Objective: Strength training is recommended for people with hemophilia; however, published data are anecdotal and have methodological limitations. The purpose of this study was to evaluate the safety and effectiveness of progressive moderate-to-vigorous intensity elastic resistance training on physical function and pain in this patient population.Methods: A randomized controlled trial was conducted in a university laboratory setting where 20 patients (17 with severe, 1 with moderate, and 2 with mild hemophilia) aged 21 to 53 years received evaluations at baseline and 8-week follow-up. Participants were allocated to intervention (progressive strength training) or control (usual daily activities) groups. The intervention group trained 2 days per week during 8 weeks with elastic resistance. Intensity during the first 2 weeks was a 20-repetition maximum and increased progressively toward 15, 12, and finally 10 repetition maximum. The primary outcome was muscle strength. Secondary outcomes were the Timed “Up and Go” Test score, sit-to-stand, range of motion, Haemophilia Joint Health Score, kinesiophobia score, global impression of pain change, general self-rated health status, and desire to exercise.Results: The intervention group showed greater strength improvements than the control group in almost all of the joints, with moderate to high effect sizes. The intervention group also showed better Timed “Up and Go” and sit-to-stand scores than the control group (moderate effect size), greater range of motion at the knee flexion with the right leg (trivial effect size), and better Haemophilia Joint Health Score at the left knee (small effect size). The intervention group showed greater overall pain reduction, self-rated overall status, and desire to exercise than the control group.Conclusions: Progressive strength training with elastic resistance performed twice a week during 8 weeks is safe and effective in people with hemophilia to improve muscle strength and functional capacity, reduce general pain, and improve self-rated health status and desire to exercise.Impact: This study provides evidence for the use of a specific strength training regimen for people with hemophilia.Lay Summary: People with hemophilia of differing levels of severity, with adequate coverage with clotting factor, can safely engage in progressive strength training and can improve their functioning.

Background and objective: In chronic obstructive pulmonary disease (COPD), accessory respiratory muscles are recruited as a compensatory adaptation to changes in respiratory mechanics. This results in shortening and overactivation of these and other muscles. Manual therapy is increasingly being investigated as a way to alleviate these changes. The aim of this study was to measure the immediate effect on lung function of a soft tissue manual therapy protocol (STMTP) designed to address changes in the accessory respiratory muscles and their associated structures in patients with severe COPD. Methods: Twelve medically stable patients (n=12) with an existing diagnosis of severe COPD (ten: GOLD Stage III and two: GOLD Stage IV) were included. Residual volume, inspiratory capacity and oxygen saturation (SpO₂) were recorded immediately before and after administration of the STMTP. A Student’s t-test was used to determine the effect of the manual therapy intervention (P<0.05). Results: The mean age of the patients was 62.4 years (range 46–77). Nine were male. Residual volume decreased from 4.5 to 3.9 L (P=0.002), inspiratory capacity increased from 2.0 to 2.1 L (P=0.039) and SpO2 increased from 93% to 96% (P=0.001). Conclusion: A single application of an STMTP appears to have the potential to produce immediate clinically meaningful improvements in lung function in patients with severe and very severe COPD.

Study Design: Case series. Background: This case series describes a combined program of dry needling and therapeutic exercise in a small group of patients with persistent pain following total knee arthroplasty (TKA). Case Description: Fourteen patients who underwent TKA had persistent postsurgical pain and myofascial trigger points that were nonresponsive to treatment with conventional physical therapy and/or medication. The patients received a weekly dry needling treatment in combination with therapeutic exercises for 4 weeks. Pain perception was assessed preintervention and postintervention with a visual analog scale and function was assessed with the Western Ontario and McMaster Universities Osteoarthritis Index, 6-minute walk test, timed up-and-go test, 30-second chair-stand test, and knee joint range of motion. Outcomes: After TKA, the patients had a mean ± SD symptom duration of 6.3 ± 3.1 months. Subsequent to dry needling, patients reported a significant mean ± SD decrease in pain intensity from 55.6 ± 6.6 to 19.3 ± 5.6 (P<.001) and improvements in Western Ontario and McMaster Universities Osteoarthritis Index scores from 10.1 ± 0.8 to 4.9 ± 1.0 for pain (P<.001), from 5.3 ± 0.4 to 2.4 ± 1.2 for stiffness (P<.001), and from 36.7 ± 2.0 to 20.1 ± 3.2 for function (P<.001). Knee flexion increased from a mean ± SD of 82.7° ± 5.2° to 93.3° ± 4.3° (P<.001), and joint extension improved from 15.8° ± 2.9° to 5.3° ± 2.4° (P<.05). The 6-minute walk test also showed improvement in postintervention values from a mean ± SD of 391.4 ± 23.7 to 424.7 ± 28.4 m (P<.05). Discussion: After dry needling combined with therapeutic exercises, patients who had chronic pain following TKA showed clinically significant improvements in pain, range of motion, function, and myofascial trigger points. Future randomized clinical trials should further investigate the effectiveness of this protocol under similar conditions. Level of Evidence: Therapy, level 4. J Orthop Sports Phys Ther 2017;47(3):209–216. Epub 3 Feb 2017. doi:10.2519/jospt.2017.7089

Most of the studies evaluating core muscle activity during exercises have been conducted with healthy participants. The objective of this study was to compare core muscle activity and tolerability of a variety of dynamic and isometric exercises in patients with non-specific low back pain (NSLBP). 13 outpatients (average age 52 years; all with standing or walking work in their current or latest job) performed 3 consecutive repetitions at 15-repetition maximum during different exercises in random order. Surface electromyography was recorded for the rectus abdominis; external oblique and lumbar erector spinae. Patients rated tolerability of each exercise on a 5-point scale. The front plank with brace; front plank and modified curl-up can be considered the most effective exercises in activating the rectus abdominis; with a median normalized EMG (nEMG) value of 48% (34–61%), 46% (26–61%) and 50% (28–65%), respectively. The front plank with brace can be considered the most effective exercise in activating the external oblique; with a nEMG of 77% (60–97%). The squat and bird-dog exercises are especially effective in activing the lumbar erector spinae; with nEMG of 40% (24–87%) and 29% (27–46%), respectively. All the exercises were well tolerated; except for the lateral plank that was mostly non-tolerated. In conclusion; the present study provides a variety of dynamic and isometric exercises; where muscle activity values and tolerability can be used as guide to design evidence-based exercise programs for outpatients with NSCLBP.