Comparison of Effectiveness of Passive Hamstring Stretching Technique and Neurodynamic Sciatic Nerve Sliding Technique in Low Back Pain

Objective: Low back pain (LBP) is a very common health problem worldwide having global point prevalence of 9.4%. Correlations have been found between decreased length of the hamstrings and LBP. It was found that improving the flexibility of hamstrings can significantly reduce chronic LBP. This study compared the effectiveness of two techniques i.e. passive hamstring stretching technique (PHS) and neurodynamic sciatic nerve sliding technique (NDS) on hamstring flexibility and pain in non-radiating LBP patients. Methods: 26 patients between the age group of 25-45 years having non-radiating LBP were recruited in the study. Group A (n=13) were given passive hamstring stretching while Group B (n=13) performed neurodynamic sciatic nerve sliding technique under guidance of the researcher. Baseline data were obtained for hamstring length and pain before and after intervention. Pain was assessed using ‘visual analogue scale’ and hamstring length was measured using ‘passive knee extension test’. Intervention was performed on alternate days for three sessions with 48 hours rest period in between each session. Results: Data were analysed for hamstring length and pain between both the groups using ‘unpaired t’ test. NDS technique was statistically significantly more effective in improving pain (p =0.03 at 95%CI= -2.07 to -0.09). There was no statistically significant difference in the effectiveness of both techniques in improving hamstring length (p =0.08 at 95%CI= -3.4 to 0.25). Conclusions: Both the techniques are equally effective in improving hamstring length, however NDS was more effective in improving pain in low back pain patients as compared to PHS. Keywords: Low back pain; Neural sliders; Static hamstring stretch; Hamstring flexibility .

Trajectory Tracking Control of Mobile Manipulators Subject to Unknown External Forces

This work proposes a new class of controllers for mobile manipulators subject to both undesirable forces exerted on the end-effector and slip reaction forces acting on the platform wheels, unknown friction forces coming from joints directly driven by the actuators as well as undesirable forces caused by kinematic singular configurations appearing on the mechanism trajectory. Based on suitably defined task space non-singular terminal sliding manifold (TSM) and the Lyapunov stability theory, we derive a class of estimated extended transposed Jacobian controllers which seem to be effective in counteracting the unstructured forces. Moreover, in order to eliminate (or to alleviate) undesirable chattering effects, the proposed control law involves second order sliding technique. The numerical computations closely related to an experiment, which are carried out for a mobile manipulator consisting of a platform of (2, 0) type and holonomic manipulator of two revolute kinematic pairs, illustrate the performance of the proposed controllers.

Assessment of the Algorithms for Diagnostics and the Possibilities of Treating Patients with a Penile Dysmorphie Disorder

The article discusses issues related to the choice of diagnostic algorithms and planning tactics for treating patients with penile dysmorphophobia. The psychological characteristics of this group of patients, methods of diagnosis, psychotherapy correction and the choice of surgical tactics are sounded. The manifestations of penile dysmorphophobia and dysmorphomania, as disorders of a deeper level, are considered as an integrative problem solved from the standpoint of urology, psychotherapy, and aesthetic surgery. In conjunction with an andrologist, the involvement of a psychotherapist and, if necessary, a psychiatrist is required. At the initial stages of working with a patient, narrowly focused psychotherapy is used. The next level of correction is cognitive behavioral psychotherapy (CBT) with the technique of “exposure and prevention of reactions” or “cognitive restructuring”. The “mindfulness CBT” technique is considered important for teaching the patient the ability to stop subjective perception of personal experiences. To consolidate the result, individual hypnosuggestational therapy and group (family) psychotherapy are used. The indications for surgical enlargement of the penis are divided into medical, functional and aesthetic. Penile dysmorphophobia is an aesthetic indication for surgery. Contradictions in carrying out such interventions include the lack of standardized methods with a high positive prognosis, overestimated patient expectations, and the lack of a result to improve a man’s self-esteem even with a positive result of the operation. The clinic of the Department of Sexopathology and Andrology of the State Institution «Institute of Urology of the National Academy of Medical Sciences of Ukraine» uses a ligamentotomy technique to lengthen the penis and implant a polypropylene mesh under the superficial fascia of the penis to thicken it. For patients with manifestations of penile dysmorphophobia simultaneously with severe forms of erectile dysfunction, a number of operations have been proposed for the simultaneous installation of penile implants and augmentation of the tunica albuginea using a graft: corporoplasty with a circular graft, Sliding Technique, modification of the sliding technique (MoST), Multiple-slid-Technique (MuST) augmentation technique. These techniques are not included in the list of recommendations offered by the urological community; they have high predictable risks of complications requiring urgent explantation of the prosthesis and irreversible loss of penile length.

