Dr Obispo Sports Rehabilitation & Osteopathy

15/11/2025

Just published 🔥

Physical and Psychological Predictors for Persistent and Recurrent Non‐Specific Neck Pain: A Systematic Review

▶️ Non‐specific neck pain (NSNP) is a highly prevalent musculoskeletal disorder, with up to 57% of patients developing persistent disability one year after onset (https://pubmed.ncbi.nlm.nih.gov/23664654/) and 23–48% experiencing recurrent episodes within a year (https://pubmed.ncbi.nlm.nih.gov/15284511/, https://pubmed.ncbi.nlm.nih.gov/15561381/).

▶️ Persistent pain is typically defined as lasting ≥3 months (https://pubmed.ncbi.nlm.nih.gov/30586067/), whereas recurrent pain refers to episodic pain with ≥24-hour duration, separated by at least one month of remission (https://pubmed.ncbi.nlm.nih.gov/19531986/).

▶️ Previous reviews have focused predominantly on psychological and demographic predictors of chronic neck pain (https://pubmed.ncbi.nlm.nih.gov/20466711/, https://pubmed.ncbi.nlm.nih.gov/31026716, ) https://pubmed.ncbi.nlm.nih.gov/32517732/, with limited attention to physical factors such as neuromuscular function, sensory changes, and motor control impairments (https://pubmed.ncbi.nlm.nih.gov/30690409/, https://doi.org/10.1038/s41598-022-14696-8, https://pubmed.ncbi.nlm.nih.gov/23849933/).

▶️ Identifying modifiable predictors of persistence and recurrence is crucial for developing targeted interventions (https://pubmed.ncbi.nlm.nih.gov/25659245/)

📘 In a brand-new systematic review, published in the “European Journal of Pain”, Yu et al. (2025) conducted a systematic review to evaluate both physical (e.g., cervical strength, range of motion, sensory thresholds) and psychological (e.g., catastrophizing, distress) predictors of persistent or recurrent NSNP.

📊 Results

🧠 Psychological predictors:

✅ Pain catastrophizing and psychological distress (e.g., depression, anxiety, perceived stress) were consistently associated with persistent and recurrent neck pain and disability, supported by low-to-moderate certainty of evidence.

✅ Catastrophizing predicted higher Neck Disability Index (NDI) scores and greater pain intensity

💪 Physical predictors:

❓ Findings for neck flexion strength, pain inducing pressure threshold (PPT), pain inducing cold threshold (CPT), conditioned pain modulation (CPM), temporal summation (TS), and neck endurance were inconsistent or limited.

❎ Cervical range of motion, cold pain threshold at the neck, and neck extensor strength showed no predictive value.

Certainty of evidence: Overall, evidence for psychological predictors was stronger than for physical measures, though all were limited by study design heterogeneity and small sample sizes.

💡 Conclusions

High pain catastrophizing and psychological distress are consistent predictors of persistent and recurrent NSNP and related disability. Evidence for physical predictors remains inconclusive due to methodological variability and limited longitudinal data.

The authors recommend incorporating early assessment of maladaptive psychological traits into clinical screening and exploring targeted cognitive-behavioral or multimodal rehabilitation strategies to prevent chronicity. In this context, Farrell and colleagues confirmed that psychological interventions provided by physiotherapists were more effective than standard physiotherapy for treating chronic, non-traumatic neck pain. The effect size was low to moderate (https://pubmed.ncbi.nlm.nih.gov/37731474/).

09/11/2025

Kanokvaleewong et al report that conservative treatment was effective for the treatment of frozen shoulder. It improved night pain within a month and enhanced range of motion significantly within a year

03/11/2025

✅ Enhancing muscle and brain resilience: The role of prehabilitative exercise in mitigating disuse effects

🧠 Effectiveness of Prehabilitative Exercise

Prehabilitative exercise, defined as structured exercise preparing for anticipated disuse (such as bed rest or limb immobilization), is emerging as a potent strategy to preserve brain and neuromuscular structures and function in various populations.

