Physical Rehabilitation and Recreational Health Technologies

Early Cervical Immobilization Combined with Targeted Rehabilitation in Hirayama Disease: A Case Report

Hasmik Mkrtchyan, Sargis Grigoryan, Tigran Petrosyan — Thu, 30 Apr 2026 00:00:00 +0300

Purpose. Hirayama disease is a rare, self-limiting lower motor neuron disorder characterized by asymmetric distal upper-limb weakness in adolescent males. Cervical collar immobilization is widely accepted as the primary conservative management strategy; however, evidence describing functional changes associated with structured rehabilitation during the progressive phase remains limited. Aim: to descriptively report short-term functional and electrophysiological changes observed following an individualized physiotherapy program combined with cervical immobilization in an adolescent with Hirayama disease.

Material & Methods. This observational case report describes a 17-year-old male with clinically, radiologically, and electrophysiologically confirmed Hirayama disease. Over a six-week period, the patient underwent continuous cervical collar immobilization alongside a structured rehabilitation program including stretching, core stabilization, progressive distal upper-limb strengthening, and task-specific hand training. Outcomes assessed before and after the intervention included wrist range of motion, postural stability, a composite hand-function performance index, and qualitative electromyographic findings.

Results. Following the intervention, improvements were observed in wrist mobility, including increased flexion and ulnar deviation, as well as modest gains in functional hand-task performance and grip-related measures. Postural stability improved by one level on a four-point balance scale. Electromyographic reassessment suggested changes in motor-unit recruitment patterns and compound muscle action potential amplitude, although these findings were qualitative in nature. The patient also reported reduced fatigability and improved coordination during daily activities.

Conclusions. In this single case, cervical immobilization combined with structured physiotherapy was associated with short-term improvements in upper-limb mobility, functional performance, and neuromuscular activation. The report supports the potential role of rehabilitation as an adjunct to conservative management and highlights the need for further systematic investigation using standardized outcome measures.

Maladaptation in middle-aged and elderly bodybuilders resulting from training loads with anaerobic energy supply

Thu, 30 Apr 2026 00:00:00 +0300

Purpose. To analyze the characteristics of maladaptation in novice middle-aged and elderly bodybuilders engaged in training programs with varying workload intensities and anaerobic energy supply mechanisms.

Material & Methods. 90 middle-aged and elderly men with only one year of bodybuilding experience were examined. Three groups of 30 people each were formed: the first (A) and second (B) groups consisted of middle-aged men, and the third (C) group consisted of elderly men. To monitor maladaptation and adaptation failure, blood biomarkers (creatine phosphokinase, lactate dehydrogenase, cortisol, and testosterone) were used. The studies were conducted before and after 3 months of using two exercise regimens differing in intensity (Ra=0.78; Ra=0.56), anaerobic energy supply mechanisms, and training models 1 and 2.

Results. After 12 months of using the traditional training model during the initial phase of the study, middle-aged and elderly bodybuilders showed low levels of adaptive reserves. Specifically, in response to a test load (Ra=0.67), there was a significant increase in LDH (+61.7%) and a simultaneous decrease in cortisol (–17.8%) in their blood. The application of high-intensity training loads (Ra=0.78) over three months positively affected long-term adaptation in middle-aged bodybuilders. Baseline levels of CPK and testosterone increased by 30.9% and 29.3%, respectively, while LDH decreased by 5.3%. In response to a stimulus, moderate increases were observed in CPK (+3.9%), LDH (+5.6%), and testosterone (+9.4%), indicating an adequate physiological response. In elderly participants, signs of maladaptation included an increase in baseline CPK levels (+564.4%) and cortisol (+117.1%) above the upper reference limits. In response to the test load, CPK and LDH levels exceeded the upper reference limits, along with decreased blood cortisol, indicating failure to adapt. After extended use of training model 2, elderly bodybuilders showed signs of successful long-term adaptation, with basal LDH levels decreasing (–10.1%), and in response to the stimulus, testosterone (+25.6%), CPK (+8.1%), and cortisol (+11.9%) all rose simultaneously. The maladaptive signs seen in middle-aged participants included a decline in baseline testosterone (–14.6%) and increases in blood LDH (+119.8%) and cortisol (+95.6%). Adaptation failure in response to the test load was marked by exceeding the upper limits of LDH and a decrease in blood cortisol (–30.0%).

