mohamed ali, M., S. M. Elhafez, S. M. Abdelmeged, and A. F. Hanafy, "Which is better to decompress the nerve roots in cervical radiculopathy: stretching or traction from foraminal opening position?", Physiotherapy Quarterly, vol. 32(3), issue 2544-4395, pp. 52-62, 2024. elrazzy_paper_2024.pdf
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Ashour, A. A., S. M. Elhafez, M. M. ElMeligie, and A. F. Hanafy, "Crossover effect of knee and ankle joint training on knee mechanics after ACL reconstruction: A randomized controlled trial", Gait and Posture, vol. 113, issue 2024, pp. 512-518, 2024. 3-_journal_of_gait_and_posture_q2_wos_accepted_august_2024_.pdf
Elhafez, S. M., A. A. Ashour, N. M. Elhafez, G. M. Elhafez, and A. M. Abdelmohsen, "Percentage Contribution of Lower Limb Moments to Vertical Ground Reaction Force in Normal Gait", Journal of Chiropractic Medicine, vol. 18, issue 2, pp. 90-96, 2019. 1-_first_paper.pdf
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Youssef, N. M., A. M. A. E. Mohsen, A. A. Ashour, and S. M. Elhafez, "Effect of different balance training programs on postural control in chronic ankle instabitly: a randomized controlled trial", Acta of Bioengineering and Biomechanics, vol. 20 (2), pp. 159-169, 2018.
Elhafez, S. M., and M. M. M. Eisa, "Effect of Specific Training Programmes on Hip Musculature Peak Torque in Osteoporotic Patients", International Journal of PharmTech Research, vol. 9, issue 8, pp. 103-109, 2016. osteoporosis.pdf
Elhafez, S. M., N. S. Nassif, G. M. Elhafez, S. Abdelwahid, and M. M. Ali, "Lower Extremity Flexors and Exttensors Isokinetic Testing During Closed Kinetic Chain", World Confederation for Physical Therapy WCPT, Vancouver, Canada, 09-22, pp. 93(S1):S552, 2007. Abstract

PURPOSE: This study was conducted to determine the lower extremity flexors/extensors ratio of the dominant side in normal individuals during closed kinetic chain (CKC) isokinetic testing and to investigate the effect of velocity on this ratio. RELEVANCE: Although the CKC activities have been introduced and well documented as an alternative tool to evaluate patient’s ability to return to a higher functional level, limited data exists about muscle strength balance during this type of activities. This study provides the information regarding muscle strength balance in multiple joint performance, i.e. CKC activity which may help in assessment of functional performance and for injury prevention. PARTICIPANTS: Thirty healthy male subjects with a mean age of 19.8±2.9 years volunteered to participate in the study. They were free from any musculoskeletal impairment. METHODS: Each subject was asked to perform a CKC testing (leg press task) which consisted of concentric isokinetic lower extremity flexion and extension at linear velocities of 24.44 cm/sec (slow velocity), 48.89 cm/sec (medium velocity), and 73.33 cm/sec (fast velocity). The test was performed using a Biodex system 3-isokinetic dynamometer. ANALYSIS: One way ANOVA with repeated measures was performed using StatGraphics software to test the effect of the three velocities on the peak force ratio. RESULTS: The main outcome of this study was that the peak force ratios of the lower extremity flexors and extensors were 0.36, 0.48, and 0.60, at slow, medium and fast velocities respectively. There was a significant increase (p < 0.05) in flexors/extensors ratios of peak force with increased speed. The total work and average power ratios remained constant around 0.30 with no significant difference (p > 0.05) between the three tested velocities. CONCLUSIONS: Ratio of peak force is velocity dependent. When using this ratio as an evaluative tool of the leg strength, the velocity dependent changes in the flexors/extensors ratio must be taken into consideration. Total work produced and average power generated, are highly relevant measures but are not affected by increasing speed. IMPLICATIONS: The CKC ratio of isokinetic testing can be used as an alternative tool to assess the isokinetic muscle strength instead of only depending on the open kinetic chain ratio of flexors and extensors. KEYWORDS: Isokinetic, Closed Chain. FUNDING ACKNOWLEDGEMENTS: This study was not funded. CONTACT: drsobhymahmoud@yahoo.com, Nagui3@gega.net