■ 💪 Reduction of Adverse Outcomes
Clinical studies across multiple medical specialties suggest that prehabilitative exercise has positive effects on preserving muscle function, reducing adverse outcomes, and shortening the length of hospital stay.

■ 📈 Improvement in Clinical Measures
Several meta-analyses have demonstrated mostly positive effects of pre-habilitative exercise on clinical outcomes and in vivo measurements of physical function.
Includes improving post-operative cognitive function and enhancing recovery in functional performance following total hip or knee replacement.

■ ⏱️ Enhanced Recovery
It is likely that pre-disuse training promotes a more complete, or even faster, recovery following a period of disuse.
This is particularly important since intensive rehabilitation training does not restore all individuals to their pre-disuse levels.

■ ⚠️ Counteracting Severe Decline
Disuse (even short-term periods like 3–7 days of hospitalization) causes profound negative impacts on bodily functions, leading to rapid declines in muscle mass and strength.
These declines can push an individual below the threshold for independent living, underscoring the need for effective treatment regimens like prehabilitation to ameliorate these debilitating effects.

👇

🌍 Societal and Logistical Benefits

From a societal perspective, pre-habilitative initiatives offer significant logistical and quality-of-life benefits:

■ 🏥 Reduced Burden of Care
Prehabilitation initiatives might shorten the length of stay, reduce the number and severity of post-surgical complications, and lead to overall improvements in patient quality of life.

■ 🏡 Feasibility and Accessibility
Prehabilitative exercise has the inherent benefit that it can be performed away from the hospital and closer to the patient’s home.
This allows the patient to be more actively involved in their treatment and less affected by surgical stress.

■ ⌛ Timeliness of Intervention
Even if the time between a medical decision and surgery is short, this window is not too small to deliver effective exercise training.
Significant improvements in cardiorespiratory function can be achieved after as little as two weeks of high-intensity interval training (HIIT), and muscle strength can improve after four weeks of home-based resistance exercise in older adults.

📝

🏋️‍♀️ 1. Types of Structured Exercise

Specific examples and categories of exercises that have been studied in the context of exercise training, recovery, and prehabilitation:

🧱 Resistance Exercise (Strength Training)

■ Heavy resistance exercise of the lower limbs was used in a 12-week bed rest study and completely ameliorated the decline in muscle strength when performed every third day in bed.
■ A single bout or four bouts of resistance exercise prevented declines in Muscle Protein Synthesis (MPS) during bed rest, although results for muscle size were mixed.
■ Home-based, non-supervised, resistance exercise training improved muscle strength in older adults after just 4 weeks.
■ In the context of muscle memory, training the leg press is mentioned as a mode of prehabilitative resistance exercise to create a motor representation in the brain.
■ A single bout of heavy resistance exercise has been shown to influence gene expression of ACh receptors in muscle in a subunit-specific and temporal manner.
When performed for 8 weeks, this type of exercise led to significant reductions in markers of muscle denervation and increases in muscle strength.

🫀 Aerobic Exercise / Cardiovascular Exercise

■ High-intensity interval training (HIIT) improved cardiorespiratory function after as little as 2 weeks in young and older adults.
■ Cardiovascular exercise in general can improve cognitive functions and may increase or maintain the size of the hippocampus.

🔄 Combined Exercise

■ One meta-analysis examined the effects of pre-operative combined aerobic and resistance exercise training in cancer patients undergoing tumor resection surgery.

⚙️ Other Related Modalities

■ Muscle damaging eccentric exercise conducted before immobilization partially prevented declines in muscle volume and MPS but negatively impacted muscle strength, which raises questions about its suitability for patient populations.
■ Treadmill running interventions (ranging from one session to 8 weeks) in animal models generally preserved muscle mass and specific force during subsequent hindlimb unloading.

