Background/Objectives: Strokes remain a major global health concern, contributing significantly to disability and healthcare costs. Currently, there are no established indicators to accurately assess the degree of muscle tissue impairment in stroke-affected individuals. However, ultrasound imaging with an echotexture analysis shows potential as a quantitative tool to assess muscle tissue quality. This study aimed to identify specific echotexture features in the gastrocnemius medialis that effectively characterize muscle impairment in post-stroke individuals. Methods: An observational study was conducted with 22 post-stroke individuals. A total of 21 echotexture features were extracted and analyzed, including first-order metrics, a grey-level co-occurrence matrix, and a grey-level run length matrix. The modified Heckmatt scale was also applied to correlate with the most informative echotexture features. Results: Among the features analyzed, echovariation (EV), echointensity, and kurtosis emerged as the most informative indicators of muscle tissue quality. The EV was highlighted as the primary feature due to its strong and significant correlation with the modified Heckmatt scale (r = −0.81, p < 0.001) and its clinical and technical robustness. Lower EV values were associated with poorer muscle tissue quality, while higher values indicated better quality. Conclusions: The EV may be used as a quantitative indicator for characterizing the gastrocnemius medialis muscle tissue quality in post-stroke individuals, offering a more nuanced assessment than traditional qualitative scales. Future studies should investigate the correlation between the EV and other clinical outcomes and explore its potential to monitor the treatment efficacy, enhancing its applicability in clinical practice.

Background and Objectives: Percutaneous Electrical Stimulation (PES) interventions, particularly percutaneous neuromodulation (PNM) and electroacupuncture (EA) techniques, have shown potential in targeting neuromusculoskeletal tissues, primarily for improving pain and functionality. Regarding functionality, this study specifically aims to analyze the impact of PES interventions on active muscle functionality in both healthy individuals and those with neuromuscular pathologies. Methods: A systematic review was registered in PROSPERO (CRD42024605747) following PRISMA guidelines. A literature search was conducted in July 2024 across PubMed, Cochrane, BVS, Science Direct, Web of Science, and Scopus. Included studies were randomized controlled trials in which a group received an isolated PES intervention and variables related to active muscle functionality were addressed (e.g., strength, endurance, contractile properties). Methodological quality was assessed using the PEDro scale, and the risk of bias was evaluated with the RoB2 tool. Results: A total of 359 participants from 8 studies were included. Regarding active muscle functionality variables, 5 studies targeted strength, 1 study assessed endurance, 1 study evaluated contraction time, and 1 study examined nerve excitability. PES demonstrated positive effects on all variables except contraction time, where PES was no more effective than non-percutaneous interventions. Discussion: PES interventions are suggested to be effective for enhancing active muscle functionality, particularly in individuals with neuromusculoskeletal conditions who are more likely to present muscle impairments. However, these findings should be interpreted with caution due to significant heterogeneity in PES protocols, comparators, and study populations, making direct comparisons between studies challenging. Conclusions: PES, including EA and PNM interventions, is an effective approach for enhancing active muscle functionality, specifically in terms of maximum isometric strength, endurance, and nerve excitability, in both healthy individuals and populations with musculoskeletal pathologies. Further research is needed to establish standardized PES application protocols in rehabilitation settings.

Background/Objectives: Low back pain is considered one of the leading causes of disability. Up to 90% of cases are classified as non-specific, which, if prolonged for at least 12 weeks, is considered non-specific chronic low back pain (NSCLBP). Physical exercise is one of the selected treatments for NSCLBP. Interest in the use of remote interventions has recently emerged. The main objective was to analyze the effect of home exercise interventions to reduce pain intensity and functional disability in individuals with NSCLBP. Methods: A systematic review was conducted in April 2024. Both multivariate and univariate meta-analysis was performed with the difference before and after treatment, adjusting both models with a meta-regression that included the covariates age and body mass index (BMI). Heterogeneity was analyzed with Cochran’s Q test as well as with the I² estimator, and effect size was calculated with Hedges’G. Results: A total of six studies, with moderate–high methodological quality and a heterogeneous risk of bias, were included. There was a statistically significant pre-/post-treatment effect on functional disability (moderate effect: Hedge’s g = 0.69, p = 0.018) and pain intensity (large effect: Hedge’s g = 1.11, p = 0.007) in both univariate and multivariate (moderate effect: Hedge’s g = 0.77) meta-analyses when comparing unsupervised home exercise with supervised in-person exercise, in favor of the latter. This effect was significantly moderated by BMI (p = 0.003 for both outcomes) negatively. Conclusions: Unsupervised home exercise appears to be less effective than supervised in-person exercise in effectively reducing pain intensity and functional disability in the short term in individuals with NSCLBP.