Conclusions. Research findings suggest the need for a detailed study of changes in blood biomarkers to predict signs of adaptation failure and maladaptation in middle-aged and elderly novice bodybuilders as they develop training programs. The study revealed that, depending on training regimens, variability of exercises, and energy supply mechanisms, middle-aged and elderly novice bodybuilders exhibited different types of adaptive and compensatory reactions. The results showed that only bodybuilders of late middle age did not exhibit signs of adaptation failure or maladaptation, despite using various training models.

Functional overreaching and adaptation failure in special operations forces servicemen with varied resistance during intensive loads

Andrii Savenko, Ivan Shtefiuk, Oleh Olkhovyi, Ihor Pashkov, Andrii Chernozub — Thu, 30 Apr 2026 00:00:00 +0300

Purpose. To study the features of manifestations of adaptive and compensatory reactions for assessing the state of functional overreaching against the background of adaptation failure of special operations forces servicemen with different levels of resistance in the process of intensive loads.

Material & Methods. 75 special operations forces servicemen (men) aged 25±3.2 years were examined. Previously, the participants were using high-intensity loads with a large volume of work in their units for 3 months. The participants were divided into three groups depending on their units. During the test trials, modes of strength loads of different volumes and intensities were used (Ra=0.56; Ra=0.68; Ra=0.78). To assess the basal level and features of adaptive and compensatory reactions of the examined in response to a stress stimulus, indicators of spectral analysis of heart rhythm and blood biomarkers (creatine phosphokinase, lactate dehydrogenase, cortisol) were used.

Results. It was established that after the preliminary 3 months of high-intensity training, 50% of servicemen of each unit have a high level of adaptive reserves. Thus, these participants (subgroups 1A, 2A, 3A), by the type of heart rhythm regulation, belong to normotensives, and the studied blood biomarkers are within the reference values. In the other part of the examined, the initial parameters of the tension of the heart rhythm regulation systems were on average 5.4 times higher compared to the opponents, and the basal level of biochemical blood indicators exceeded the upper limits of the reference. Similar results of the studied biomarkers, which were found in the servicemen of the subgroups (1B, 2B, 3B), indicate a possible state of adaptation failure. It was found that in response to test trials using different load modes, in servicemen of each of the subgroups with adaptation failure, a completely opposite nature of adaptive and compensatory reactions was recorded. A decrease in the level of tension of the heart rhythm regulation systems and VLF power, stability of the cortisol level in the blood, and the absence of enzymes exceeding the reference limit in response to a stimulus indicate the mechanisms of short-term adaptation. The effectiveness of the implementation of short-term adaptation mechanisms was recorded only in servicemen of subgroup 2B (Ra=0.68) and in representatives of subgroup 1B (Ra=0.78). In all other cases, a shift in the autonomic balance towards sympathetic activity was recorded against the background of strengthening the central circuit with a simultaneous increase in lactate dehydrogenase and a decrease in cortisol in the blood, which indicates compensatory reactions to the stimulus.

Conclusions. It was established that in servicemen, regardless of the peculiarities of their special operations forces units, training system, and even the type of heart rhythm regulation, we simultaneously record both a high level of functional capabilities and a state of adaptation failure. It was investigated that the use of basal parameters of HRV indicators and biochemical blood indicators to determine the state of functional overreaching (FOR) in servicemen of special operations forces units with signs of adaptation failure is insufficient. The identified features of adaptive and compensatory reactions of the body of special operations forces servicemen against the background of adaptation failure to different intensity load modes require a radical correction of the process of optimizing the training system.

Effectiveness of suboccipital muscle inhibition technique in patients with chronic headache: a pilot study

Hareeshankar D., Sathya Siva, Aravind S., Boopathy D., Dilip G. — Thu, 30 Apr 2026 00:00:00 +0300

Purpose. To evaluate the effectiveness of the suboccipital muscle inhibition (SMI) technique in reducing headache intensity and headache-related disability, and to compare its outcomes with general exercise therapy in patients with chronic headache.

