Author: Zuzanna Wiecheć, Arkadiusz Żurawski, Żaneta Wypych, Marek Wiecheć, Zbigniew Śliwiński

The influence of anatomical markers on the precision of body posture measurement in the DIERS Formetric 4D system – intra- and inter-rater analysis

Zuzanna Wiecheć, Arkadiusz Żurawski, Żaneta Wypych, Marek Wiecheć, Zbigniew Śliwiński

Zuzanna Wiecheć, Arkadiusz Żurawski, Żaneta Wypych, Marek Wiecheć, Zbigniew Śliwiński – The influence of anatomical markers on the precision of body posture measurement in the DIERS Formetric 4D system – intra- and inter-rater analysis –  Fizjoterapia Polska 2025; 25(3); 432-440

DOI: https://doi.org/10.56984/8ZG7D193RN5

Abstract
Introduction. Diagnostics in physiotherapy is increasingly based on precise measuring devices; one of the increasingly popular in clinical practice is the DIERS Formetric 4D system. Its effectiveness has been confirmed in many studies, but there is still no assessment of the effectiveness of measurements depending on whether photosensitive anatomical markers were used.
Aim of the study. The aim of the study was to verify the effect of anatomical markers on the results of a photogrammetric examination using the DIERS Formetric system as an example.
Material and methods. The study involved 20 healthy adults. Each subject was examined three times by two independent researchers with two measurement variants – one with anatomical markers and one without markers. Seven body posture parameters were taken into account in the analysis. The intraclass correlation coefficient (ICC), standard error of measurement (SEM), minimal detectable change (MDC) and Student’s t-test and Wilcoxon test were used to determine the variability and reliability of the measurements (SEM), minimal detectable change (MDC), and Student’s t-test and Wilcoxon test.
Results. Five of the seven parameters showed slight differences. Higher values of thoracic kyphosis and lumbar lordosis angles and lower values of surface rotation and lateral deviation were obtained in measurements using markers (p < 0.05). ICC values ranged from 0.88 to 0.99, showing very high repeatability in both conditions. Slightly lower values of SEM and MDC in the case of markers indicate higher precision of this method.
Conclusions. The use of anatomical landmarks can increase both the accuracy and reliability of body posture assessment using the DIERS Formetric 4D system, which is particularly important in the case of examinations requiring a high level of precision.
Key words
DIERS Formetric 4D, rasterstereography, posture assessment, anatomical markers, repeatability of measurement, measurement accuracy
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Effect of low-level laser therapy on sitting tolerance and activities of daily living in individuals with coccydynia

Jeniffer A, N Senthil Kumar, Jeslin G N, Ramya S, Pooja S, Surya V, Aravindh B, Karthick K

Jeniffer A, N Senthil Kumar, Jeslin G N, Ramya S, Pooja S, Surya V et al. – Effect of low-level laser therapy on sitting tolerance and activities of daily living in individuals with coccydynia –  Fizjoterapia Polska 2025; 25(3); 428-431

DOI: https://doi.org/10.56984/8ZG7D19O1M3

Abstract
Introduction. Coccydynia is defined as pain developing in the coccyx region. The condition is three times more common among women and people with obesity. Common treatments include corticosteroid injections, manual therapy, and physical modalities. However, there is limited research on the effectiveness of physical therapy interventions, particularly low-level laser therapy, in managing coccydynia.
Aim of the study. To determine the effectiveness of low-level laser therapy in improving sitting duration and daily activity participation among patients with coccydynia.
Materials and methods. This study was conducted in a private hospital in Chennai with 30 participants selected from an initial pool of 50 using random sampling. Participants were randomly assigned to two groups: the LLLT group (n = 15) received low-level laser therapy (LLLT), and the US group (n = 15) received ultrasound therapy (US). Both groups also received pelvic bridging exercises over a 2-week intervention period. Outcome measures included the Dallas Pain Questionnaire (DPQ) and the pain-free sitting duration (PFSD) scale.
Results. Both groups showed significant improvement in DPQ and PFSD scores (p < 0.0001). The LLLT group showed a reduction in DPQ scores from 71.60 to 39.40 and an increase in PFSD from 7.30 to 11.10. The US group showed a greater reduction in DPQ scores from 68.60 to 27.30 and a larger improvement in PFSD from 7.20 to 15.60. These findings indicate that while both therapies were effective, ultrasound therapy achieved a more pronounced reduction in pain and better functional outcomes than low-level laser therapy.
Conclusion. Both LLLT and ultrasound therapy effectively reduced pain and improved sitting tolerance in individuals with coccydynia. However, ultrasound therapy demonstrated superior clinical outcomes, making it a more effective conservative treatment option in this population.
Keywords
coccydynia, pelvic floor, exercise therapy, laser therapy, therapeutic ultrasound, coccyx
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The impact of structured postnatal exercise program on salivary cortisol levels in postpartum women following caesarean section

