Doaa Ahmed Mohamed Osman

Background: Pathological conditions of the Shoulder joint are very common as the shoulder is the most freely movable joint in the body (and hence the most unstable). These conditions can lead to pain and disability that affect individuals socially and economically. Purpose: This study was conducted to identify the prevalence and characteristics of shoulder pathologies in two main hospitals in two Egyptian governorates as up to researchers’ knowledge, no previous epidemiological studies of shoulder conditions attending orthopedic physical therapy outpatient clinics have been carried out in Egypt, sothe current study provides valuable information about diseases’ burden for researchers and healthcare policy makers, thus assisting in disease prevention , identifying health economic models and establishing guidelines. Methodology: A hospital- based record study was made for 1633 patients, 101 patients of them were suffering from shoulder pathologies, data were collected from patients’ referral records to orthopedic physical therapy outpatient clinics in two hospitals (Kasr Aini educational hospital) (KA) in Cairo and (Benha educational hospital) in Qalubiya – Egypt, that are reviewed from the first of January 2019 to 31 December 2019. Demographic characteristics including (gender, affected side) and different types of pathologies were described. Results: One –year prevalence of shoulder pathologies was 6.1% (101/1633 cases). Male to female ratio was 1:2.6. The most frequent type of shoulder pathologies was impingement syndrome (38.6%), followed by rotator cuff tear (17.8%). Right side was most frequently affected (43.6%). Conclusion: Shoulder impingement syndrome (SIS) and rotator cuff tear (RCT) were the two main types of shoulder pathologies among people living in Cairo and Qalubiya- Egypt. Concerning gender, higher prevalence was in women, and finally when considering the affected side, right side was commonly affected.

Objectives: To determine the effect of neurogenic acupoint dry cupping therapy on high sensitive C-reactive protein (hs-CRP) level, pain perception & intensity, and life impact of pelvic pain in women with chronic pelvic pain (CPP), with regard to the biological and neurophysiological impacts of dry cupping on acupoint. Methods: Thirty women with CPP were randomly divided into two equal groups; the study group received dry cupping on neurogenic acupoints plus lifestyle modifications for 8 weeks (n=15), while the control group received only lifestyle modifications for 8 weeks (n=15). Women were assessed pre- and post-rehabilitation program with the hs-CRP blood test, the short-form McGill Pain Questionnaire (SF-MPQ), and the pelvic pain impact questionnaire (PPIQ). Results: Comparing both groups post-treatment revealed that there were significant reductions in levels of hs-CRP, and scores of SF-MPQ & PPIQ (p<0.05) in the study group compared with the control group. Also, there were significant positive correlations between hs-CRP and both SF-MPQ “Visual Analogue Scale (VAS), Present Pain Intensity (PPI) index & Pain Rating Index (PRI)” and PPIQ (p<0.05). Conclusion: Neurogenic acupoint cupping therapy had significantly improving effects on the degree of inflammation, pain perception & intensity, and life impact of pelvic pain in women with CPP.
Keywords: C-Reactive Protein, Dry Cupping, Female Chronic Pelvic Pain, Neurogenic Acupoint, Pain Perception

Objectives. It is well documented that acupressure has a beneficial effect on reducing pain severity of primary dysmenorrhea; however, none of the previous studies had investigated the effect of acupressure on prostaglandin levels in females with primary dysmenorrhea. This study aimed to investigate the effect of acupressure on prostaglandin F2α (PGF2α) in primary dysmenorrhea.
Methods. A total of 50 adult females with primary dysmenorrhea participated in this study. Their ages ranged from 19 to 27 years and their body mass index (BMI) ranged from 20 to 25 kg/m2. They were randomized into 2 equal groups. Group (A) received nutritional modification for 3 consecutive menstrual cycles, while group (B) received the same nutritional modification in addition to acupressure at the liver point (LIV3) for 3 consecutive menstrual cycles. The primary outcome was plasma levels of PGF2α while the secondary outcome was short form of McGill pain questionnaire. The outcome measures were evaluated pre- and post- treatment.
Results. Comparing both groups post-treatment revealed that there were significant reductions in PGF2α levels and short form of McGill pain questionnaire scores (p < 0.0001) in favour of group (B).
Conclusions. Acupressure is effective in treating females with primary dysmenorrhea through reducing levels of PGF2α and scores of short form of McGill pain questionnaire.

