BACKGROUND: Chronic low back pain lasts longer than 12 weeks and is characterised by pain, muscle weakness, reduced functional ability and psychosocial burden. AIM: To compare the effects of two physical modalities, high-intensity laser against ultrasound therapy in the treatment of patients with chronic low back pain. MATERIAL AND METHODS: This was a prospective, monocentric, controlled clinical study comprising a group of 54 patients at the age between 25 and 65 years. Patients were divided into two groups: examined group of 27 patients (high-intensity laser and exercises) and a control group of 27 patients (ultrasound therapy and exercises). The results were evaluated by the Numeric Pain Rating Scale, Oswestry Disability Index and Schober’s test. Clinical findings were evaluated at the same time points for all patients, before treatment, at two weeks and three months following treatment. Statistical analyses were made to compare the differences between the results obtained on admission and the two consecutive control check-ups. Statistical significance was defined as a P value < 0.05. RESULTS: The examined group showed statistically significantly better results than the control group after completion of the treatment (at two weeks) and at follow up after three months. CONCLUSION: This study has shown that patient with chronic low back pain treated with a high-intensity laser has significantly reduced low back pain, reduced disability and improved range of motion. Its positive effect maintained for three months. It seems to be an effective, safe and useful physical modality in the treatment of a patient with chronic low back pain.

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.

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.

Спастицитетот на шаката по мозочен удар ги зголемува тешкотиите на болните во секојдневното самозгрижување и ја ограничува ефикасноста на рехабилитацијата. Радијалната екстракорпорална терапија со ударни бранови (РЕКТУБ) е предложена како алтернативен третман за редукција на спастицитетот. Целта на истражувањето беше да се евалуираат ефектите од апликација на РЕКТУБ на спастична шака по мозочен удар. Материјал и методи: Контролирана клиничка студија во која беа вклучени 30 пациенти со спастична шака по мозочен удар, поделени во две групи. Испитуваната група беше третирана со РЕКТУБ (6 третмани секој втор или трет ден) и стандардна рехабилитациона програма. Контролната група беше третирана само со стандарднарехабилитациона програма. За клиничка евалуација беа користени Модифицираната Ашфорт Сакала (МАС) и супскорот за моторно закрепнување од Фугл-Мајер тестот за процена на сензомоторната функција на горен екстремитет и тоа пред третманот, по завршување на 2-та, 6-та и 14-та недела од почетокот на рехабилитацијата. Резултати: Средната вредност на оцената на МАС беше значително намалена кај испитуваната група веднаш по РЕКТУБ. Кај испитуваната група се забележа значително подобрување на скорот за  моторно закрепнување на Фугл-Мајертестот. Овие резултати се задржаа 12 недели по третманот. Заклучок: РЕКТУБ го намали спастицитетот на шаката по мозочен удар и доведе до нејзино подобро моторно закрепнување.