Dasarapu Indrani, Shenbaga Sundaram Subramanian, Prathap Suganthirababu, Dubba NagaRaju, Surya Vishnuram, Jagatheesan Alagesan, Purna Chandra Shekhar, Rahul Shaik, K.Himabindu, Kiran Velukuri

Dasarapu Indrani, Shenbaga Sundaram Subramanian, Prathap Suganthirababu, Dubba NagaRaju, Surya Vishnuram, Jagatheesan Alagesan et al. – The impact of structured postnatal exercise program on salivary cortisol levels in postpartum women following caesarean section –  Fizjoterapia Polska 2025; 25(3); 423-427

DOI: https://doi.org/10.56984/8ZG7D19P4A8

Abstract
Background. Elevated cortisol levels contribute to maternal stress and delayed recovery in the postpartum period, particularly following lower segment caesarean section (LSCS), which poses unique physiological and psychological challenges.
Objective. To evaluate the impact of a 12-week structured postnatal exercise program on salivary cortisol levels in postpartum women following LSCS.
Methods. Sixty postpartum women who had undergone LSCS were randomly assigned to either an experimental group (n = 30) or a control group (n = 30). The experimental group received a physiotherapist-guided postnatal exercise program, progressing from breathing and mobility exercises to core stability training. Salivary cortisol levels were measured pre- and post-intervention. Secondary outcomes included core strength, exhaustion, and mental health.
Results. Post-intervention salivary cortisol levels were significantly lower in the experimental group than in the control group (mean difference: 5.2607 nmol/L; 95% CI: 3.9917–6.5296; p < 0.0001), with the experimental group demonstrating significant improvements in secondary outcomes.
Conclusion. A structured postnatal exercise program effectively reduces salivary cortisol levels and enhances recovery after LSCS. These findings support the incorporation of physiotherapy-led exercise into routine postpartum care to reduce stress and improve maternal health outcomes.
Keywords
cortisol levels, postpartum, caesarean section, postnatal exercise, stress
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Fractional erbium-yag laser versus microneedling for delivery of tranexamic acid in the treatment of melasma in postpartum women: a clinical and dermoscopic study

Dalya Kamal Kandil, Mai Abdelraouf Osman

Dalya Kamal Kandil, Mai Abdelraouf Osman – Fractional erbium-yag laser versus microneedling for delivery of tranexamic acid in the treatment of melasma in postpartum women: a clinical and dermoscopic study –  Fizjoterapia Polska 2025; 25(3); 416-422

DOI: https://doi.org/10.56984/8ZG7D19G6C9

Abstract
Background. As a recent addition to pigmentation therapy, tranexamic acid (TA) is receiving increasing attention for the treatment of melasma. Fractional lasers and microneedling have recently emerged as innovative drug delivery techniques aimed at enhancing the efficacy of topical treatments.
Objective. To compare the efficacy and safety of fractional 2940-nm erbium:yag (Er:YAG) laser with microneedling for transepidermal delivery of TA in patients with melasma.
Methods and materials. Thirty postpartum female patients with bilateral, symmetrical facial melasma were randomly assigned to receive fractional Er:YAG laser treatment on one side of the face and microneedling on the other, each followed by topical application of 5% TA solution. The treatment protocol consisted of five biweekly sessions. Assessment included the melasma area and severity index (MASI) score, physician’s evaluation, patient satisfaction, and dermoscopy.
Results. Three months after the last session, both the laser and microneedling were significantly effective for the delivery of TA. However, the fractional Er:YAG laser resulted in significantly better clinical and dermoscopic improvement compared to microneedling. Post-inflammatory hyperpigmentation (PIH) was observed on the laser-treated sides, whereas higher pain scores were reported on the microneedling-treated sides.
Conclusion. Both fractional Er:YAG laser and microneedling can be successfully used for the delivery of TA in the treatment of postpartum melasma.
Keywords
fractional erbium:yag laser, microneedling, postpartum melasma, tranexamic acid, dermoscopy
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Pelvic congestion syndrome management: a comparative study of targeted physiotherapy interventions

