BACKGROUND: Osteoporosis is a systemic skeletal disease characterised by a low bone density and microarchitectural deterioration of bone tissue leading to decrease of its strength and increased risk of fracture. Drug therapy decreases the risk of fracture, thus influencing on the mechanism of bone remodelling. Non-pharmacological interventions include specific exercises for osteoporosis that improve muscle strength and balance, decrease pain and improve quality of life. AIM: To compare the quality of life in patients with postmenopausal osteoporosis who practice exercises with those who do not practice on the beginning and after a year. MATERIJAL AND METHODS: A randomised Single-blind randomised controlled prospective trial study, which included 92 women with postmenopausal osteoporosis diagnosed and treated at the Institute of Physical Medicine and Rehabilitation in Skopje, Republic of Macedonia. Patients were randomly assigned to three groups: the first group of patients with exercises and physical modalities (gr. I), the second group with exercises (gr. II), and the third control group of patients who did not practice exercises (gr. III).  Exercises were practised 3 times a week; each exercise was repeated for 5-8 times. Patients regularly took bisphosphonates, calcium and vitamin D. The follow-up period lasted for one year. Quality of life was determined with a specific questionnaire Qualeffo-41. RESULTS: The results showed, significant statistical difference in terms of pain, physical activity, social life, the perception of own health were shown between the groups (p < 0.0001), only in term of mental function were no significant (p < 0.3). CONCLUSION: Patients who practice exercises for osteoporosis have a significantly better quality of life than patients who do not perform exercises.

Osteoarthritis is a rheumatic disease characterized by degeneration and decay of cartilage in the joints. As the disease worsens, the joint space narrows causing numbness and pain, which often impairs movement. In addition to pharmacological therapy, low-intensity laser (LILT), high-intensity laser (HILT) and exercise are used to treat osteoarthritis (OA) of the knee. HILT is a new modality in our country and the experience from its application is small, especially in the treatment of OA of the knee. Aim of the paper was to compare the effect of HILT with LILT in the treatment of OA of the knee. Material and methods: This was a randomized comparative unilateral blind study involving 72 patients divided into two groups. The first group was treated with HILT, the second group treated with LILT. Outcome measure was the visual analogue scale (VAS) for pain, which was made on the first and tenth day of treatment. Statistical significance was defined as p <0.05. Results: We found a significant difference between the two groups in terms of VAS score after 10 therapies  in favor to a significantly lower score, that is, less pain in the HILT group (p = 0.0035). The comparison of the VAS score between the two times in the two groups separately showed that in both, the HILT and the LILT groups, the VAS score after 10 days of therapy was significantly lower compared to thatat 0 time, for consequently p = 0.00001vsp = 0.00001. Conclusion: Treatment with HILT and LILT significantly reduces pain and stiffness in patients with OA. Patients treated with HILT had better results, i.e., had a significant reduction in pain than patients treated with LILT. HILT was more effective than LILT.

Calcific tendinitis of the shoulder is a frequent disorder with an unknown etiology. It is usually treated with different physical therapy modalities where extracorporeal shockwave therapy comes as a new effective method.The aim of the study was to compare extracorporeal shockwave therapy and conventional physical therapy in the treatment of calcific tendinitis of the rotator cuff of the shoulder.The study is a prospective, monocentric clinical trial involving 40 patients with calcific tendinitis of the rotator cuff of the shoulder who were divided into two groups: group 1 (study group), 20 patients receiving extracorporeal shockwave therapy and performing shoulder exercises, and group 2 (control group), 20 patients who received conventional physical therapy with therapeutic ultrasound and diadynamic currents and performed shoulder exercises. Patients were evaluated with a Numerical Pain Scale and the range of motion in the shoulder joint was assessed. Clinical findings were evaluated before starting treatment and at the end of the treatment.All patients after the treatment showed statistically significantly better results in the Numerical Pain Scale and the shoulder range of motion.Extracorporeal shockwave therapy is a safe and non-invasive treatment that reduces pain and improves range of motion in the treatment of calcific tendinitis of the rotator cuff.

BACKGROUND:Achilles tendinopathy (AT) is a pathological state resulting from repetitive loading or stress on the tendon. The article aims to evaluate the effects of the low - energy radial extracorporeal shockwave therapy (RESWT) in the treatment of the adult with chronic insertional Achilles tendinopathy (AT) after the unsuccessful conservative treatment, with 18 months follow - up evaluation.CASE REPORT:We report the case of a 55 years - old male suffering from severe right posterior heel pain for 4 months. For his chronic insertional Achilles tendinopathy on the right heel, he received conservative treatment in the Institute of Physical Medicine and Rehabilitation. For outcome assessment, Numerical Rating Scale (NRS) for pain, the range of motion in the ankle, and Roles-Maudsley Score (RMS) for assessment of function were used. At the baseline the pain was severe, and he received physical therapy treatment. After unsuccessful conservative treatment, he underwent RESWT treatment. Numeric Rating Scale was significantly decreased at immediate, short-term and long-term follow-up. After the last treatment, the patient had no pain, and function assessed by Roles-Maudsley Score was excellent. At the follow-up check-up at 3, 6, 12 and 18 months the patient had no pain and excellent functional results.CONCLUSION:Radial ESWT is a safe and effective treatment even for a longer period for patients with chronic insertional Achilles tendinopathy.

Knee osteoarthritis is a common musculoskeletal disorder. Radial extracorporeal shock wave therapy (RECTUB) is as a new effective conservative method.This was a prospective, monocentric, interventional, non-randomized, controlled, clinical study that included a total of 50 patients divided into two groups. The study group was treated with RECTUB and kinesitherapy, and the control group was treated with conventional physical therapy and kinesitherapy. The patients' progress was monitored on the Numeric scale of pain and the WOMAC Index of functional ability before the treatment started; then immediately after its completion, and finally 3 months afterwards.It was shown that patients from the study and control groups did not differ significantly in terms of pain intensity at the treatment beginning and at their first control, while the difference in pain intensity between the two groups at their second control was significantly different in favor of the study group. The total value and the values of the three subscales on the WOMAC index were insignificantly different between the two groups before the treatment from a statistical point of view, with significantly lower values thereof obtained in patients in the study group at the first and second control.The results of this study demonstrate the benefits of using RECTUB as a safe, noninvasive, conservative treatment for knee osteoarthritis with better and longer-lasting effect on reducing pain and improving the functional ability of patients with knee osteoarthritis in contrast to patients treated with conventional physical therapy.