Key words:

acupressure, prostaglandin F2α, short form of McGill pain questionnaire, primary dysmenorrhea

The second stage of labor (SSL) has often been neglected, leading to birthing complications, perinatal
morbidities, and higher rates of cesarean section (CS) in nulliparous women. In this paper, it was aimed to
determine the effect of antenatal exercises on labor outcomes in nulliparous women. Two-group posttest-only
randomized study. Overall, 60 nulliparous women at their 30th to 32nd weeks of gestation were allocated into two groups randomly. Group (A) received only routine antenatal care and educational instructions till the time of
delivery (n=30), while group (B) received the same routine antenatal care and educational instructions in addition to antenatal exercises till the time of delivery (n=30). Comparing both groups revealed that group (B) had a significant increase in the number of spontaneous vaginal deliveries (p<0.05) and a significant decrease in duration of SSL (p<0.05), without any need to admit their neonates to the neonatal intensive care unit (NICU).

Objectives. Postmenopausal osteoporosis, a major public health problem worldwide, is associated with low quality of life, morbidity, significant mortality and huge socio-economic burden. Therefore, this study aimed to investigate the effect of bioptron light therapy on postmenopausal osteoporosis.
Methods. Thirty postmenopausal women with hip osteoporosis, aged 50-60 years, were randomized into 2 equal groups. Group (A) received medical treatment in the form of calcium, vitamin D3 and sodium fluoride supplementation for 4 weeks (n = 15), while group (B) received the same medical treatment in addition to bioptron light therapy for 4 weeks (n = 15). The primary outcome was total hip T–score, while the secondary outcome was total score of Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO-41). The outcome measures were evaluated pre- and post-treatment.
Results. Comparing both groups pre- and post-treatment revealed that there was a statistically non-significant difference in total hip T–score (P > 0.05). Also, total score of QUALEFFO-41 revealed a statistically non-significant difference pre-treatment (P > 0.05), while post-treatment, it revealed a statistically significant reduction (P < 0.05) in favour of group (B). The percentages of improvement post-treatment in total hip T–score and total score of QUALEFFO-41 were 2.4% and 15.65% in group (A), while they were 11.29% and 31.63% in group (B).
Conclusions. Bioptron light therapy is effective in treating postmenopausal women with hip osteoporosis through producing a greater improvement percentage in total hip T–score and improving their quality of life.
Key words:
Postmenopausal osteoporosis, Bioptron Light Therapy, Quality of Life Questionnaire

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Background: Premenstrual syndrome (PMS) is a cyclic disorder that affects social activities, interpersonal relationship, and educational productivity of adolescents. Therefore, this study aimed to compare the effect of whole body vibration (WBV) and resistive exercise on premenstrual symptoms in adolescents with PMS.
Methods: Sixty adolescents, aged 16–19 years and with body mass index > 19.9 kg/m2, participated in the study. They were randomly assigned to three groups equal in number. Control group received magnesium (Mg) (250 g) and vitamin B6 supplementation once daily. Resistive exercise group received the same supplementations and resistive exercise for three times/week, while the WBV group received the same supplementations and WBV training three times/week for 12 weeks. Premenstrual syndrome questionnaire (PMSQ) was used to evaluate premenstrual symptoms, including anxiety symptoms (PMS-A), depression symptoms (PMS-D), craving symptoms (PMS-C), hyperhydration symptoms (PMS-H), other symptoms, cramp, and low back pain.
Results: Pair-wise comparison test revealed a significant decrease (p = 0.000) in PMS-A, PMS-C, PMS-D, PMS-H,other symptoms, cramp, and low back pain of the resistive exercise group and WBV group after treatment. However, there was only a significant decrease in PMS-C (p = 0.03) of the control group after treatment. Post hoc test showed no significant difference (p > 0.05) between the resistive group and WBV group in all PMS symptoms after treatment.
Conclusions: Passive muscular training using WBV has a similar effect to resistive exercise on premenstrual symptoms that affect the quality of life in adolescents with PMS.
Trial registration: PACTR, PACTR201908589835132. Registered 26 June 2019—retrospectively registered.
Keywords: Whole body vibration, Resistive exercise, Premenstrual syndrome, Adolescents

