[Purpose] We have previously shown inversion therapy to be effective in a small prospective randomised controlled trial of patients with lumbar disc protrusions. Our purpose now was to measure symptoms and to compare the surgery rate following inversion for 85 participants with the surgery rate in 3 control groups. [Participants and Methods] Each of the 85 inverted participants acted as their own control for the “symptomatic” part of the study. In the “Need for surgery” part of the study, one control group was made up of similar patients with leg pain and sciatica who were referred to the same clinic in the same year. Two additional control groups were examined: the original control group from the pilot trial and the lumbar disc surgery waiting list patients. [Results] Inversion therapy relieved symptoms: there were improvements in the Visual Analogue Score, Roland Morris and Oswestry Disease indices and Health Utility Score compared with their pre-treatment status. Also, the 2 year surgery rate in the inversion participants in the registry (21%) was significantly lower than in the matched control group (39% at two years and 43% at four years). It was also lower than the surgery rate in the other 2 control groups. [Conclusion] Inversion therapy relieved symptoms and avoided surgery.

[Purpose] This study aimed to clarify the immediate effect of adding mirror visual feedback to lateral weight-shifting training on the standing balance control of the left unilateral spatial neglect model. [Participants and Methods] We included 64 healthy participants to create left unilateral spatial neglect models and divided them into four subgroups. Each subgroup received opposite lateral weight-shifting training with or without mirror visual feedback. We then evaluated the static and dynamic standing balance by measuring the center of pressure point alterations in the medial-lateral and anterior-posterior planes. We further evaluated the center of pressure length and bilateral load ratio. [Results] The center of pressure was significantly stable upon performing the eyes-open static standing balance test in the left weight-shifting training subgroup with mirror visual feedback. When participants performed the left dynamic standing balance test, the center of pressure moved significantly rightward and became significantly stable in the right weight-shifting training subgroup with mirror visual feedback. The left load ratio significantly decreased in the right weight-shifting training of subgroups that either did or did not receive mirror visual feedback upon performing the left dynamic standing balance test. [Conclusion] We concluded that adding mirror visual feedback to lateral weight-shifting training affected some measurements of standing balance control of the left unilateral spatial neglect model.

[Purpose] We examined the inter-rater reliability of the Wright respirometer between therapists who assessed the vital capacity of patients with neuromuscular disorders. [Participants and Methods] We examined 18 patients with neuromuscular disorders. We performed a test-retest method after measuring their vital capacities. Two physical therapists experienced in the use of the Wright respirometer, specifically, therapist A with six years of clinical experience and therapist B with one, each took one measurement of the vital capacity of the same patients. The measurements between the therapists were taken at intervals of 3–7 days. We made a manual to standardize the measurements between the therapists. [Results] The vital capacities were 905 ± 490 mL for therapist A and 897 ± 483 mL for therapist B. The inter-rater reliability of ICC_2,1 was 0.96 (95% CI: 0.89–0.98). Bland-Altman analyses revealed neither a fixed nor proportional bias. [Conclusion] These results demonstrated good to excellent inter-rater reliability of the Wright respirometer for patients with neuromuscular disorders using a manual and instructions.

[Purpose] The purpose of this study was to propose potential preventive measures against future mobility impairments and muscle loss in healthy young adults by comprehensively evaluating their status of frailty, locomotive syndrome, and sarcopenia. [Participants and Methods] A total of 83 Japanese young adults were enrolled in this study and evaluated using the diagnostic criteria for frailty (Japanese version of the Cardiovascular Health Study), locomotive syndrome (calculated as scores of the LOCOMO-25, the stand-up test, and two-step test), and sarcopenia (handgrip strength, usual gait test, skeletal muscle index). [Results] The prevalence of frailty-prefrailty (45.9%) was higher than that of presarcopenia (22.3%) and locomotive syndrome (14.1%). The prevalence of combinations of frailty-prefrailty and presarcopenia; frailty-prefrailty and locomotive syndrome; and frailty-prefrailty, locomotive syndrome, and pre-sarcopenia was 9.4%, 4.7%, and 3.5%, respectively. [Conclusion] Only 40% of the participants did not meet the three diagnostic criteria. On the other hand, there were not many participants with sarcopenia and/or locomotive syndrome diagnoses, suggesting that the improvement in intrinsic skeletal muscle mass rather than physical function is important for healthy Japanese young adults and could possibly be protective against future mobility or muscle-loss disorders.