Material & Methods. This randomized controlled pilot study was conducted at Saveetha Hospital, Chennai, India. Thirty-four patients with chronic headache aged 25–60 years were randomly allocated into two groups: Group A (SMI, n=17) and Group B (General Exercise Therapy, n=17). Interventions were administered three times per week for four weeks. Outcomes included the Numerical Pain Rating Scale (NPRS) and the Headache Impact Test-6 (HIT-6), assessed at baseline and post-intervention. Data normality was evaluated using the Shapiro–Wilk test, which showed non-normal distributions; therefore, non-parametric tests were used. Within-group comparisons were analyzed using the Wilcoxon signed-rank test, and between-group differences were assessed using the Mann–Whitney U test. Effect sizes (r) and 95% confidence intervals (CI) were calculated. Statistical significance was set at α=0.05 (two-tailed).

Results. All 34 participants completed the study, with no adverse events reported. Within-group analysis using the Wilcoxon signed-rank test demonstrated significant reductions in pain intensity and headache-related disability in both groups (p<0.05). In Group A, NPRS scores decreased from 7.29±0.92 to 5.00±1.00, while Group B showed a reduction from 7.29±0.98 to 6.53±0.80, indicating greater improvement with SMI. HIT-6 scores also decreased in Group A from 55.06±2.77 to 52.94±2.75, and in Group B from 55.53±2.56 to 53.76±2.46. Overall analysis showed a significant reduction in HIT-6 scores from 55.29±2.54 (95% CI: 54.41–56.17) at pre-test to 53.35±2.60 (95% CI: 52.44–54.26) at post-test (p<0.05, Mann–Whitney U test), with a small-to-moderate effect size (r=0.179). NPRS scores reduced from 7.29±0.94 (95% CI: 6.96–7.62) to 5.76±1.18 (95% CI: 5.35–6.17), demonstrating a statistically significant and clinically meaningful reduction in pain (Z=−3.844, p<0.001) with a large effect size (r=0.659).

Conclusions. Suboccipital muscle inhibition was more effective than general exercise therapy in reducing headache intensity and produced meaningful improvement in headache-related disability. The findings support SMI as a safe, healthy and effective non-pharmacological intervention for chronic headache management. Larger randomized controlled trials with extended follow-up are warranted to confirm these pilot findings.

The use of adaptive rowing in complex rehabilitation of wounded patients with lower limb amputations

Thu, 30 Apr 2026 00:00:00 +0300

Purpose. Mine-blast injuries represent a leading cause of modern combat-related trauma, often resulting in unilateral or bilateral lower-limb amputation. One of the most promising contemporary approaches in rehabilitation of the wounded with lower limb amputations is adaptive sports, in particular, adaptive rowing. The study aimed to investigate the effectiveness of adaptive rowing in the complex rehabilitation of individuals with lower-limb amputations.

Material & Methods. The study involved 30 wounded servicemen with lower limb amputations undergoing rehabilitation, randomly allocated into a main group (n=15) and a control group (n=15). All participants received standard rehabilitation according to established clinical protocols. The wounded in the main group performed rowing technique exercises in the main part of the session, both on the water and on a rowing machine, allowing upper-body engagement while accommodating reduced or absent lower-limb function. The rehabilitation course for both groups was 30 days.

Results. Patients in the main group showed a significantly greater improvement (p<0.05) in the indicators for the scales "Physical functioning" and "Social functioning". These improvements in the "Physical Functioning" domain may be explained by using more load-bearing exercises on the rowing machine. In that case, the improvement in the "Social functioning" assessment directly indicates the positive social aspect of using adaptive rowing. The most demonstrative changes were in the depression level in the main group, which led to a change in the depression level assessment from clinically pronounced to subclinical.

Conclusions. The use of adaptive rowing in the comprehensive rehabilitation of the wounded with lower limb amputations is an effective method for improving the quality of life and optimizing the psycho-emotional status.