Background/Objectives: Ultrasound (US) imaging and echotexture analysis are emerging techniques for assessing muscle tissue quality in the post-stroke population. Clinical studies suggest that echovariation (EV) and echointensity (EI) serve as objective indicators of muscle impairment, although methodological limitations hinder their clinical translation. This secondary analysis aimed to refine the assessment of echotexture by using robust statistical techniques. Methods: A total of 130 regions of interest (ROIs) extracted from the gastrocnemius medialis of 22 post-stroke individuals were analyzed. First, inter-examiner reliability between two physiotherapists was assessed by using Cohen’s kappa for muscle impairment classification (low/high) for each echotexture feature. For each examiner, the correlation between the classification of the degree of impairment and the modified Heckmatt scale for each feature was analyzed. The dataset was then reduced to 44 ROIs (one image per leg per patient) and assessed by three physiotherapists to analyze inter-examiner reliability by using Light´s kappa and correlation between both assessment methods globally. Statistical differences in 21 echotexture features were evaluated according to the degree of muscle impairment. A binary logistic regression model was developed by using features with a Cohen’s kappa value greater than 0.9 as predictors. Results: A strong and significant degree of agreement was observed among the three examiners regarding the degree of muscle impairment (Kappa_light = 0.85, p < 0.001), with nine of the 21 features showing excellent inter-examiner reliability. The correlation between muscle impairment classification with the modified Heckmatt scale was very high and significant both globally and for each echotexture feature. Significant differences (<0.05) were found for EV, EI, dissimilarity, energy, contrast, maximum likelihood, skewness, and the modified Heckmatt scale. Logistic regression highlighted dissimilarity, entropy, EV, Gray-Level Uniformity (GLU), and EI as the main predictors of muscle tissue impairment. The EV and EI models showed high explanatory power (Nagelkerke’s pseudo-R² = 0.74 and 0.76) and robust classification performance (AUC = 94.20% and 95.45%). Conclusions: This secondary analysis confirms echotexture analysis as a reliable tool for post-stroke muscle assessment, validating EV and EI as key indicators while identifying dissimilarity, entropy, and GLU as additional relevant features.

Background: Patellar tendinopathy (PT) is a degenerative condition characterized by pain and functional impairment, primarily affecting physically active individuals. In recent years, non-pharmacological invasive physiotherapy techniques such as percutaneous needle electrolysis (PNE) and dry needling (DN) have increased. Objective: To evaluate the effectiveness of non-pharmacological invasive physiotherapy techniques in reducing pain and improving functional disability in patients with PT. Methods: A total of 2,644 studies were identified through an electronic search in July 2024. After applying the selection criteria, four randomized controlled trials were included. These assessed pain and/or functional disability in 254 adults with PT who received invasive physiotherapy treatments. Results: DN and PNE improved pain and functional disability in patients with PT. However, these improvements are comparable to those achieved through conventional physical therapy (CPT). Only in the case of pain does the addition of DN to CPT appear to offer greater effectiveness than CPT alone. Discussion: In line with previous reviews, the use of invasive physiotherapy techniques has shown a positive effect on pain intensity and functional functional disability in patients with PT. This benefit may be attributed to the mechanical effect induced by the needle and the biological processes triggered after its application. A relevant finding was the influence of symptom severity in patients with PT, as those with more severe symptoms experienced greater benefits in terms of functional disability. This pattern is consistent with previous studies conducted in other populations. Notably, none of the reviewed studies reported adverse effects, possibly due to using ultrasound guidance during the interventions. Conclusions: PNE and DN effectively reduce pain intensity when combined with combined with eccentric exercises (EE) or CPT in individuals with PT. PNE and DN do not enhance the effectiveness of EE and CPT in improving functional disability. Future studies should examine the effect of invasive techniques as stand-alone treatments. Other information: PROSPERO (CRD42024608225).