Abstract
Despite the well-known benefits of exercise on the physical and mental health of postnatal women, none of the former studies had evaluated the impact of moderate exercise on breast milk cortisol in healthy lactating women. Therefore, the aim of this study was to investigate the impact of moderate exercise on breast milk cortisol in healthy lactating women. Forty-seven healthy lactating women, between 1 and 5 months postpartum, were distributed randomly into two groups. The control group received only lactational and nutritional counseling for 4 weeks, while the exercise group received the same lactational and nutritional counseling, as well as engaged in an aerobic exercise program of moderate intensity for 4 weeks. Breast milk cortisol was assessed pre and post-intervention. The breast milk cortisol showed a significant decrease (P=0.001) within both groups, while it showed a non-significant difference between both groups post-intervention (P>0.05). Moderate aerobic exercise doesn’t have any negative impact on breast milk cortisol in healthy lactating women.
Keywords: moderate exercise, lactation, breast milk cortisol

Aim: to explore the effect of forward head posture (FHP) on temporomandibular joint (TMJ) proprioception in post-pubertal females.
Material and Method. Forty post-pubertal females participated in this study. They were classified in accordance with the craniovertebral angle (CVA) into two groups. The Forward head posture (FHP) group had CVA of less than 48° (n = 21), while the control group had CVA of more than 48° (n = 19). TMJ repositioning accuracy had been measured by vernier caliper for females in both groups.
Results. Statistical analysis revealed that there were no significant (p > 0.05) differences between both groups regarding TMJ repositioning errors in all directions (mouth opening, protrusion and lateral movements) with eyes open or closed.
Conclusion and Discussion. In post-pubertal females, FHP has no negative effect on TMJ proprioception in all directions whether the eyes are open or closed.

Key words:
Forward head posture, craniovertebral angle, temporomandibular joint, proprioception, post-pubertal females

Introduction. To explore the effect of myofascial release on electrophysiological and clinical measures of pregnant women with carpal tunnel syndrome (CTS).
Methods. Randomized controlled trial. Overall, 30 pregnant women with CTS, aged 25–35 years, were randomized into 2 equal groups. The control group only wore a neutral wrist splint during sleeping for 4 weeks, while the study group received a myofascial release in addition to wearing a neutral wrist splint during sleeping for 4 weeks. All pregnant women in both groups were evaluated pre- and post-treatment with median nerve distal motor latency and Boston Carpal Tunnel Questionnaire to assess pain, numbness, and tingling sensation severity, as well as hand function.
Results. Comparing both groups post-treatment revealed that there was a statistically highly significant decrease in median nerve distal motor latency, pain intensity, numbness, and tingling sensation severity, as well as in weakness and difficulty in grasping severity (p < 0.001) in favour of the study group.
Conclusions. Myofascial release is an effective method for improving electrophysiological and clinical measures of pregnant women with CTS.
Key words: myofascial release, carpal tunnel syndrome, pregnancy, median nerve distal motor latency, Boston Carpal Tunnel Questionnaire

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Aim: In this study, we aimed to explore the effect of a suggested physical therapy protocol on the anthropometric parameters and hormonal profile of obese adolescent girls with polycystic ovarian syndrome (PCOS). Material and Method: Twenty obese adolescent girls with PCOS participated in this study. Their ages ranged from 14 to 18 years and their body mass index (BMI) ranged from 30 to 35 kg/m2. They received a specific diet therapy connected with a program of aerobic exercise for 6 months. Anthropometric parameters and serum luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels were measured before starting the study, after 3 months and after 6 months of the suggested physical therapy protocol. Results: There was a statistically highly significant reduction in the anthropometric parameters and LH/FSH ratio in the post 6 months of treatment compared with the pre-treatment and post 3 months of treatment (p<0.01). Also, there was a statistically highly significant reduction in the anthropometric parameters (p<0.01), while there was a statistically significant reduction in the LH/FSH ratio in the post 3 months of treatment compared with the pre-treatment (p<0.05). Discussion: The suggested physical therapy protocol for obese adolescent girls with PCOS is optimal for improving their anthropometric parameters and hormonal profile.

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Objective: To evaluate Bone Mineral Density (BMD) and body composition in adolescent female gymnasts with different menstrual status in comparison with normal controls.

Design: Observational, cross-sectional study.