A Study of comparative effectiveness of Otago Exercise and Retro Walking along with moist heat therapy in osteoarthritis

Priyali Priyadarsini, Gunarathna K., Prasanna Mohan, Jayaprakash Janarthanan — Thu, 30 Apr 2026 00:00:00 +0300

Purpose. Osteoarthritis (OA) is a leading cause of pain and disability among older adults, frequently leading to decreased physical functioning and quality of life. Exercise therapy has been considered one of the most effective non-pharmacological treatments for OA. This study aimed to compare the effects of the Otago Exercise Program and retro walking, both combined with moist heat therapy, on pain reduction and functional improvement in individuals with OA.

Material & Methods. This was a randomised, pre-test–post-test experimental study with three parallel groups that recruited 63 participants aged 40–60 years diagnosed with chronic knee osteoarthritis. Participants were randomly allocated into three groups: Group A (Otago exercise program + moist heat therapy), Group B (retro walking + moist heat therapy), and Group C (moist heat therapy alone). Interventions were administered three times per week for six weeks. Pain intensity and functional status were assessed using the Numerical Pain Rating Scale (NPRS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Data were analyzed using non-parametric statistical tests, including the Wilcoxon Signed-Rank Test and the Kruskal–Wallis test with Dunn’s post-hoc analysis. Effect sizes were calculated to estimate practical significance.

Results. Sixty participants completed the study, and all intervention groups demonstrated statistically significant improvements in pain intensity and functional status (p<0.05). The Otago Exercise Programme (OEP) group exhibited the greatest reductions in pain and functional disability, with a 63.47% decrease in NPRS scores and a 56.05% reduction in WOMAC scores. These improvements were associated with large within-group effect sizes for pain and function (WOMAC: r=0.88, Cohen’s d=3.91; NPRS: r=0.88, Cohen’s d=5.14), indicating a strong and clinically meaningful treatment effect. The mean change in WOMAC scores in the OEP group was 47.95 (95% CI: 42.21–53.69), while the mean reduction in NPRS scores was 5.30 (95% CI: 4.82–5.78). Between-group analysis revealed that the OEP was significantly more effective than both retro walking and moist heat therapy (p<0.001), with between-group effect size (η²=0.94), demonstrating treatment efficacy and supporting the clinical superiority of the multicomponent exercise intervention.

Conclusions. The Otago Exercise Program combined with moist heat therapy was found to be superior in reducing pain and improving functional outcomes in individuals with knee osteoarthritis. Its low cost, safety, and ease of implementation support its use in both clinical and community-based rehabilitation settings.

Bridging the Legitimacy Gap: Epistemic Authority and Self- Efficacy in NCD Screening Among Indonesian Industrial Workers

Nasrul Zaman, Marthoenis, Umi Salmah, Yuseva Sariati, Atik Badi'ah — Thu, 30 Apr 2026 00:00:00 +0300

Purpose. Non-Communicable Diseases (NCDs) pose a critical burden on Indonesia's industrial workforce, yet participation in government-mandated screening remains suboptimal, indicating a disconnect between service availability and acceptance. This study aimed to analyse the determinants of perceived program effectiveness among workers, focusing on the mediating role of self-efficacy and distinct influences of multi-level social support.

Material & Methods. A cross-sectional study involving 1,050 blue-collar workers from seven industrial estates was conducted. Data were analysed using Partial Least Squares Structural Equation Modelling (PLS-SEM) to test the structural relationships and mediation effects.

Results. Family and peer support significantly built self-efficacy but did not directly influence program perception. While self-efficacy strongly predicted perceived effectiveness, a critical "legitimacy gap" emerged. Health professionals significantly influenced program perception and exerted an overwhelming influence on cadres, yet cadres themselves failed to affect program effectiveness directly. The structural model demonstrated substantial explanatory power, with the combined variables accounting for 35.8% of the variance in perceived program effectiveness (R2).

