Physiotherapists have developed examination techniques known as ‘neural tension tests’ to assess the mechanosensitivity of the major nerve trunks. Changes in neural tension provoked by these tests may alter the nociceptive responses of nearby tissues.

The aim of our study was to evidence changes in mechanical nociceptive thresholds (MNTs) of upper trapezius muscle in different neurodynamic positions.

Cross-sectional study. Fifty asymptomatic volunteers were evaluated with algometer in four neurodynamic positions:

Contralateral side-lying position with knees at 90° of flexion, hips at 70° of flexion and spine in neutral;

One physiotherapist (PT) measured MNTs unilaterally over TrPs1. Three consecutive measurements was evaluated in the four described positions, a second PT reported the data in kilograms (kg). A third PT was responsible for modifying subjects positions.

The findings revealed significant mean differences (SMD) in algometry measurements (P < 0.0001) between position 1 (mean 2.880 kg; SD 1.012 kg) and position 3 (mean 2.522 kg; SD 0.87 kg), SMD (P < 0.01) between position 1 and position 4 (mean 2.616 kg; SD 0.968 kg). No SMD between position 1 and 2 (mean 2.728 kg; SD 1.103 kg) (P < 0.08) and between positions 3 and 4 (P < 0.378).

We concluded that MNTs of upper trapezius muscle decrease with neural tension positions. MNTs decrease is similar with crural nerve and median nerve tension positions. So, neurodynamic positions are important procedures to be taken into account in clinical reasoning, both physical therapy diagnosis and treatment.

Although modern operative intervention for calcaneal fractures has improved the outcome in many patients, there still is no real consensus on treatment, operative technique, or postoperative management. Vira® is a system for reconstruction-arthrodesis of severe calcaneal fractures, consisting in minimally invasive surgery using cannulation technique.

The aim of our study was to elaborate a CPG to assist physiotherapists in decision making and to improve the efficacy and uniformity of care for patients with severe calcaneal fractures.

The CPG was developed according to international methods of guideline development. To identify “best evidence” a structured search was performed. When no evidence was available, consensus between experts (physiotherapist and orthopaedic surgeons) was achieved to develop the guideline. To identify “best clinical experience” and “physiopathology reasoning” focus group of practicing physiotherapists was used. They reviewed the clinical applicability and feasibility of the guideline, and their comments were used to improve it.

CPG include three phases determined from the physiopathology and biomechanical reasoning of surgical system (weeks after the surgery: 2^a–5^a, 5^a–14^a, 14^a–+/−24^a). Unfortunately, evidence related to the treatment of severe calcaneal fracture was sparse and often of poor methodologic quality. The recommendations that were included: early onset (2^a week after the surgery) with early mobility and loading, program of home exercises, manual therapy (articular and miofascial techniques), walking in swimming pool, continuous electromagnetic fields of 99Hz with an intensity of 99 Gaussian during 30 min/day; electrotherapy of the intrinsic muscles of the feet (80Hz; 8:12, 20 mi), a program of active exercises of the feet (dorsiflexion and plantarflexion, not supination and pronation) and resistive exercises of triceps surae muscle (7^a week), criotherapy and anti-inflammatory positions.

Anterior knee instability associated with rupture of ACL is a disabling clinical problem, especially in the athletic individual. The gracilis and semitendinosus tendon (T4) represent an alternative autograft donor material for reconstruction of the ACL.

The aim of our study was to elaborate a CPG to assist physiotherapists in decision making and to improve the efficacy and uniformity of care for patients with ACL reconstruction with T4.

The CPG was developed according to international methods of guideline development. To identify “best evidence” a structured search was performed. When no evidence was available, consensus between experts (physiotherapist and orthopaedic surgeons) was achieved to develop the guideline. To identify “best clinical experience” and “physiopathology reasoning” focus group of practicing physiotherapists was used. They reviewed the clinical applicability and feasibility of the guideline, and their comments were used to improve it.

