This quasi-experimental study was done on 12 children with spastic CP at University of Social Welfare and Rehabilitation, in Tehran, Iran during 2010-11. Initially neoprene dynamic orthosis is designed specifithy for each subject, this neoprene dynamic orthosis was used for six weeks and 6-8 hrs daily. For evaluating the walking speed and the gait variation, 10 meter walking test and visual analogue scale have been used. Modified Ashworth’s Scale and electro-goniometre were used to assess muscle spasticity and the flexion degrees of knee joint. Data were analyzed using SPSS-16, Kolmogorov-Smirnov and Paired t-tests. Results: The alteration of knee flexion angle, walking speed and walking distance following dynamic orthosis were -18.31±4.61 (degree), -0.50±1.82 (meter) and 4.18±1.51, respectively. The improvement in knee joint angle and walking following dynamic orthosis was significant (P<0.05), but the walking speed was not significant. Conclusion: This study showed that neoprene dynamic orthosis can improve knee flexion angle and walking distance among children with spastic diplegic cerebral palsy.

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Background and Objective: Proprioceptive, vestibular and visual senses control human movements. This study was carried out to compare the posture of head and shoulder in blind, deaf and ordinary pupiles. Materials and Methods: This descriptive and analytic study was done on 16 blind, 30 deaf and 60 ordinary pupiles in Ardabil city, Noth-west of Iran. Sagital and frontal planes Photos for each child was used for determination of head and shoulder deviation. Results: Forward head in blind group significantly was lower than deaf and ordinary pupiles (P<0.05). Rounded shoulder in blind and deaf pupiles significantly was lower than ordinary pupiles (P<0.05). Uneven shoulders in deaf pupiles significantly was lower than ordinary and blind children (P<0.05). Lateral flexion of the head in blind and deaf pupiles significantly was higher than ordinary children (P<0.05). Conclusion: There is a relationship between sensory impairment and postural problems paticularly in blindness Pupils.

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Background and Objective: Disabilities in upper limb due to stroke are the major problems in hemiplegic patients. Recently, joystick method as new method is applied for the improvment of upper limb disabilities. This study was carried out to compare the effect of joystick in compination verses routine rehabilitation and routine rehabilitation program on hand muscles stiffness in hemiplegic patients. Methods: In this clinical trial study, 12 hemiplegic patients were randomly divided into two control and interventional groups. Subjects in the control group were received rehabilitation program with placebo joystick. Patients in interventional group were received joystick treatment with routine rehabilitation program for 10 sessions, 3 times a week. Pre and post-treatment evaluation was performed based on Wrist Robo Hab method. Results: Flextion and pronation muscle stiffness in control patients showed non significant improvement, but in the interventional group, significant improvement were observed (P<0.05). At the end of study, there was not any significant difference between control and interventional group. Conclusion: According to this finding, there was not any significant difference between the combination of joystick and rehabilitation treatment and routine rehabilitation program on the hand muscle function in hemiplegic patients.

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Background and Objective: By increasing the number of athletes, sports-related injuries are increased and of those lower extremities injuries are more common. This study was done to evaluate the relation of sole arch index and static balance in female athletes with lower-extremity injury. Methods: This case – control study, was done on 18 female athletes without a history of lower extremity injury which were considered as controls and 18 female athletes with a history of lower extremity injury in past two years which were considered as cases. Static balance and sole arch index were evaluated using stork stand and Chippaux-Smirak index tests. Results: Static balance with open eyes was 16.10 seconds and 26.53 seconds in cases and controls (P<0.05), whereas, there was no significant difference in static balance with closed eyes and sole arch index between cases and controls. Conclusion: Poor static balance with neuromuscular control deficit can consider as lower extremity injury in female athletes.