-----------------
⚠️Disclaimer: Sharing a study or a part of it is NOT an endorsement. Please read the original article and evaluate critically.⚠️

Link to Article 👇

25/10/2025

✅ Clinical Applications in "Physiotherapy Management of Adolescent Idiopathic Scoliosis"

🩺 1. Diagnosis and Assessment Tools

◼ Screening
▪ School-based screening is used for early detection.
▪ The Adam’s forward bending test uses a scoliometer to quantify the angle of trunk rotation (ATR).
▪ Professional societies recommend an ATR ≥ 7 degrees as the threshold for recommending further evaluation to minimize overdiagnosis and unnecessary radiographic exposure.
▪ Combining two screening modalities (e.g., Adam’s test, scoliometer, and Moiré topography) achieves the highest sensitivity (91.8 to 93.8%), specificity (99.2%), and positive predictive value (81.0%).

◼ Imaging and Measurement
▪ Scoliosis is traditionally assessed using the Cobb method on standing posteroanterior radiographs, measuring the angle between the superior endplate of the uppermost vertebra and the inferior endplate of the lowest vertebra involved in the curve.
▪ EOS imaging is a low-dose, weight-bearing X-ray technology that delivers 16 to 34 times less radiation than standard digital radiography and enables three-dimensional reconstruction of the spine.
▪ Computer-assisted measurement methods for the Cobb angle can reduce intra- and inter-rater errors to within 3 degrees.

◼ Growth Potential Assessment
▪ The risk of curve progression is strongly tied to remaining growth potential. Clinical tools used to grade this potential include:
◼ Risser grade: Measures iliac crest apophysis ossification (0 to 5), where a lower grade indicates more remaining spinal growth and a greater risk of progression.
◼ Distal radius and ulna classification score: Provides a finer estimate of skeletal maturity by examining the appearance and closure of growth plates.
◼ Tanner stage: Classifies pubertal development; earlier stages reflect higher growth potential.

✨

🧠 2. Intervention Strategies

◼ Based on the Cobb angle, progression rate, and remaining skeletal growth potential:
▪ < 20 degrees → Observation advised. PSSE may be considered first-line.
▪ 20–25 degrees → Observation or bracing may be considered.
▪ 26–45 degrees → Bracing is recommended. PSSE may be used adjunctively.
▪ 46–50 degrees → Bracing or surgery may be appropriate.
▪ > 50 degrees → Surgery is recommended.

A. Therapeutic Exercises

▪ Therapeutic exercises, including Generic Therapeutic Exercises (GTE) and Physiotherapy Scoliosis-Specific Exercises (PSSE), aim to modify spinal neuromuscular control and actively stabilize the spine in corrected postures.
▪ They can serve as primary treatment for mild curves (≤ 25°) or as an adjunct to bracing.

◼ Physiotherapy Scoliosis-Specific Exercises (PSSE)
▪ PSSE (such as SEAS and Schroth exercises) target personalized self-correction, muscle control education, and training in activities of daily living.
▪ The Schroth method focuses on isometric exercises performed in desirable self-correction postures to promote stabilization, emphasizing specific breathing techniques to achieve symmetrical chest expansion.

◼ Effectiveness Evidence
▪ PSSE vs. No Treatment: Therapeutic exercises led to a clinically meaningful improvement in back pain compared with no treatment (low-certainty evidence). PSSE showed superiority to no treatment in improving Cobb angle or waist asymmetry, potentially delaying the need for bracing (very low-certainty evidence).
▪ PSSE vs. GTE: PSSE was more effective than GTE in preventing curve progression > 5 degrees (low-certainty evidence). PSSE also resulted in a greater reduction in angle of trunk rotation (ATR), which was considered clinically meaningful (moderate-certainty evidence).
▪ PSSE + Bracing vs. Bracing Alone: Adding PSSE to bracing improved the Cobb angle slightly more than bracing alone (low-certainty evidence), although this difference was not clinically meaningful. Exercises may enhance brace effectiveness and mitigate side effects such as muscle weakness and flat back.
▪ PSSE vs. Bracing Alone: Bracing alone resulted in better Cobb angles than PSSE alone (very low-certainty evidence), though this difference was not clinically meaningful.

