Study Design. Prospective randomized clinical trial. The trial is registered in the Chinese registry of clinical trials with a trial number of ChiCTR1800019908. Background. Median nerve mobilization is a relatively new technique that can be used to treat carpal tunnel syndrome. But literature about additional effects of neuromobilization for the management of carpal tunnel syndrome is scarce. Objective. To examine and compare the role of median nerve neuromobilization at the wrist as compared to routine physical therapy in improving pain numeric pain rating scale (NPRS), range of motion (Ballestero‐Pérez et al., 2017), muscle strength, and functional status. Methods. A sample size of 66 patients was recruited using convenient sampling and distributed randomly in two groups. After assessing both groups using ROM, manual muscle strength, pain at NPRS, and functional status on the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ), which consists of two further scales (the symptom severity scale (SSS) and the functional status scale (FSS)), Group 1 received conservative treatment including ultrasound therapy two days a week for six weeks, using a pulsed mode 0.8 W/cm² and frequency 1 MHz, wrist splinting, and tendon gliding exercises, while Group 2 received both conservative treatments including ultrasound, splinting, and tendon gliding exercises as well as a neuromobilization technique. Treatment was given for 6 weeks, 2 sessions/week, and patients were reassessed at the end of the 3^rd and 6^th weeks. Results. Although both groups improved significantly in terms of all the outcome measures used, the neuromobilization groups showed a statistically more significant increase in flexion, extension, decrease in pain, decrease in SSS, decrease in FSS, and BCTQ as compared to the routine physical therapy group. Conclusions. The addition of neuromobilization in the rehabilitation program of carpal tunnel syndrome has better effects on treatment outcomes.

Kinetic chains (KCs) are primarily affected by the load of different activities that recruit muscles from different regions. We explored the effects of strengthening exercises on KCs through muscle activation. Four databases were searched from 1990 to 2019. The muscles of each KC, their surface electromyography (sEMG), and the exercises conducted were reported. We found 36 studies that presented muscle activation using the percent (%) maximal voluntary isometric contraction (MVIC) or average sEMG for nine KCs in different regions. The % MVIC is presented as the following four categories: low (≤20%), moderate (21~40%), high (41~60%), and very high (>60%). Only four studies mentioned muscle activation in more than three KCs, while the remaining studies reported inconsistent sEMG processing, lacked normalization, and muscle activation in one or two KCs. The roles of stabilizers and the base of support in overhead throwing mobility using balance exercises were examined, and the concentric phase of chin-up and lat pull-down activated the entire KC by recruiting multiple muscles. Also, deep-water running was shown to prevent the risk of falls and enhance balance and stability. In addition, low-load trunk rotations improved the muscles of the back and external oblique activation. Based on this study’s findings, closed-chain exercises activate more groups of muscles in a kinetic chain than open-chain exercises. However, no closed or open chain exercise can activate optimal KCs.

Objective: To determine the effects of Pilates exercises on pain, knee range of motion and functional disability in women with knee osteoarthritis. Method: The double-blind randomised controlled trial was conducted at the National Orthopaedic Hospital, Bahawalpur, Pakistan, from April to September 2018, and comprised female patients with knee osteoarthritis. The subjects were selected randomised into control group A receiving isometrics and intervention group B receiving Pilates exercises. Both groups received one-hour sessions 3 times per week for 8 weeks. The groups were assessed at baseline and at the end of the 8th week using numeric pain rating scale and Western Ontario and McMaster Universities osteoarthritis index for pain and functionality level respectively. Data was analysed using SPSS 23. Results: Of 44 patients, there were 22(50%) in each of the two groups. Mean age of group B was 57.60±6.34 years, and it was 55.65±7.28 in group B. Mean body mass index of group B was 25.812±4.16, and it was 26.93±4.4 in group A. The study was completed by 40(91%) patients; 20(50%) in each of the two groups. Both groups showed significant improvement for pain, range of motion and physical function post-intervention (p<0.05). Group B showed significantly more improvement in terms of pain and physical function compared to group A (p<0.05). Conclusion: Pilates exercises were found to be more effective in the treatment of patients with knee osteoarthritis. Key Words: Isometrics exercise, Knee osteoarthritis, Knee pain, Pilates, Range of motion, WOMAC. Continuous...

