BACKGROUND: Stiff skin syndrome (SSS) is a rare disease characterized by sclerosis of the skin. Cases of both widespread and segmental SSS have been reported.
OBJECTIVE: To report the clinical and histopathological characteristics of a large series of SSS.
METHODS: We retrospectively analysed the clinical and histopathological characteristics of widespread and segmental SSS collected from a dermatology department. We also compared histopathology between segmental SSS and morphea.
RESULTS: Thirty-one cases, including three widespread SSS and 28 segmental SSS, were collected. Skin lesions of widespread SSS generally showed skin sclerosis concentrating over the lumbar, buttocks, thighs, proximal part of limbs, and shoulders with specific abnormal gait and posture. Skin lesions of segmental SSS generally showed sclerotic plaques involving the thigh, lumbar area and buttocks, associated with hypertrichosis, hyperpigmentation and a cobblestone appearance. Segmental SSS did not typically cause joint limitation or serious physical discomfort. Histopathologically, SSS showed proliferation of fibroblasts and sclerosis of collagen in the dermis or subcutaneous tissue. Compared with morphea, SSS showed more prominent proliferation of fibroblasts and completely lacked lymphocyte infiltration.
CONCLUSIONS: Segmental SSS represents the major variant of SSS. Histopathologically, SSS shows proliferation of fibroblasts, sclerosis and an absence of inflammation.

Research on biomechanics in rowing has mostly focused on the lumbar spine. However, injuries can also affect other body segments. Thus, the aim of this pilot study was to explore any potential variations in the kinematics of the cervical spine during two different stroke rates on the rowing ergometer in young rowers.
Twelve young rowers of regional or national level were recruited for the study. The experimental protocol consisted of two separate test sessions (i.e., a sequence of 10 consecutive strokes for each test session) at different stroke rates (i.e., 20 and 30 strokes/min) on an indoor rowing ergometer. Kinematics of the cervical spine was assessed using an inertial sensor capable of measuring joint ROM (angle of flexion, angle of extension, total angle of flexion-extension).
Although there were no differences in the flexion and total flexion-extension movements between the test sessions, a significant increase in the extension movement was found at the highest stroke rate (p = 0.04, d = 0.66).
Young rowers showed changes in cervical ROM according to stroke rate. The lower control of the head during the rowing stroke cycle can lead to a higher compensation resulting in an augmented effort, influencing sports performance, and increasing the risk of injury.

Pain related to pregnancy can occur anytime between conception to the postpartum period. Pregnancy and the following months after birth are a time of physical change to the woman\'s body, with significant hormonal effects. We present a case of a young female with chronic pain several years after her second pregnancy that presented a diagnostic challenge. She was initially diagnosed with persistent pelvic girdle pain (PGP) type 2, responded somewhat to appropriately targeted pelvic floor therapy, with a plateau in her progress. The diagnosis was revised to PGP type 4, with some improvement in pain with customized therapy. Her treatment again changed with a focus on sacroiliac joint (SIJ) dysfunction and iliopsoas tendinopathy with excellent and complete resolution of her pain. The overlapping nature of these diagnoses caused a significant challenge in creating a tailored physical therapy approach to her pain that eventually led to her final diagnosis being one of exclusion. Treatment was focused on optimization of joint mobility and tissue lengthening, with the resolution of her pain.

Sport-climbing popularity increased intensely over the past years. Particularly, children\'s and adolescents\' interest therein is constantly growing. Despite a large effort in preventing injuries and muscle overloads, a fine-tuned training for each sensitive phase of child development is still needed. The objective of the study was to evaluate an innovative training program aimed at the preservation of joint mobility during the developmental age. This article relies on the results of a steady training program allowing to retain joints integrity among the practice of sport climbing in children. Joint mobility changes have been monitored before and after a one-year training program in fifteen subjects aged between 8 and 18 years. Subjects were divided into three groups depending on age (Turgor Secundus, Proceritas Secunda and Turgor Tertius). The motor tests administered were the sit-and-reach test, coxo-femoral mobility test and scapula-humeral mobility test. Our results showed that one-year training improved joint mobility at each analyzed phase, suggesting that this training program could improve mobility and flexibility. Given the importance of joint mobility preservation for discipline-related injuries prevention and eventually recovering, it is essential to provide a specific training program as a route to approach sport climbing, and even more importantly, at an early age. This work represents a preliminary study in order to demonstrate both efficacy on the joint mobility and the requirement of our playful work to support the global sport-climbing workout.