Methods: Twenty oligomenorrheic gymnasts, twenty eumenorrheic gymnasts and twenty age-matched eumenorrheic controls participated in this study. Their ages ranged from 12 to 17 y old. Bone mineral density and body composition were evaluated by dual X-ray absorptiometry. Menstrual status and training profile were assessed through a self-administered questionnaire.

Results: Both oligomenorrheic and eumenorrheic gymnasts had significant lower total BMD, total fat percentage, and total and regional fat mass (P<0.05) when compared with eumenorrheic controls. Also, oligomenorrheic gymnasts had significant lower BMD at arms and legs (P<0.05) when compared with eumenorrheic controls. Trunk lean mass was a strong indicator for trunk BMD in all groups (P<0.05). In oligomenorrheic gymnasts, there were significant positive correlations between BMD and lean and fat mass (at total body, trunk and legs) (P<0.05).

Conclusion: Gymnastics training during puberty is associated with low body mass, total and regional fat mass, and total BMD, regardless of menstrual status.

Although it is well documented that moderate exercise enhances cell-mediated
immunity, effect of moderate exercise on breast milk leukocytes has not been studied yet. So,
the aim of this study was to investigate the effect of moderate exercise on breast milk
leukocytes in exclusively breast-feeding mothers. Forty-seven exclusively breast-feeding
mothers at 1st to 5th month postpartum were randomized into two groups. Group A received
breast-feeding and nutritional counseling and engaged in moderate aerobic exercise for 4
weeks with a total of 12 sessions. Group B received only the same breast-feeding and
nutritional counseling for 4 weeks. Both groups were evaluated pre and post-intervention.
The outcome measures were maternal anthropometric parameters and breast milk total and
differential leukocytes counts. Post-intervention, there was a non-significant difference in the
maternal anthropometric parameters (P > 0.05) while there was a highly significant increase
in breast milk total and differential leukocytes counts (P = 0.001) in favor of group A. There
was a significant inverse relationship between maternal anthropometric parameters and
lymphocytes count in group A. This study explored that moderate aerobic exercise during
exclusive breast-feeding was associated with increased breast milk total and differential
leukocytes counts.

This study was conducted to determine the effect of physical training on menstrual functions, BMD, body composition and nutritional status in adolescent female athletes. Twenty-five adolescent female athletes and twenty-five adolescent female non-athletes participated in this study. BMD and body composition were evaluated using DEXA. The training, nutritional, menstrual and fractures histories were assessed through a self-administered questionnaire. Results showed that percentages of athletes who had menstrual dysfunction, low BMD and stress fractures were 48%, 4% and 28%, respectively and 12%, 4% and 8%, respectively in the nonathletes. Results revealed a significant increase (p<0.05) in menarche age and statistically significant decrease in No. of menstrual cycles in last year, total BMD, as well as highly significant decrease (P<0.0001) in total fat % and total fat mass, while there were non-significant differences (P>0.05) in femoral neck BMD, femoral neck Z-score and total lean mass of the athletes compared with the non-athletes. Also, results showed significant increase (P<0.05) in menarche age and highly significant decrease (P<0.0001) in No. of menstrual cycles in last year, as well as significant
decrease (P<0.05) in femoral neck BMD and femoral neck Z-score, while there were non-significant differences (P>0.05) in total BMD and body composition of oligo/amenorrheic athletes compared with eumenorrheic athletes. Also, there were significant increase (P<0.05) in menarche age and highly significant decrease (P<0.0001) in No. of menstrual cycles in last year, as well as significant decrease (P<0.05) in femoral neck BMD and femoral neck Z-score, while there were non-significant differences
(P>0.05) in total BMD and body composition of oligo/amenorrheic nonathletes compared with eumenorrheic non-athletes. Sport training during puberty, low BMI and low body fat in athletes can be associated with delayed menarche, menstrual dysfunction, low total BMD and stress fractures. Female athletes should be evaluated periodically and educated about the possible negative effects of oligo/amenorrhea on bone health.

If you are a breast-feeding mother, this book will provide you information about the most important factors that influence your breast milk immune system. These factors include exercise, stress and nutrition. To boost the immune system of the breast milk and subsequently the immune system of the breast-fed infant, the breast-feeding mother should be encouraged to exercise moderately, avoid stress and have a healthy nutrition.