Objective: To measure additional benefits of neuromobilisation along with conventional treatment in improving the functional status in patients having carpal tunnel syndrome. Method: The prospective, double-blind randomised controlled trial was conducted from August 2018 to June 2019 at the Physiotherapy outdoor clinic of Mayo Hospital, Lahore, Pakistan, and comprised patients of either gender aged 20-45 years with <3-month history of carpal tunnel syndrome. The patients were randomised into control group 1 and experimental group 2. Group 1 received conservative treatment including ultrasound therapy, wrist splinting, and tendon-gliding exercises, while Group 2 additionally received neuromobilisation. Functional limitation was measured using the Functional Status Scale and the Symptom Severity Scale of the Boston Carpal Tunnel Syndrome Questionnaire. Patients had 2 sessions per week for 6 weeks. Clinical data was noted at baseline, after 3 weeks of treatment and finally at the end of the 6-week intervention. Data was analysed using SPSS 21. Results: Of the 66 patients, there were 33(50%) in Group 1; 3(9.1%) males, 30(90.9%) females, overall mean age 37.79 ±5.91 years. The remaining 33(50%) were in Group 2; 2(6.1%) males, 31(93.9%) females, overall mean age 35.58 ±7.15 years. Both the groups showed significant improvement (p <0.05), but the addition of neuromobilisation in Group 2 showed better results compared to Group 1(p<0.05). Conclusion: The addition of neuromobilisation to routine physical therapy was found to have significantly decreased the symptoms of carpal tunnel syndrome and improved the functional status of the patients. Key Words: Functional status, Carpal tunnel syndrome, Neuromobilisation.

This study assessed doctor of physical therapy (DPT) students’ perceptions of the educational environment at public and private physical therapy institutes in Pakistan. This cross-sectional study was conducted at 6 physical therapy institutions in Punjab, Pakistan from April 2018 to December 2019. In total, 500 Dundee Ready Educational Environment Measure (DREEM) questionnaires were distributed among DPT students identified through convenience sampling (response rate, 86.4%). The correlations between each item of the DREEM score were analyzed. The mean overall DREEM score was 128±19.63 for all 5 subscales (range, 33 to 166; standard error of the mean, 0.954). The correlations of atmosphere, learning, and self-perception with the overall educational environment were r=0.896, r=0.853, and r=0.846, respectively. Student-centered approaches were found to be more effective than teacher-centered approaches for promoting a positive educational environment.

Both the detrimental effect of prenatal exposure to di-(2-ethylhexyl)-phthalate (DEHP) and the beneficial effects of physical exercise on brain functions have been reported. The oxytocin pathway has been implicated in the onset of maternal behaviors. Epigenetic modification of the oxytocin receptor gene (OXTR) through DNA methylation has been associated with the pathogenesis of neuropsychiatric disorders. The purpose of this study was to investigate the effects of prenatal DEHP exposure on oxytocin-regulated maternal behaviors and to examine the protective effect of exercise. Pregnant rats (F0) were fed with vehicle or DEHP during gestation and the offspring females (F1) were assessed for their maternal behaviors by pup retrieval test at postpartum. The results showed that reduced pup retrieval activities without significant alteration of stress responses were observed in the prenatally DEHP-exposed females. Prenatal DEHP exposure decreased the expressions of oxytocin, Oxtr mRNA, and oxytocin receptor, and increased Oxtr methylation in the hypothalamus of postpartum female rats. There were no significant effects of exercise on behavioral, biochemical, and epigenetic measurements. These results suggest that prenatal DEHP exposure has a long-term adverse effect on maternal behaviors; Oxtr hyper-methylation may be a potential epigenetic mechanism for this alteration, which cannot be prevented by physical exercise during childhood.