The positive effects of factor treatment of hemophilia are well established, but the long-term outcomes are not well documented. This panel study evaluated changes in bleeding frequency, joint mobility, physical function, and symptoms in Danish patients with moderate to severe hemophilia A or B over 24 years.
Three anonymous surveys were conducted in 1988, 2001, and 2012 targeting Danish patients with moderate to severe hemophilia, and the study participants, respectively, were 128, 156, and 164 male patients with hemophilia (PWH). The number of bleeding episodes, the use of factor concentrate, comorbidities, joint mobility, physical function, and symptoms were evaluated by means of self-reporting. Trends over time were analyzed using ordinal and multinomial logistic-regression models controlling for age group.
The proportion of PWH in the oldest age group (55-88 years) increased from 4% in 1988 to 18% in 2012. In 1988, a high risk of bleeding episodes was primarily found in the age group of 16-34 years. In 2012, a high risk was primarily found in the age group of 35-54 years. Joint mobility and physical function increased significantly from 1988 to 2012 but showed a noticeable decrement in the older age groups, even in 2012. Pain in the extremities, anxiety, and depression decreased significantly, but back pain increased. No significant changes were found for 7 other symptoms.
Significant improvements in joint mobility and physical function have occurred over the last 24 years, but PWH > 35 years still experience a decline in these areas with age. This decline underscores the importance of life-long treatment and continuous rehabilitation of PWH.

BACKGROUND: In Sweden, homecare services take care of elderly and disabled people, work that often requires heavy lifting and forward bending, resulting in high prevalences of pain and work accidents.
OBJECTIVE: Using an eight-year follow-up, this study determines the prognostic importance of certain musculoskeletal signs reported in earlier studies [1, 2] with respect to aspects of pain and perceived disability.
METHODS: Baseline data has been reported in earlier studies of 607 women [1-3]. This study uses a postal questionnaire survey and reports the results of eight years post initial study.
RESULTS: Segmental pain at L4-L5 and/or L5-S1 levels was associated with higher low back pain intensity and disability at the eight-year follow-up. A decrease in low back pain intensity over eight years was larger for those with segmental pain. The important signs in the longitudinal analyses of pain aspects and disability were lumbar spinal mobility and segmental pain at L4-L5 and L5-S1 levels, but the explained variations were low.
CONCLUSIONS: Evaluation of low lumbar segmental pain provocation and mobility should be considered in routine clinical assessments, as this type of evaluation provides prognostic pain and disability information over time.