Achilles tendon Z-plasty with rollover tensor fascia lata graft for correction of equinus foot deformity

Equinus deformity is a condition in which dorsiflexion movement of the ankle joint is limited or decreased. Equinus deformity arises due to contracture/shortening/tightening in achilles tendon or soleus muscles or gastrocnemius muscle. The lengthening procedure of the achilles tendon can be done by various techniques such as the open or percutaneous method and Z-plasty versus sliding technique. Here we reported a case of post-traumatic equinus deformity of the right foot. The patient’s dorsiflexion movement was restricted. In this case, the patient was operated for open Z-plasty of the achilles tendon with rollover tensor fascia lata graft for lengthening of the contracted achilles tendon. The patient was discharged on the third postoperative day uneventfully. After 7 months of follow-up, the patient was walking normally without limping with the full range of motion at the right ankle joint as similar to his left ankle joint.

Crossover effects of ultrasound-guided percutaneous neuromodulation on contralateral hamstring flexibility

Background Crossover effects refer to the responses of a non-exercised contralateral limb. There is evidence of this effect, as it relates to muscle fatigue, strength, and stretch, but not as it relates to neuromodulation. Objectives To compare the crossover effects of percutaneous neuromodulation (PNM) on hip range of motion (ROM), observed in a straight leg raise (SLR) test, in asymptomatic participants with bilateral reduced hamstring flexibility, versus the neurodynamic sciatic sliding technique, hamstring stretching and mechanical stimulation of the sciatic nerve using a needle (without electrical stimulation). To evaluate the tensiomyographic changes between the two lower limbs after these interventions. Methods 80 participants with bilateral reduced hamstring flexibility were randomized into four groups: Stretching, Neurodynamic, PNM, and Needle groups. All interventions were performed on the right limb. Each participant’s leg was subjected to SLR testing and tensiomyography before and after the interventions. Results Each group improved their SLR values in the non-intervention limb compared to baseline values, but the PNM and Needle groups obtained higher values for the SLR test in the non-intervention limb compared with the Neurodynamic and Stretching groups. There were statistically significant differences for mean SLR measures between limbs pre- and post-intervention for all groups except the PNM group, suggesting crossover effects for PNM but not the other techniques studied. There were no differences in tensiomyographic assessments between groups or between sides, at baseline or upon completion of the study. Conclusion PNM produced benefits in the SLR test in the non-intervention limb and only 1.5 min was enough to obtain this effect. In addition, no technique interfered with muscle activation.

Flap Sliding Technique for Managing Flap Striae following Laser In Situ Keratomileusis

Purpose. To assess the efficacy and safety of a simple, noninvasive, “flap-sliding” technique for managing flap striae following laser in situ keratomileusis (LASIK). Methods. This prospective, interventional study included eyes with post-LASIK flap striae. All eyes underwent flap sliding 1-2 days after surgery. Following flap edge epithelialisation, a cellulose sponge was used to gently slide the flap perpendicular to the striae direction. This technique allows for flap striae treatment without flap lifting, avoiding any associated lifting complications. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and refractive error were monitored one day after the flap-sliding procedure. Results. Fifteen eyes (15 patients) with post-LASIK flap striae were managed using the flap-sliding technique. The procedure did not successfully relocate the flap striae in 1 eye, and flap elevation and floating (using a balanced salt solution) were required. Therefore, 14 eyes were included in post-flap-sliding analyses. The UDVA improved in all patients the first day after the flap-sliding procedure was performed, with 11 of 14 eyes (78.57%) reaching an UDVA of 20/25 or better. Complications following flap sliding occurred in 2 eyes (14.29%). One eye had intraoperative epithelial abrasion, and 1 eye had residual postoperative striae outside of the optical zone. Conclusion. The flap-sliding technique is a simple, noninvasive, efficient, and safe technique for managing post-LASIK flap striae that develop after epithelial healing in the early post-LASIK period. This trial is registered with NCT04055337.