Ali, M. M., S. M. Elhafez, and H. M. elhafez, "Effect of Trunk Rotation on Soleus H-Reflex and Radicular Symptoms in Subjects with Sciatica", World Confederation for Physical Therapy WCPT, Vancouver, Canada, 990, pp. 93(S1):S31, 2007. Abstract

PURPOSE: The first aim of this study was to test the effect of trunk rotation from side lying (on the pain free side) on soleus H-reflex and radicular symptoms in case of discogenic sciatica. The second aim was to test whether a prolonged use of this position as a home program can reduce the radicular symptoms. RELEVANCE: Controlling or reducing radicular pain without drug intake is the main purpose of effective treatment. This study identifies how this pain could be reduced using positional technique of the trunk in subjects with discogenic sciatica. PARTICIPANTS: Thirty subjects with L5-S1 sciatica were randomly selected and examined. Their age ranged from 25-45 years. They were all suffering from unilateral sciatica with radicular symptoms (pain, numbness, and/or weakness) matching the dermatomal distribution of S1 nerve root. METHODS: H-reflex of the soleus muscle was recorded by stimulating the posterior tibial nerve using 1 ms pulse at 0.2 pps and recording the reflex using surface electrodes. For each subject, H reflex was tested in two positions (the unloading prone lying and the loading standing positions). The H-reflex was tested for three times. The first time was before any treatment. The second time was immediately after the subject had assumed the position (trunk rotation from side lying) for 15 minutes. Then each subject was instructed to assume this position three times per day for 2 weeks as a home program and after that the H reflex was recorded for the third time. The pain intensity was tested using Visual Analogue Scale (VAS) in the three tested conditions and Stanford score was measured in the first session and after the 2 weeks of home program to test how effective the treatment has been. ANALYSIS: The Stanford score was tested using t-test. Two ways ANOVA was carried out by using StatGraphics software with multiple range test to examine the significant difference between the three studied conditions. RESULTS: The results of the study indicated that trunk rotation from side lying position on the pain free side significantly increases (p < 0.05) the amplitude of the soleus H reflex whether tested in loading or unloading position. Similarly the statistical analysis revealed that the level of pain reduced significantly (p < 0.05) after positioning. On the other hand the results indicated that the prolonged use of this position as a home program (for 2 weeks) maintained the improvement of the H reflex of the soleus muscle. The functional performance of the subjects improved significantly (p < 0.05) after two weeks of positioning. CONCLUSIONS: Trunk rotation from side lying position (on the pain free side) improves the H reflex of the soleus muscle and significantly reduces the pain of the affected lower limb. IMPLICATIONS: Using trunk rotation as a treatment program for subjects with sciatica was reported to be effective in reducing the radicular pain in the affected extremity. In addition this position improves the functional performance of the subjects when used as a home program. KEYWORDS: Sciatica, Rotation, H-reflex. FUNDING ACKNOWLEDGEMENTS: This research study was not funded. CONTACT: dr3mpt@yahoo.com, balbaaaa@yahoo.com, egyptsalam@yahoo.co.uk

Elhafez, S. M., N. S. Nassif, G. M. Elhafez, and H. E. Fawaz, "Effect of Trunk Range of Motion and Angular Velocity on Isokinetic Peak Torque of Trunk Flexor and Extensor Muscles. Elhafez S1, Nassif N1, Elhafez G1, Fawaz H1, Balbaa A2;", World Confederation for Physical Therapy WCPT, Vancouver, Canada, 15-07, pp. 93(S1):S282, 2007. Abstract