BACKGROUND: Joint and connective tissue integrity, comfort and function are paramount to optimal performance in exercise, recreational and occupational activities. The fruit of Terminalia chebula has been used extensively in various traditional health systems for different ailments, with additional preclinical and clinical data demonstrating antioxidant and anti-inflammatory potential. The aim of this study was to evaluate the effects of a standardized aqueous extract of Terminalia chebula fruit (AyuFlex®) dietary supplementation on joint mobility, comfort, and functional capacity in healthy overweight subjects.
METHODS: One-hundred and five (105) overweight, apparently healthy male and female subjects (35-70 years of age) were pre-screened and randomized to one of three groups for 84 days: placebo, AyuFlex1 (250 mg twice daily) or AyuFlex2 (500 mg twice daily) in a randomized, double-blind, placebo-controlled design. A two-week placebo lead-in period was used to improve data quality/validity. All subjects had no knee joint discomfort at rest, but experienced knee joint discomfort only with activity/exercise of at least 30 on 100 mm Visual Analog Scale (VAS). Primary outcome measures included symptoms of joint health and function as measured by modified-Knee Injury & Osteoarthritis Outcomes Score (mKOOS) global & modified-Western Ontario and McMaster Universities Arthritis Index (mWOMAC) subscales (discomfort, stiffness and function). Secondary outcomes included VAS questionnaires on overall/whole-body joint health, low back health, knee mobility, willingness and ability to exercise, 6-min walk test for distance and range of motion (ROM) of pain-free knee flexion/extension. Tertiary outcome measures included inflammatory (high sensitivity C-reactive protein (hsCRP), tumor necrosis factor (TNF)-α) and extracellular matrix (ECM)/Connective Tissue (COMP) biomarkers, and safety (vital signs and blood markers) & tolerability (Adverse Event (AE)/ side effect profiles).
RESULTS: Compared to placebo, at day 84 AyuFlex® treatment significantly: 1) improved mKOOS global scores in AyuFlex1 + AyuFlex2 (P = 0.023), and improved total and physical function subscale of mWOMAC relative to baseline, 2) improved VAS scores for Knee Discomfort with activity/exercise in AyuFlex1 + AyuFlex2 (P = 0.001) relative to baseline, 3) improved VAS scores for whole-body joint function in AyuFlex1 + AyuFlex2 (P < 0.029) relative to baseline, 4) improved VAS score for decreased knee joint soreness following leg extension challenge for AyuFlex1 (P = 0.022) and AyuFlex2 (P = 0.043) relative to baseline, 5) improved 6-min walk performance distance covered (P = 0.047) and VAS discomfort (P = 0.026) post-6 min walk in AyuFlex1 + AyuFlex2 relative to baseline, 6) and tended to decrease COMP levels in AyuFlex1 + AyuFLex2 (P = 0.104) relative to baseline. All biomarkers of safety remained within normative limits during the study. Low back health tended to improve in the AyuFlex1 and AyuFlex2 group, but failed to reach significance relative to placebo group.
CONCLUSIONS: AyuFlex® improved mKOOS global scores, knee joint discomfort with activity/exercise, 6-min walk test distance covered and discomfort post-6 min walk test, overall whole-body joint function, knee soreness following leg extension resistance exercise in a healthy, overweight population, without AE. Differences between 250 mg/BID and 500 mg/BID were non-significant for most of the outcome measures, validating the efficacy of the lower dose.
BACKGROUND: ClinicalTrials.gov identifier NCT02589249 ; October 26, 2015.

Amyoplasia, the most common form of arthrogryposis is characterized by typical deformities of the joints and replacement of skeletal muscles by fibrous tissue and fat. There is sparse literature on adaptation to adult life with amyoplasia.
To describe physical function and activity strategies in adults with amyoplasia, as this knowledge is important for relevant function-enhancing measures.
Twenty-two adults (20-91 years) with amyoplasia participated. Demographic factors and clinical history were registered. Body proportions were measured. Joint mobility and muscle strength in the upper limbs were examined. The Functional Independent Measure was used to assess performance of activities of daily living. Compensatory strategies were described.
The majority had undergone comprehensive conservative and surgical treatment. Mean height was below typical. Range of motion was below lower limit of normal in most joints, passive range of motion was mainly larger than active. Muscle strength was reduced for most movements. Seven were independent in all activities. Need of assistance was highest regarding bathing and dressing. A variety of compensatory strategies were used.
Adults with amyoplasia are heterogeneous regarding function. Independence in everyday life requires a combination of muscle strength to move against gravity, ability to passive joint motion, and use of compensatory strategies. Implications for rehabilitation The ability to joint motion in the upper extremities is essential for independency in activities of daily living, especially when the muscle strength is impaired. Training of muscle strength is recommended, whenever possible, as muscle strength to move against gravity makes the performing of everyday tasks easier. The use of compensatory techniques, adaptions to the environment and relevant, often custom made, assistive devices is required to perform activities of daily living. Living an active life with physical challenges like in amyoplasia requires flexible and individually adapted solutions.