Ramya.S, Jeslin.G. N, Harini PS, Pooja.S, Neha Lakshmanan, Mythri Jain, Vaheedha S, Simran Sharma

Ramya.S, Jeslin.G. N, Harini PS, Pooja.S, Neha Lakshmanan, Mythri Jain et al. – Pelvic congestion syndrome management: a comparative study of targeted physiotherapy interventions –  Fizjoterapia Polska 2025; 25(3); 412-415

DOI: https://doi.org/10.56984/8ZG7D19GXVH

Abstract
Introduction. Pelvic congestion syndrome (PCS) is a chronic condition causing pelvic pain due to venous insufficiency. Although medical treatments exist, there is limited research supporting the role of physiotherapy.
Aim of the study. To compare the effectiveness of two physiotherapy protocols in managing PCS symptoms, focusing on pain relief, pelvic floor muscle strength, and pelvic blood flow.
Materials and methods. A randomized controlled trial was conducted with 56 women diagnosed with PCS at Saveetha Hospital, SIMATS, India. Participants were randomly assigned to the MLP group (n = 28; received lymphatic drainage, myofascial manipulation, and pelvic floor exercises) or the MP group (n = 28; received myofascial manipulation and pelvic floor exercises). Interventions were applied three times per week for eight weeks. Outcomes included pain (visual analogue scale), muscle strength (electromyography), and blood flow (transabdominal ultrasonography), assessed at baseline and post-intervention.
Results. The MLP group showed significant improvement in pain (VAS: 6.7 ± 1.11 to 3.8 ± 1.5), muscle strength (EMG: 10.2 ± 3.5 to 17.7 ± 3.17), and blood flow (USG: 8.5±1.2 to 4.7±1.5) (p < 0.05). The MP group also demonstrated improvements, although less pronounced, across all outcomes.
Conclusion. The combination of lymphatic drainage, myofascial manipulation, and pelvic floor exercises is more effective than myofascial manipulation and pelvic floor exercises alone in reducing pain, increasing pelvic floor muscle strength, and improving pelvic blood flow in women with PCS.
Keywords
venous insufficiency, pelvic diaphragm, electromyography feedback, blood flow
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Effect of bodyweight exercises versus resistance band exercises to improve strength in post-COVID individuals

Dubba NagaRaju, Shenbaga Sundaram Subramanian, Dasarapu Indrani, Surya Vishnuram, Kiran Velukuri, S Purna Chandra Shekhar, K. Himabindu, Jagatheesan Alagesan, Fadwa Alhalaiqa

Dubba NagaRaju, Shenbaga Sundaram Subramanian, Dasarapu Indrani, Surya Vishnuram,Kiran Velukuri, S Purna Chandra Shekhar et al. – Effect of bodyweight exercises versus resistance band exercises to improve strength in post-COVID individuals –  Fizjoterapia Polska 2025; 25(3); 408-411

DOI: https://doi.org/10.56984/8ZG7D192ROZ

Abstract
Background. Resistance training is essential for enhancing muscular strength and overall physical health. Among various methods, bodyweight and elastic resistance training are economical and accessible, making them especially useful for young adults. However, limited research compares their relative effectiveness. The aim of this study was to determine the impact of bodyweight exercises versus resistance band exercises on muscle strength in young adults.
Methods. Thirty young adult participants were randomly assigned to two groups: group A (bodyweight training) and group B (elastic band training), with 15 individuals in each. A structured training protocol was followed for four weeks. Strength was assessed pre- and post-intervention using the push-up test and squat test. Paired t-tests were used to determine within-group changes at p < 0.05.
Results. Both training modalities significantly improved muscular strength. Group A demonstrated notable gains in both the push-up          (t = -9.025, p < 0.001) and squat tests (t = -13.169, p < 0.001). Group B showed greater improvements, with push-up                                           (t = -23.438, p < 0.001) and squat (t = -16.430, p < 0.001) scores improving significantly, and higher mean changes compared to group A.
Conclusion. While both bodyweight and elastic resistance exercises effectively enhance strength, elastic band training yielded slightly superior outcomes. These preliminary findings support the use of resistance bands, especially in settings with limited resources.
Key words
strength training, bodyweight workout, elastic resistance, young adults, push-up test, squat test
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Deciphering the role of otolin-1 in predicting benign paroxysmal positional vertigo severity and recurrence: a comprehensive scoping review