✨

B. Bracing

▪ Bracing is the mainstay conservative treatment for Cobb angles between 20 and 45 degrees.
▪ Rigid braces are designed to restore normal body alignment.

◼ Effectiveness Evidence
▪ A large-scale randomized controlled trial showed that full-time rigid bracing (72% success) was superior to observation alone (42% success) in preventing progression to a Cobb angle ≥ 50 degrees or the need for spinal surgery before skeletal maturity.
▪ Pooled data showed success rates (≤ 5 degrees coronal curve progression) were 73% for full-time rigid braces, 79% for night-time rigid braces, and 62% for full-time soft braces.
▪ Bracing is most effective for AIS patients with Risser signs of 0 to 2 and 0 to 3 stages of skeletal maturity.

✨

C. Surgical Interventions and Perioperative Care

▪ Surgical correction (e.g., posterior spinal fusion) is indicated for Cobb angles ≥ 45 degrees.
▪ Physiotherapists play a key role in perioperative care to optimize recovery.
▪ Enhanced Recovery After Surgery (ERAS) protocols include structural physiotherapy before surgery, patient and parental education, and early postoperative mobilization (e.g., sitting out of bed).
▪ A systematic review found that ERAS significantly reduced hospital stay (by an average of 1.44 days) compared to traditional protocols, with no significant difference in complication rates.

✨

💬 3. Psychosocial Management

▪ AIS, bracing, and curve progression can adversely affect self-image and quality of life in teenagers; psychosocial support is critical.
▪ Psychosocial interventions such as imagery and cognitive behavioral therapy reduce postoperative anxiety and pain, improve bracing compliance, and increase participation in social activities.
▪ Appropriate social support and coping-based interventions enhance psychological wellbeing.
▪ Clinicians should engage both patients and parents in shared decision-making to improve treatment adherence and overall health outcomes.

-----------------
⚠️Disclaimer: Sharing a study or a part of it is NOT an endorsement. Please read the original article and evaluate critically.⚠️

Link to Article 👇

11/10/2025

📌◼️ Understanding Modic Changes: A Key Indicator of Vertebrogenic Pain📃

✔️Modic changes are specific findings observed on magnetic resonance imaging (MRI) that are critical in the diagnostic evaluation of chronic low back pain (CLBP).
These changes relate directly to degenerative endplate changes and edema in the vertebral bodies adjacent to the intervertebral disc.

👉◼️ Modic Changes and Vertebrogenic Pain
Identifying Modic changes is crucial because they characterize vertebrogenic pain, one of the potential sources of axial chronic low back pain.

▪️ Vertebrogenic Pain: This pain etiology is characterized by the degeneration of the smooth endplate adjacent to the disc. The endplate serves as the nutrient porous barrier between the vertebral body and the disc.

▪️ Pain Transmission: The pain associated with endplate degeneration is carried by the fibers of the basivertebral nerve (BVN).

▪️ Imaging Evidence: When investigating axial CLBP, the presence of changes in the endplates, such as invaginations and edema in the vertebral bodies (specifically Modic type I–II), supports a diagnosis of vertebrogenic pain.

👉◼️ Visualizing Modic Changes on MRI
Modic changes are classified into types based on their specific signal intensity appearance on T1 and T2 weighted MRI images.

▪️ Modic type 1: Dark on T1 and bright on T2.
▪️ Modic type 2: Bright on both T1 and T2.
▪️ Modic type 3: Dark on both T1 and T2.

▪️ Modic types I and II are the types explicitly mentioned as being visible in patients experiencing vertebrogenic pain.

