Background: Earlier randomized controlled trials (RCTs) reported only midterm (3-4 months) results of extracorporeal shockwave therapy (ESWT) as a treatment for noninsertional Achilles tendinopathy (NAT). This study compared the effectiveness of an eccentric loading program followed by stretching exercises combined with ESWT (study group) or sham ESWT (control group) for treating chronic NAT in both the short and long term. Methods: This double-blind RCT was conducted between 2018 and 2020. Adult patients with unilateral NAT who failed standard conservative treatment were randomly allocated to either group. Function and pain were assessed at baseline, 1 month, and 16 months using the Victorian Institute of Sport Assessment–Achilles questionnaire (VISA-A) and visual analog scale (VAS), respectively. Mixed-design analysis of variance and nonparametric statistics were performed. Twenty-two men and 28 women aged 18 to 40 years were allocated into 2 equally matched groups. Results: Function and pain scores in the study group were not significantly different from control group scores at baseline (VISA-A: 22.2 ± 6.5 vs 21.0 ± 5.2 and VAS: 8 ± 1 vs 8 ± 1, respectively). Both groups significantly improved posttreatment (VISA-A: 85 ± 6.2 vs 53.4 ± 7.7 and VAS: 1 ± 2 vs 7 ± 2, respectively). At the 16-month follow-up, outcome scores declined slightly but significantly in the study group (VISA-A: 80 ± 5.3; VAS: 3 ± 2) and improved in the control group (VISA-A: 67 ± 5.6; VAS: 5 ± 1). However, both groups were significantly better than baseline. At both time points, the study group had significantly superior scores (statistically and clinically) than the control group ( P = .0001). Conclusions: Combining calf eccentric loading with stretching exercises resulted in significant improvements in the pain and functional scores in patients with NAT. Adding ESWT to this combined protocol resulted in significantly greater improvements in both the short and long term. Level of Evidence: Level I, randomized controlled trial.

Background Complex regional pain syndrome (CRPS) is a chronic condition following inciting events such as fractures or surgeries with sensorimotor and autonomic manifestations and poor prognosis. This review aimed to provide conclusive evidence about the sensory phenotype of CRPS based on quantitative sensory testing (QST) to understand the underlying pain mechanisms and guide treatment strategies. Databases Eight databases were searched based on a previously published protocol. Forty studies comparing QST outcomes (thermal, mechanical, vibration, and electric detection thresholds, thermal, mechanical, pressure, and electric pain thresholds, wind-up ratio, mechanical pain sensitivity, allodynia, flare area, area after pinprick hyperalgesia, pleasantness after C-tactile stimulation, and pain ratings) in chronic CRPS (adults and children) versus healthy controls were included. Results From 37 studies (14 of low quality, 22 of fair quality, and 1 of good quality), adults with CRPS showed: (i) significant loss of thermal, mechanical, and vibration sensations, significant gain of thermal and mechanical pain thresholds, significant elevation of pain ratings, and no difference in wind-up ratio; (ii) significant reduction of pleasantness levels and increased area of pinprick hyperalgesia, in the affected limb. From three fair-quality studies, adolescents and children with CRPS showed loss of cold detection with cold hyperalgesia in the affected limb. There was moderate to substantial overall heterogeneity. Conclusion Diffuse thermal and mechanical hypoesthesia with primary and secondary hyperalgesia, enhanced pain facilitation evidenced by increased area of pinprick hyperalgesia, and elevated pain ratings are dominant in adults with CRPS. Adolescents and children with CRPS showed less severe sensory abnormalities.

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Background: Dorsal hyperkyphosis is a condition indicated by the abnormal increase in the curvature convexity of the thoracic vertebral column. The neck pain is a common clinical complaint that commonly seen at physiotherapy clinics all over the world. In order to properly prevent or treat a clinical problem, potential risk factors need to be identified. Aim of the Study:The purpose of this study was to investigate the correlation between thoracic hyperkyphosis and cervical ROM, neck pain and functional abilities of the neck. Subjects and Methods:Sixty subjects diagnosed as mechanical neck pain with dorsal hyperkyphosis of both sexes participated in this study. Their ages ranged from 20 to 40 years. Agreement of the Ethical Committee of Faculty of Physical Therapy was obtained before beginning of the study, degree of hyerkyphosis was measured by gravity dependent inclinometer, assessment of cervical range of motion was performed by the researcher via using OB Myrien inclinometer, VAS scale was used for assessment of neck pain, and NDI was used for assessment of neck disabilities.Results: There was a statistical significant positive correlation between degree of hyperkyphosis and neck pain, there was a statistical significant negative correlation between degree of hyperkyphosis and neck extension, there was no correlation between degree of hyperkyphosis and neck disabilities and there was no correlation between degree of hyperkyphosis and neck flexion, side bending and neck rotation.Conclusion: Degree of dorsal hyperkyphosis could affect the severity of neck pain and could decrease the mobility of the neck in the extention range of motion. On the other side degree of dorsal hyperkyphosis couldn't affect neck abilities and the mobility of the neck in the other directions.