[Purpose] The coronavirus disease (COVID-19) pandemic has caused sudden lifestyle changes. This study aimed to determine the limitations in activity and the influences of remote exercise training on community-dwelling older adults during a state of emergency in Japan. [Participants and Methods] In May 2020, during the COVID-19 state of emergency, we carried out a mail survey of community-dwelling older adults who had previously participated in a disability prevention program in Ami town, Ibaraki, Japan. The mail included a brochure on exercises and a DVD. The attached exercise program was comprised of 10 different exercises, which could be conducted in approximately 30 minutes. [Results] Of the 191 older adults, 73 responded to this survey (38.2%), of which 42 (58.5%) participants had decreased outdoor exercise activity, and 50 (68.5%) decreased the amount of time spent on physical activities during the COVID-19 state of emergency. There were significant reductions (19.2–22.5%) in the perceived exercise load for each posture after two weeks of remote exercise training with DVD (n=26). [Conclusion] Our results suggested that the remote exercise training with the brochure and DVD may be effective. Since this study involved a small number of participants, future studies should involve larger populations.

[Purpose] The physical functions related to swimming should be evaluated to enhance competitive performance and prevent sports injuries. This study aimed to determine the physique, range of motion, and gross muscle strength of the limbs among hemiplegic para swimmers. [Participants and Methods] Three male para swimmers with hemiplegia and five male para swimmers with impaired vision were included in the study. The limb circumference, range of motion, quadriceps flexibility, and gross muscle strength were evaluated. The hemiplegic swimmers and swimmers with impaired vision were compared using an unpaired t-test. [Results] The maximum values of the upper and forearm circumferences; the range of motion for shoulder flexion, external rotation, ankle dorsiflexion on the paretic side; and the single-leg sit-to-stand test of the dominant limb were significantly lower in hemiplegic swimmers than in swimmers with impaired vision. [Conclusion] Hemiplegic swimmers had decreased upper limb circumferences on the paretic limb; the range of motion for shoulder flexion, external rotation, and ankle dorsiflexion on the paretic limb; and muscle strength on the dominant lower limb.

[Purpose] This study aimed to investigate the effect of the combination of 15° tilt-in-space and recline angles on the fluctuation of shear forces exerted on the buttocks. [Participants and Methods] The participants were 11 healthy adult males. The parameters of the shear forces were the parallel and perpendicular forces exerted on the buttocks as measured by a force plate. The two conditions tested were T0R100-130 and T15R100-130. The tilt-in-space angles were set to 0° and 15° in the T0R100-130 and T15R100-130 conditions, respectively. The reclining angles were determined to be 100° to 130° in both conditions. [Results] Upon comparing the two conditions, the parallel and the perpendicular forces exerted on the buttocks in the T15R100-130 condition were significantly lower than those in the T0R100-130 condition in all positions of back support. Upon comparing the fluctuation values of the parallel and perpendicular forces, those applied in the T15R100-130 condition were significantly higher than those in the T0R100-130 condition. [Conclusion] These results suggest that the fluctuation of shear forces exerted on the buttocks could be decreased by using a combination of 15° tilt-in-space and reclining functions.

[Purpose] This study aimed to observe the thickness of the transverse abdominis muscle in different contraction states using ultrasound, and to investigate the diagnostic capability of transverse abdominal muscle thickness for nonspecific lower back pain. [Participants and Methods] This study included 108 healthy adults (30–50 years old), consisting of 33 participants with low back pain (13 males, 20 females; defined as those who had experienced low back pain for more than six months) and 75 participants without low back pain (22 males, 53 females). The body mass index, body trunk muscle mass, and transverse abdominal muscle thickness, measured at a static state, during the end of inspiration, end of expiration, transverse abdominis contraction, and simultaneous pelvic floor and transverse abdominis muscle contraction, were measured. [Results] Chronic low back pain was correlated with the transverse abdominis muscle thickness during simultaneous transverse abdominis and pelvic floor muscle contraction. [Conclusion] The thickness of the transverse abdominis muscle during simultaneous transverse abdominis and pelvic floor muscle contraction was a viable diagnostic index for evaluating the degree of chronic lower back pain.

[Purpose] This study aimed to observe the changes in the thickness of the transverse abdominis muscle after long-term training with a new device using ultrasound imaging and to determine the impact of these changes on chronic low back pain (CLBP). [Participants and Methods] This study included 60 participants with CLBP, who were divided into groups that adopted different positions during the training regimen: new device intervention group (NDG), sitting training group (STG), and supine training group (SPTG). Patients in the NDG used the new device during training. We measured the thickness of the transverse abdominis muscle and determined the pain level using the visual analog scale (VAS). [Results] After 8 weeks of training, the thickness of the transverse abdominis muscle changed in all the three groups, with the change being significantly greater in the NDG than in the other groups. Additionally, the VAS results indicated that the pain relief was highest when the new device was used. [Conclusion] The thickness of the transverse abdominis muscle increased the most in patients who were trained with the new interventional device, and the CLBP was significantly relieved in them.