PURPOSE: This study was conducted to explore the effect of different trunk ROM (30°, 50° and 70°) and different angular velocities (30°/sec and 60°/sec) on the trunk flexor and extensor isokinetic peak torque ratio. RELEVANCE: There is a lack of data concerning the interpretation of spinal isokinetic parameters with different spinal ROM. Thus, the ability to specify the optimal range of motion and angular velocity that can develop maximal trunk muscle strength is not clear. Therefore, the current study was designed to test the trunk flexors/extensors strength ratio through a different spinal range of movement and angular velocities. PARTICIPANTS: Thirty healthy male subjects with a mean age of 19.95 years volunteered to participate in this study. They were all free from any musculoskeletal impairment. METHODS: The study was carried out using the Biodex system 3 Isokinetic dynamometer. Each subject was instructed to perform four trials of consecutive trunk flexion and extension at the three trunk ROM in the concentric trunk flexors and extensors contraction mode. During each ROM, the subject performed the trial with 30°/sec velocity and another time with 60°/sec velocity. ANALYSIS: Two way ANOVA with repeated measures and LSD multiple comparison post-hoc test were performed to compare between the different ROM with the two velocities on the trunk flexors and extensors. RESULTS: The results indicated that the trunk flexors PT and the trunk flexors/extensors PT ratio decreases significantly (p < 0.05) with increasing trunk ROM at the two tested velocities. In contrast, the PT values of the trunk extensors at the two angular velocities increased significantly (p < 0.05) by increasing the trunk ROM. Furthermore, the trunk flexors and extensors PT value at 60°/sec angular was lower than that at 30°/sec angular velocity. CONCLUSIONS: This study revealed that the spinal isokinetic data is dependent on the spinal ROM. Moreover, the optimal trunk ROM and angular velocity that produce the highest torque of trunk flexor were at the first ROM (30° flexion) using 30°/sec angular velocity. Regarding the trunk extensors peak torque, the highest PT value can be obtained at the third ROM (70° flexion) using 30°/sec angular velocity. IMPLICATIONS: The current study can help physical therapists to accurately specify the optimal trunk ROM and angular velocity that can develop maximal trunk muscle strength. Furthermore, it may help physical therapists in designing the preventive and rehabilitative programs for subjects with trunk disabilities. KEYWORDS: Trunk, Isokinetic, Velocity. FUNDING ACKNOWLEDGEMENTS: This study was not funded. CONTACT: drhfawaz@yahoo.com, Nagui3@gega.net

Ali, M. M., A. A. Balbaa, and S. M. Elhafez, "Comparative Study Between Chemical and Mechanical Treatment of Lumbosacral Radiculopathy", World Confederation for Physical Therapy WCPT, Vancouver, Canada, 1205, pp. 93(S1):S348, 2007. Abstract

PURPOSE: This study was designed to compare the chemical, mechanical and their combination in treatment of sciatica in subjects with lumbar disc prolapse. RELEVANCE: This may establish the best treatment or combination of treatments in relieving the radicular pain in lumbar radiculopathy. PARTICIPANTS: Thirty subjects with unilateral L5 discogenic sciatica and radicular symptoms of pain, numbness and/or weakness were randomly selected and examined. Their age ranged from 25-45 years. METHODS: The subjects were divided randomly into 3 groups of 10. Group (A) received medications only in the form of NSAID, neurotonics and muscle relaxant for 2 weeks. Group (B) received positional treatment in the form of exercise based on Optimal Spinal Posture (OSP) 3 sessions per week for 2 weeks. The OSP was determined by conducting the kinsiologic H-reflex of the soleus muscle. Group (C) received both treatment protocols of group A and B for 2 weeks. Each subject had pre and post treatment evaluation of pain level using Visual Analogue Scale (VAS), and functional activity level using Oswestry scale and Stanford score. ANALYSIS: Statistical analysis of the pre and post test using two ways ANOVA was performed using Statgraphics software with multiple range tests to examine the differences between the three studied groups. RESULTS: The statistical analysis of this study indicated that the pain level reduced significantly (p < 0.05) in group C compared to the other groups. Group B showed significant improvement in the pain level compared to that of group A. Similarly, the Stanford scale improved significantly (p < 0.05) in group C compared to that of group A and group B. Regarding the Oswestry scale, the results revealed that there was no significant difference (p > 0.05) in the functional performance of group A and group B. On the other hand, the functional performance of group C improved significantly (p < 0.05) compared to that of groups A and B. CONCLUSIONS: Combining both chemical and mechanical intervention in the form of medications and positional treatment based on OSP as an exercise program has a significant improvement in the level of pain and the functional performance in subjects with lumbar disc prolapse. IMPLICATIONS: It is recommended for the physical therapist to combine the positional treatment based on OSP with medications in treating patients with lumbar disc prolapse. KEYWORDS: Sciatica, H-Reflex, Medications. FUNDING ACKNOWLEDGEMENTS: Self. CONTACT: dr3mpt@yahoo.com