Context: Neuromobilization exercises (NE) could be a useful therapeutic tool to induce analgesia and increase function and range of motion (ROM) in patients with musculoskeletal pathologies with neuropathic components; however, the effectiveness of this intervention in patients with cervical radiculopathy (CR) is unknown. Objective: To determine the effectiveness of NE in CR on pain, function, and ROM. Design: Systematic review and meta-analysis. Evidence Acquisition: An electronic search was performed in the MEDLINE, Scopus, PEDro, and EBSCO databases from inception until June 2022. The authors included randomized clinical trials that evaluated the effectiveness of NE against control groups or other interventions that aimed to treat patients with CR. Evidence Synthesis: Seven clinical trials met the eligibility criteria, and for the quantitative synthesis, 5 studies were included. For the studies that compared NE with a control group, the standardized mean difference for pain was −1.33/10 (95% confidence interval [CI], −1.80 to −0.86; P < .01; I 2 = 0%), for function with the Neck Disability Index was −1.21/50 (95% CI, −1.67 to −0.75; P < .01; I 2 = 0%), and for neck flexion and extensions was 0.66 (95% CI, 0.23 to 1.10; P < .01; I 2 = 0%) and 0.47 (95% CI, 0.04 to 0.90; P < .01; I 2 = 0%), respectively, with evidence of clinical effectiveness. These findings were based on moderate-quality evidence according to the Grading of Recommendation, Assessment, Development, and Evaluation rating. In studies that compared NE with other interventions, the meta-analysis failed to demonstrate the statistical or clinical superiority of NE. Conclusions: Moderate quality of evidence suggests that NE may be superior to no treatment for pain, function, and ROM in patients with CR. In contrast, NE are not superior to other interventions in the same outcomes, based on low- to very low-quality evidence. More high-quality research is needed to assess the consistency of these results.
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Eleftherios Paraskevopoulos, George Koumantakis, and Maria Papandreou
Eleftherios Paraskevopoulos, Georgios Gioftsos, Georgios Georgoudis, and Maria Papandreou
Adherence to exercise rehabilitation has been shown to be an important factor that may influence successful treatment. In professional athletes, a significant reduction in exercise adherence delays recovery. The aim of this study was to explore barriers to and facilitators of exercise rehabilitation adherence in injured volleyball athletes. Eight professional volleyball athletes were recruited, and qualitative data were collected using semistructured interviews. All athletes had completed their rehabilitation program after they had suffered a musculoskeletal injury. All data were analyzed using thematic analysis after the investigators ensured that saturation had been reached. Pain was identified as a significant barrier to exercise adherence by all athletes. The provision of social support, including mental, practical, and task related, also had a significant positive impact. The athletes’ ability to develop the necessary coping strategies and confidence on performing exercises at home was also mentioned as a factor that affected exercise adherence, although less often.
Eleftherios Paraskevopoulos, Theocharis Simeonidis, Charilaos Tsolakis, Panagiotis Koulouvaris, and Maria Papandreou
Context: Volleyball players have shown to be at an increased risk of developing scapular dyskinesis. The kinetic chain exercise approach has gained a lot of attention because of its claims to provide an improved motor control and scapular kinematics. A form of cross exercise, known as mirror therapy, may enhance the effects of a kinetic chain exercise approach in throwing performance. Objective: To examine the effects of mirror cross exercise (MCE), based on a kinetic chain exercise approach in the throwing performance of volleyball athletes with scapular dyskinesis. Design: Randomized controlled trial. Setting: Biomechanics laboratory. Methods: 39 volleyball players with scapular dyskinesis were randomly allocated into 3 groups. The first group completed a 6-week kinetic chain approach (KCA group), the second group completed a kinetic chain exercise approach program in addition to MCE group, and the control group followed only their regular training program. Before and after delivering both interventions, throwing accuracy, speed, and force were determined while measuring the ground reaction forces of the drive leg during throwing. Two-way mixed analysis of variance investigated the effects of intervention and time and their interaction. Results: The results showed intervention × time statistically significant interactions for throwing accuracy, speed, and force for the MCE and the KCA groups. Over the 6-week training period, the MCE and the KCA groups showed significant improvements in throwing accuracy (P < .01) and speed (P < .01), while the ground reaction forces did not change (P > .05). Throwing force increased significantly in the MCE group (P = .01). Between-group comparison showed statistically significant improvements in the throwing accuracy for the MCE and KCA groups against the control group (P < .01) at posttesting. The MCE demonstrated superior results over the KCA in the aforementioned measures. Conclusions: This study suggests that the addition of MCE in a KCA program enhances energy transfer throughout the distal and proximal segments, thus improving kinetic chain recruitment and potentially preventing shoulder pathology.