Hepzibah Rubella D, Antony Leo Aseer P, Mr. Soundararajan K

Hepzibah Rubella D, Antony Leo Aseer P, Mr. Soundararajan K – Deciphering the role of otolin-1 in predicting benign paroxysmal positional vertigo severity and recurrence: a comprehensive scoping review –  Fizjoterapia Polska 2025; 25(3); 403-407

DOI: https://doi.org/10.56984/8ZG7D19TVZF

Abstract
Background. Benign paroxysmal positional vertigo (BPPV) is the most common vestibular disorder, characterized by extremely short episodes of vertigo. Recent studies have identified serum otolin-1 as a potential biomarker for BPPV, useful in predicting symptom severity and recurrence. This scoping review summarizes published evidence on the relationship between serum otolin-1 and BPPV, highlighting major trends, research gaps, and future directions.
Methods. A comprehensive literature search was conducted using PubMed, Scopus, Web of Science, and Google Scholar to identify relevant studies published from January 2020 to the present. Studies were included if they reported on the association between serum otolin-1 levels and BPPV in human subjects. Data were extracted using a structured form and synthesized through descriptive and thematic analysis.
Results. Five studies met the inclusion criteria, with a total sample size of 342 participants from various geographic regions. The results showed that serum otolin-1 levels were significantly higher in BPPV patients compared to controls. Kim et al. (2024) reported otolin-1 levels of 350.1±319.1 pg/mL in BPPV patients versus 183.6±134.1 pg/mL in other positional vertigo patients (p = 0.037). Similar trends were observed in Yadav et al. 2021, Aygun et al. 2024, Fan et al. 2022, and Wu Y et al. 2022. However, many of the included studies had limitations, such as small sample sizes and single-centre designs.
Conclusion. The consistent association between elevated serum otolin-1 levels and BPPV suggests a potential role as a biomarker for predicting severity and recurrence. Nevertheless, significant limitations remain, including the need for larger, multicentre studies and longitudinal follow-up to confirm these findings. Further research should address these gaps to make serum otolin-1 a clinically useful tool in BPPV management.
Key words
bppv, positional vertigo, otolin 1, biomarkers, outcome measure, diagnostic tools
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Effectiveness of adding neuromuscular taping to ultrasound therapy and exercise therapy in increasing physical activity in older adults with knee osteoarthritis

Siti Muawanah, Azliyana Azizan, Zarina Zahari, Susi Endrini, Nova Relida Samosir, Suci Wahyu Ismiyasa, Rezky Guna Putra

Siti Muawanah, Azliyana Azizan, Zarina Zahari, Susi Endrini, Nova Relida Samosir, Suci Wahyu Ismiyasa et al. – Effectiveness of adding neuromuscular taping to ultrasound therapy and exercise therapy in increasing physical activity in older adults with knee osteoarthritis –  Fizjoterapia Polska 2025; 25(3); 392-402

DOI: https://doi.org/10.56984/8ZG7D19623K

Abstract
Introduction. Knee osteoarthritis (KOA) is a common degenerative condition that causes pain, swelling, limited range of motion, reduced leg muscle strength, restricted walking and stair climbing ability, and decreased quality of life.
Aim. This study aimed to evaluate the effectiveness of ultrasound therapy, exercise therapy, and neuromuscular taping (NMT) on pain, balance, and physical activity in older adults with knee osteoarthritis.
Materials and methods. An experimental design was used to compare two groups: a control group of KOA patients receiving ultrasound therapy and exercise, and an intervention group receiving a combination of neuromuscular taping, ultrasound therapy, and exercise. The effectiveness was assessed using core outcome measures: the visual analogue scale (VAS) for pain, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), range of motion (ROM), and the timed up and go (TUG) test, measured before and after a 4-week intervention (3 sessions per week) in a sample of 20 participants. Data were analyzed using parametric tests (independent samples t-test) as normality was confirmed (p > 0.05).
Results. Both groups showed a significant reduction in pain and improvements in balance and daily function, with superior outcomes in the intervention group (NMT + ultrasound + exercise). In the intervention group, VAS decreased by 2.60 (p < 0.000), WOMAC by 18.00 (p < 0.004), and TUG time by 10.86 seconds (p < 0.004). In the control group, VAS decreased by 3.20 (p < 0.000), WOMAC by 23.40 (p < 0.000), and TUG time by 14.40 seconds (p < 0.001).
Conclusions. The combination of ultrasound therapy, exercise, and neuromuscular taping is an effective therapeutic approach for improving pain, balance, and physical activity in older adults with knee osteoarthritis.
Key words
ultrasound therapy, exercise, neuromuscular taping, knee osteoarthritis, physical activity
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Investigating the role of proprioceptive neuromuscular facilitation and Brugger’s exercises in enhancing functional ability and flexibility in chronic low back pain