[Purpose] To examine the impact of the state of emergency declared with the spread of coronavirus disease (COVID) on the initiatives for the national examination. [Participants and Methods] The participants were 257 students who graduated from the International University of Health and Welfare, in March of the years 2019–2021 (non-COVID group; graduation in 2019 and 2020, COVID group; graduation in 2021). The levels of satisfaction with the department’s initiatives, test scores, and frequency of mock examinations were assessed using a visual analog scale. [Results] The COVID group was significantly more satisfied with the department’s initiatives and frequency of mock examinations than the non-COVID group. [Conclusion] The results suggest that despite the pandemic, it is possible to improve student satisfaction through measures to familiarize students with the examination.

[Purpose] We investigated the influence of gait speed on the movement strategy during gait initiation. [Participants and Methods] This study included 21 young healthy individuals (11 males and 10 females; mean age, 21.7 ± 0.5 years; mean height, 166.1 ± 9.8 cm; and mean weight, 57.3 ± 11.2 kg). A three-dimensional motion analyzer and strain gauge force platform were used in this study. The measurement task consisted of gait initiation from the quiet stance; the two measurement conditions were normal gait and the highest speed. The analysis interval was from the start of the center of pressure migration to the heel contact at the first step of the swing limb. The center of gravity, center of pressure, joint movements, step length, and step time during the anticipatory postural control (from the start of center of pressure migration to swing leg-heel off) and swing (swing leg-heel off to swing leg-heel contact) phases were analyzed. [Results] Significant differences were observed in the center of gravity, center of pressure, hip flexion, abduction movement, stance-limb ankle dorsiflexion movement during the anticipatory postural control phase, and step time during the anticipatory postural control and swing phases. The stance-limb ankle plantar flexion movement and step length did not differ significantly in the swing phase. [Conclusion] When the gait speed increases, fluctuations in the joint movements increase as the center of pressure displacement increases, thus requiring complex control.

[Purpose] This study aimed to explore the application value of yoga intervention in early postpartum recovery of the levator ani muscle hiatus (LAH) area. [Participants and Methods] Females in natural labor from May 2020 to November 2020 in the Third People’s Hospital of Sun Yat-sen University Ultrasound Research Center were prospectively included for a pelvic ultrasound examination. The control group received no intervention. The experimental group received 60-min yoga once a week from week 1 to week 12 postpartum. A pelvic ultrasound examination was performed on the week 6 and week 12 postpartum. The LAH area was measured at rest, during contraction and Valsalva maneuver. [Results] A total of 128 participants who met the inclusion criteria were selected and randomly assigned to the control group (n=66) and the experimental group (n=62) in pre and post intervention design. No significant differences were found in age, parity, body mass index, and fetal weight between the control and experimental groups. Further, no significant difference was observed in the LAH area between the control and experimental groups at rest, during contraction and Valsalva maneuver on the week 6 postpartum. However, the LAH area in experimental group significantly reduced at rest, during contraction and Valsalva maneuver on the week 12 postpartum. The differences of LAH area (date week 6 minus date week 12) in the control group at rest, during contraction and Valsalva maneuver were 0.12 ± 3.12 cm², 0.80 ± 2.29 cm², and 0.80 ± 4.22 cm², while in the control these were 1.95 ± 3.41 cm², 1.39 ± 1.91 cm², and 3.81 ± 5.49 cm², respectively. Compared with control group, the differences of LAH area significantly increased in experimental group at rest and during Valsalva maneuver. [Conclusion] Yoga intervention can help in the recovery of LAH.

[Purpose] There have been concerns that the availability and usage of electrophysical agents have decreased, based on data from cross-sectional surveys. The aim of this study was to conduct the first five-year follow-up longitudinal survey to determine the changes in the availability and usage of electrophysical agents in Nagano Prefecture, Japan. [Participants and Methods] This longitudinal observational study employed the same postal questionnaire survey of practicing clinicians in 2014 and 2019. A total of 22 modalities had been selected for inclusion in the questionnaire based on what is used in clinical facilities and hospitals. [Results] The response rate was 71% and 63% for 2014 and 2019, respectively. The modalities that were high in availability and usage for both 2014 and 2019 were hot packs, ultrasound, cryotherapy and low frequency. While most modalities demonstrated a decreased trend in usage, electrical stimulation devices increased from 2014 to 2019. The results also demonstrated that usage was affected by gender (males greater than females), years of experience (older greater than younger), qualifications (diplomas greater than degrees), and confidence (confident greater than non-confident). [Conclusion] Our results may assist educators with designing educational curricula that is consistent with the needs of clinicians.