👉◼️ Differentiating from Other CLBP Sources
Vertebrogenic pain, indicated by Modic changes, presents as central axial pain that may radiate across the lumbar region.
It must be differentiated from other causes of axial CLBP, such as facet joint syndrome and sacroiliac joint (SIJ) pain.

▪️ In patients with discogenic pain, the endplate generally remains intact, although a high-intensity zone (HIZ) may be present within the annulus of the disc.

▪️ Vertebrogenic pain and discogenic back pain are estimated to constitute 39% of all causes of chronic low back pain.

👉◼️ Clinical Significance: Treatment
The identification of Modic changes on MRI has direct implications for treatment.

▪️ If a patient presents with axial CLBP, without radicular symptoms, and other pain generators like the facet joint and SIJ have been ruled out, the presence of degenerative endplate changes on MRI makes it prudent to consider basivertebral nerve ablation as the next course of action to help alleviate debilitating pain.

▪️ Basivertebral nerve ablation is a procedure targeting the nerve fibers that carry pain signals due to endplate degeneration.

📌Significance for physiotherapists?

👉Modic changes have important implications in physiotherapy management, as they help guide both the treatment focus and clinical expectations in patients with chronic low back pain (CLBP).

◼️ 1. Identifying the Pain Source
▪️ Modic changes indicate vertebrogenic pain, meaning the primary pain generator is the vertebral endplate, not the disc, muscle, or facet joints.
▪️ This helps physiotherapists tailor treatment away from interventions targeting discogenic or facet-related pain.

◼️ 2. Adjusting Exercise Prescription
▪️ Early stages (Modic type I, with inflammation and edema) may require load management, gentle mobility, and graded activity, avoiding excessive spinal loading that aggravates endplate stress.
▪️ Later stages (Modic type II, fatty degeneration) allow for progressive strengthening and stabilization programs focusing on trunk endurance, posture control, and functional reconditioning.

◼️ 3. Pain Education and Expectation Setting
▪️ Patients with Modic changes often experience chronic, central low back pain that can persist despite traditional soft tissue–based therapy.
▪️ Educating the patient that their pain has a vertebrogenic origin helps set realistic expectations and reinforces the importance of consistent, long-term management.

◼️ 4. Multidisciplinary Approach
▪️ Recognition of Modic changes signals when collaboration with pain specialists or spine physicians may be beneficial.
▪️ If pain remains refractory to conservative physiotherapy, the patient may be a candidate for basivertebral nerve ablation, while physiotherapy continues to address movement control and functional restoration post-procedure.

◼️ 5. Clinical Insight in Imaging Interpretation
▪️ Understanding Modic changes enables physiotherapists to interpret MRI findings more meaningfully, linking imaging to functional deficits and guiding evidence-informed rehabilitation planning.

11/10/2025

It is not always the sciatic nerve

Hot off the press 🔥

𝗕𝗲𝘆𝗼𝗻𝗱 𝗡𝗲𝗿𝘃𝗲 𝗘𝗻𝘁𝗿𝗮𝗽𝗺𝗲𝗻𝘁: 𝗔 𝗡𝗮𝗿𝗿𝗮𝘁𝗶𝘃𝗲 𝗥𝗲𝘃𝗶𝗲𝘄 𝗼𝗳 𝗠𝘂𝘀𝗰𝗹𝗲–𝗧𝗲𝗻𝗱𝗼𝗻 𝗣𝗮𝘁𝗵𝗼𝗹𝗼𝗴𝗶𝗲𝘀 𝗶𝗻 𝗗𝗲𝗲𝗽 𝗚𝗹𝘂𝘁𝗲𝗮𝗹 𝗦𝘆𝗻𝗱𝗿𝗼𝗺

▶️ Sciatica-like pain is frequently attributed to lumbar disc herniation or spinal stenosis, but in many patients, symptoms persist despite treatment of spinal causes, suggesting extraspinal etiologies (Guedes e
t al., 2020). Deep Gluteal Syndrome (DGS), first described by McCrory and Bell (1999) as sciatic nerve entrapment, has emerged as a significant source of nondiscogenic buttock and leg pain.