CPG include three phases determined from the evidence, physiopathology reasoning and the biological process of autograft (weeks after the surgery: 2^a–6^a, 6^a–10^a and 10^a–16^a). The recommendations included: In postoperative weeks (2^a–6^a) physiotherapy focused on early range of motion of the knee; manual therapy (passive range of motion (PROM) 0–120° and miofascial techniques), pulsed ultrasound of low intensity with a power of 0.3w/cm2 (1MHz) during 10min/day in tibial tunnel, early active hamstring beginning with static weight bearing co-contractions (closed-kinetic-chain) and adductors, partial weight bearing with crutches, exercises in the swimming pool and cryotherapy to pain control (30 mi/4 hours). In weeks 6 to 10, full weight bearing, manual therapy (PROM 0–140° and miofascial techniques), hamstring strengthening progress complexity and repetitions of co-contractions, electrotherapy hamstring and quadriceps co-contractions. Starting at week 10, progress to more dynamic activities/movements, proprioceptive work, open-kinetic-chain, stationary bike and Theraband squats. In week 12, progress jogging program and plyometric type activities. The patients performed sports-specific exercises by about 3½ months postoperative.

Neurodynamic tests are daily regarded as important in orthopedic physical assesment. Changes in neural tension provoked by these tests over differents nerve trunks in lumbopelvic region may alter the nociceptive responses of nearby tissues.

The aim of our study was to evidence changes in mechanical nociceptive thresholds (MNTs) of lumbopelvic muscles in different neurodynamic positions.

Cross-sectional study. Fifty asymptomatic volunteers were evaluated with algometer in three neurodynamic positions:

Contralateral side-lying position with knees at 90° of flexion, hips at 70° of flexion and spine in neutral;

The pressure algometry was tested at one anatomical site on gluteal region 2.5 cm. below iliac crest bone and behind iliotibial band.

One physiotherapist (PT) measured MNTs unilaterally over gluteus medius. Three consecutive measurements was evaluated in the three described positions, while a second PT reported the data in kilograms (kg). A third PT was responsible for modifying the knee and craniocervical range of motion.

The findings revealed significant mean differences (SMD) (0.522 kg; 95% IC: 0.385–0.659 kg) in algometry measurements (P < 0.0001) betweeen position 1 (mean 3.632 kg; SD 1.235 kg) and position 2 (mean 3.110 kg; SD 1.233 kg), SMD (0.590 kg; 95% IC: 0.412–0.768 kg) (P < 0.0001) betweeen position 1 and position 3 (mean 3.042 kg; SD 1.136 kg). Furthermore, no SMD between the two different neural tension positions (P < 0.420).

We concluded that MNTs of lumbopelvic muscles decrease with neural tension positions. MNTs decrease is similar with sciatic nerve and vertebral canal neural tension positions. So, neurodynamic positions are important procedures to be taken into account in clinical reasoning, both physical therapy diagnosis and treatment.

Ultrasound has been shown to have positive biological effects, including increased angiogenic, chondrogenic, and osteogenic activities.

The aim of our study was to evaluate the evidence available in the scientific literature for the ultrasound treatment for tendon healing.

To identify “best evidence” published research a computerized literature search of Medline, Cochrane, PEDro, IME, IBECS and ENFISPO. Keywords used to identify the study population and interventions were: ultrasound, low intensity pulsed ultrasound, physiotherapy, clinical trial, meta-analysis, practice guideline, randomized controlled trial, repair tendon and tendon healing.

The scientific evidence of the group of selected documents were measured using the scale described by the US Preventive Task Force. The assignment of the evidence level to each study was evaluated independently by two reviewers without communication among them. To determine inter-rather reliability Kappa index it was used (K) with a value of CI of 95%.

The study populations were 39 pertinent recovered documents. The findings suggest that therapeutic ultrasound can increase in collagen synthesis and enhance the maturation of collagen fibrils of repairing tendons. Researchers have reported that therapeutic ultrasound could facilitate tissue recovery and US with dosages between 0.125–3 W/cm2 have been used in the treatment of tendon ruptures reported an improvement in both strength and energy absorption capacity of repairing rabbit or rat tendons with 1-MHz continuous US. Best results were: continuous US at 1 MHz, 0.5w/cm2 starting from day 5 after injury, 20 treatment sessions, 4 mi each session. There is not a general consensus on the choice of parameters for US treatment and the evidence for efficacy of therapeutic.

Limits of studies: The time needed to develop such an interface in humans was reported to be much longer than that reported in animal models.

Continuous and low-intensity pulsed ultrasound was able to accelerate tendon healing and facilitating earlier physiotherapy.