Conclusions. These findings may challenge the universality of the WHO’s "Task-Shifting" model in paternalistic cultures. In Indonesia’s hierarchical context, relying solely on cadres may create a "legitimacy gap" as workers tend to prioritize the "epistemic authority" of professionals. Consequently, effective interventions require "legitimacy transfer" strategies to bridge the authority gap between medical professionals and community-based cadres.

Physical Activity, Body Mass Index, and Functional Movement- Based Injury Risk

Khoiril Anam, Nanang Indardi, Anies Setiowati, M. Syahrul Muafi, Adi S — Thu, 30 Apr 2026 00:00:00 +0300

Purpose. This study aimed to investigate the relationship between physical activity, Body Mass Index (BMI), and functional movement-based injury risk in non-athlete university students.

Material & Methods. A cross-sectional study design was used, involving 141 students (68 males, 73 females). Physical activity was assessed using the Global Physical Activity Questionnaire (GPAQ), BMI was calculated from anthropometric measurements, and functional movement quality was evaluated using the Functional Movement Screen (FMS).

Results. Spearman’s correlation analysis revealed a weak but significant positive correlation between physical activity and FMS scores (rs=0.270, 95% CI: 0.123 to 0.412, p=0.001). BMI showed a weak but significant negative correlation with FMS scores (rs=–0.205, 95% CI: –0.349 to –0.036, p=0.015). No significant correlation was found between physical activity and BMI (rs=–0.113, 95% CI: –0.281 to 0.071, p=0.181).

Conclusions. Physical activity and BMI were significantly associated with functional movement quality in non-athlete college students. Higher levels of physical activity were associated with better functional movement quality, whereas a higher BMI is associated with reduced functional movement quality. Although these correlations were relatively weak, these findings highlighted the importance of maintaining an active lifestyle and healthy body composition to support functional movement and reduce the risk of injuries related to functional movement. Further longitudinal studies using objective measurements are recommended.

Structural analysis of musculoskeletal disorders in karate athletes aged 8–12

Thu, 30 Apr 2026 00:00:00 +0300

Purpose. The aim of the study was to determine the structure and frequency of musculoskeletal disorders in karate practitioners aged 8–12 in order to develop a correction program based on technical exercises from traditional Shotokan karate-do.

Material & Methods. The study included 118 athletes (79 boys and 39 girls) from the Kharkiv Regional Shotokan Karate-do Federation with varying training experience. Data on musculoskeletal complaints, personal, and family history were collected via parent questionnaires. Foot arch condition was assessed using plantography with FreeStep software, calculating Weissflog and Stitzler-Godunov indexes, Clarke angle, hallux valgus, fifth toe varus deviation, and gamma angle with additional measurements of the heel valgus deviation. Posture deviations were assessed using scoliometry with MultiReha software, measuring asymmetry of spinal landmarks, shoulder line, posterior superior iliac spines, and spinous processes.

Results. Complaints related to the musculoskeletal system were reported in 23 children, while only 6 were on preventive records. Valgus deviation of the heel was observed in 69.23% of cases, with symmetrical distribution and confirmed mobile flat-valgus deformity by tip-toe test. The gamma angle, reflecting longitudinal and transverse arch flattening, decreased with increasing training experience, from 41.54% (left foot) and 33.85% (right foot) in 1–2 years training to 36.92% and 26.15% in athletes training over 5 years. Stitzler-Godunov coefficient indicated longitudinal arch flattening in 25.64% of cases, predominantly on the left foot. Hallux valgus (alpha angle) was detected in 26.50% (left) and 25.64% (right) of athletes, while fifth toe varus (beta angle) occurred in 85.47% symmetrically. Scoliotic posture was found in 47.5% of children, with isolated spinal deviations in 30% and combined with flat-valgus foot deformity in 57.5%.

Conclusions. Static musculoskeletal deformities, both isolated and combined, are common among 8–12-year-old karate practitioners, with prevalence consistent with literature data. Flat-valgus foot deformities, as the primary load-bearing component of the musculoskeletal system, can contribute to pathological posture development. In the context of war and distance learning, these conditions highlight the need for preventive measures and corrective-rehabilitation programs using technical exercises suitable for limited physical activity environments.