▶️ Prevalence estimates suggest that up to 17% of patients presenting with sciatica may have DGS (Kizaki et al., 2020). Traditionally viewed as a nerve entrapment disorder, more recent evidence highlights the contribution of muscular and tendinous pathologies—particularly enthesopathies of the deep external rotators and hamstring origin—as primary pain generators (Martin et al., 2015; De Lorenzis et al., 2023).

▶️ This evolving perspective necessitates a redefinition of DGS that integrates muscle–tendon pathology with neural mechanisms.

📘 In a brand-new narrative review Yoon et al. (2025, https://www.mdpi.com/2075-4418/15/19/2531 -diagnostics-15-02531) expand the conceptual framework of Deep Gluteal Syndrome beyond sciatic nerve entrapment, emphasizing muscle- and tendon-related pathologies as central contributors.

✅ Pathogenesis: In addition to sciatic nerve compression, pathologies such as ischiofemoral impingement, proximal hamstring tendinopathy, and enthesopathy of the deep external rotators can directly generate pain or secondarily irritate neural structures.

✅ Diagnosis: Clinical differentiation from lumbar radiculopathy is critical. Provocative maneuvers (FAIR, piriformis stretch, Pace’s test) and imaging (high-resolution MRI, MR neurography, dynamic ultrasonography) aid in distinguishing nerve-dominant from tendon-dominant subtypes. This differentiation might be a crucial factor in clinical reasoning.

✅ Treatment: A stepwise strategy is recommended—beginning with conservative care (load management, progressive tendon loading exercises , neural mobilization/desensitization), depending on tendon involvement or neural mechano-hypersensitive with refractory cases reserved for surgery. But, current evidence largely comprises case series and expert opinion underscoring the need for randomized controlled trials.

💡 Conclusion:

DGS should be reframed as a heterogeneous syndrome involving both neural entrapment and muscle–tendon pathology. Recognition of tendon-dominant and mixed subtypes allows for more precise diagnosis and tailored treatment strategies. Future work must focus on validating classification systems and establishing high-level evidence for emerging therapies.

📚 References

Battaglia, P.J., Mattox, R., Haun, D.W., Welk, A.B., & Kettner, N.W. (2016). Dynamic ultrasonography of the deep external rotator musculature of the hip: A descriptive study. PM&R, 8(7), 640–650. https://doi.org/10.1016/j.pmrj.2015.11.001

De Lorenzis, E., Natalello, G., Simon, D., Schett, G., & D’Agostino, M.A. (2023). Concepts of entheseal pain. Arthritis & Rheumatology, 75(3), 493–498. https://doi.org/10.1002/art.42299

Guedes, F., Brown, R.S., Lourenço Torrão-Júnior, F.J., Siquara-de-Sousa, A.C., & Pires Amorim, R.M. (2020). Nondiscogenic sciatica: What clinical examination and imaging can tell us? World Neurosurgery, 134, e1053–e1061. https://doi.org/10.1016/j.wneu.2019.11.083

Hauser, R.A., Lackner, J.B., Steilen-Matias, D., & Harris, D.K. (2016). A systematic review of dextrose prolotherapy for chronic musculoskeletal pain. Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders, 9, 139–159. https://doi.org/10.4137/CMAMD.S39160

Hernando, M.F., Cerezal, L., Pérez-Carro, L., Abascal, F., & Canga, A. (2015). Deep gluteal syndrome: Anatomy, imaging, and management of sciatic nerve entrapments in the subgluteal space. Skeletal Radiology, 44(7), 919–934. https://doi.org/10.1007/s00256-015-2112-6