Saranraj Palanivel, Rajadurai. S, Muralidharan CK, Arun Vijay Subbarayalu, Arun. B, Susmitha. P, Dharshini. C

Saranraj Palanivel, Rajadurai. S, Muralidharan CK, Arun Vijay Subbarayalu, Arun. B, Susmitha. P et al. – Investigating the role of proprioceptive neuromuscular facilitation and Brugger’s exercises in enhancing functional ability and flexibility in chronic low back pain –  Fizjoterapia Polska 2025; 25(3); 387-391

DOI: https://doi.org/10.56984/8ZG7D19SU5U

Abstract
Background. Low back pain is defined as pain and discomfort localized below the costal margin and above the inferior gluteal folds, with or without leg pain. The aim of this study was to compare the effectiveness of proprioceptive neuromuscular facilitation (PNF) and Brugger’s exercises in reducing disability and improving flexibility in subjects with chronic low back pain.
Methodology. This study was conducted on 30 subjects with low back pain, randomly assigned into two equal groups. Group A received Brugger’s exercises, and Group B received proprioceptive neuromuscular facilitation techniques. The modified Oswestry Low Back Pain Questionnaire and the standing reach test were used to evaluate differences between groups.
Results. Statistical analysis showed that proprioceptive neuromuscular facilitation techniques were more effective than Brugger’s exercises in improving functional ability and flexibility in subjects with chronic low back pain.
Conclusion. In this study, proprioceptive neuromuscular facilitation combined with Brugger’s exercises had a positive effect on reducing disability and improving flexibility in individuals with low back pain, as measured by the standing reach test and the Oswestry Low Back Pain Questionnaire before and after therapy.
Key words
low back pain, proprioceptive neuromuscular facilitation exercises, Brugger’s exercise, flexibility, functional ability
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Targeted hip adductor training in improving weight transfer and sit-to-stand performance in hemiplegic patients

Keerthana.R, Rajarajeswari.A

Keerthana.R, Rajarajeswari.A – Targeted hip adductor training in improving weight transfer and sit-to-stand performance in hemiplegic patients –  Fizjoterapia Polska 2025; 25(3); 381-386

DOI: https://doi.org/10.56984/8ZG7D19F5HY

Abstract
Background. Individuals with stroke bear only 25%–43% of their body weight on the affected side while standing. Reduced activity of hip muscles may impair weight-bearing capacity, movement efficiency, and functional mobility. While hip abductors are more commonly researched, hip adductors remain less studied.
Aim. To evaluate the effectiveness of targeted hip adductor training in improving weight transfer and sit-to-stand performance in hemiplegic patients.
Methods. Forty hemiplegic patients with asymmetrical weight transfer and impaired sit-to-stand performance (Motor Assessment Scale [MAS] sit-to-stand grade ≤ 2) were included and assigned to either a control or intervention group. Both groups received conventional physiotherapy, while the intervention group also performed additional hip adductor training. Weight transfer and sit-to-stand performance were assessed before and after 10 days of intervention using two weighing machines and MAS component 4.
Results. Both groups showed significant improvement in weight transfer and sit-to-stand performance. However, the intervention group demonstrated significantly greater improvement compared to the control group (p < 0.05).
Conclusion. Targeted hip adductor training is effective in improving weight transfer on the affected side and sit-to-stand performance, supporting motor re-education in hemiplegic patients.
Key words
hemiplegic patients, targeted hip adductor training, weight transfer, sit-to-stand performance
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