Kizaki, K., Uchida, S., Shanmugaraj, A., Aquino, C.C., Duong, A., Simunovic, N., Martin, H.D., & Ayeni, O.R. (2020). Deep gluteal syndrome is defined as a non-discogenic sciatic nerve disorder with entrapment in the deep gluteal space: A systematic review. Knee Surgery, Sports Traumatology, Arthroscopy, 28(10), 3354–3364. https://doi.org/10.1007/s00167-020-05966-x

Martin, H.D., Reddy, M., & Gómez-Hoyos, J. (2015). Deep gluteal syndrome. Journal of Hip Preservation Surgery, 2(2), 99–107. https://doi.org/10.1093/jhps/hnv029

McCrory, P., & Bell, S. (1999). Nerve entrapment syndromes as a cause of pain in the hip, groin and buttock. Sports Medicine, 27(4), 261–274. https://doi.org/10.2165/00007256-199927040-00005

Yen, Y.S., Lin, C.H., Chiang, C.H., & Wu, C.Y. (2024). Ultrasound-guided sciatic nerve hydrodissection can improve the clinical outcomes of patients with deep gluteal syndrome: A case-series study. Diagnostics, 14(4), 757. https://doi.org/10.3390/diagnostics14040757

Yoon, Y.H., Hwang, J.H., Lee, H.W., Lee, M., Park, C., Lee, J., Kim, S., Lee, J., de Castro, J.C., Lam, K.H.S., et al. (2025). Beyond nerve entrapment: A narrative review of muscle–tendon pathologies in deep gluteal syndrome. Diagnostics, 15(19), 2531. https://doi.org/10.3390/diagnostics15192531

📷 Figure: Anatomy of the deep gluteal space. Muscles and ligaments are indicated in black, and nerves are indicated in yellow boxes. The area with red stars is where enthesopathy occurs. Ligaments are indicated by black circles, nerves by yellow boxes, and tendons by red boxes, https://www.mdpi.com/diagnostics/diagnostics-15-02531/article_deploy/html/images/diagnostics-15-02531-g002.png

05/10/2025

🤔

🔗📃Differences in the Effectiveness of Different Physical Therapy Modalities in the Treatment of Delayed-Onset Muscle Soreness: A Systematic Review and Bayesian Network Meta-Analysis✨

◼️ I. Overview and Scope of the Study

🔹 Condition Addressed:
Delayed-onset muscle soreness (DOMS) is a common clinical condition characterized by transient muscular injury typically resulting from high-intensity eccentric contractions or unfamiliar exercise.

🔹 Symptoms and Duration:
Symptoms of DOMS usually manifest 6–12 hours post-exercise, peak between 24 and 72 hours, and generally resolve within 5–7 days. DOMS is associated with muscle pain, reduced strength, stiffness, and swelling, potentially impacting athletic performance and increasing economic burdens.

🔹 Study Goal:
The systematic review and network meta-analysis aimed to assess the efficacy and safety of various physical therapy modalities (PTMs) for DOMS, providing robust, evidence-based medical insights for clinical application, especially since many previously published studies had yielded conflicting results.

🔹 Interventions Evaluated:
Nine PTMs were evaluated in the included studies: photobiomodulation therapy (PBMT), cryotherapy, sauna, electrical stimulation (ES), ultrasonic therapy (UT), irradiated therapy, soft tissue mobilization (STM), cryotherapy combined with PBMT, and cryotherapy combined with ES.

◼️ II. Effectiveness of Physical Therapy Modalities by Time Point

🔹 Overall Time Window:
Physical therapy modalities were found to be most effective within the initial 48 hours post-intervention. Beyond this period (72 hours and 96 hours), PTMs showed no notable benefit compared with placebo.

🔹 24 Hours Post-Intervention:

Photobiomodulation Therapy (PBMT) demonstrated a significant advantage over placebo (P