human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Research is limited and controversial on the effectiveness of various stretching methods on muscle lengthening . OBJECTIVE Study ing the effectiveness of static stretch and muscle energy technique on the flexibility of hamstring muscles . METHODS Thirty young females ( 20 - 25 yrs old ) participated voluntarily in this study . Subjects were r and omly assigned to two groups : static stretch group ( controls ; n=15 ) and muscle energy technique ( MET ) group ( experimental ; n=15 ) . The control group underwent ten sessions of static stretches of hamstring muscle , and the experimental group was assigned to ten sessions of MET at 50 % voluntary isometric contraction . Hamstring flexibility was evaluated by passive knee extension test at baseline and again following interventions . RESULTS Both treatment methods were capable of significantly improving the shortness of hamstring muscles ( P < 0.01 ) ; and no considerable difference was observed between the methods . CONCLUSION Ten sessions of hamstring stretches in normal young women using either static stretch or MET had similar effect on restoring flexibility to hamstrings Evidence -based practice involves the use of evidence from systematic review s and r and omised controlled trials , but the extent of this evidence in physiotherapy has not previously been surveyed . The aim of this survey is to describe the quantity and quality of r and omised controlled trials and the quantity of systematic review s relevant to physiotherapy . The Physiotherapy Evidence Data base ( PEDro ) was search ed . The quality of trials was assessed with the PEDro scale . The search identified a total of 2,376 r and omised controlled trials and 332 systematic review s. The first trial was published in 1955 and the first review was published in 1982 . Since that time , the number of trials and review s has grown exponentially . The mean PEDro quality score has increased from 2.8 in trials published between 1955 and 1959 to 5.0 for trials published between 1995 and 1999 . There is a substantial body of evidence about the effects of physiotherapy . However , there remains scope for improvements in the quality of the conduct and reporting of clinical trials STUDY DESIGN R and omized controlled trial . OBJECTIVES To compare a muscle energy technique ( MET ) for the glenohumeral joint ( GHJ ) horizontal abductors and an MET for the GHJ external rotators to improve GHJ range of motion ( ROM ) in baseball players . BACKGROUND Overhead athletes often exhibit loss of GHJ ROM in internal rotation , which has been associated with shoulder pathology . Current stretching protocol s aim ed at improving flexibility of the posterior shoulder have result ed in inconsistent outcomes . Although utilization of MET has been hypothesized to lengthen tissue , there are limited empirical data describing the effectiveness of such stretches for treating posterior shoulder tightness . METHODS Sixty-one Division I baseball players were r and omly assigned to 1 of 3 groups : MET for the GHJ horizontal abductors ( n = 19 ) , MET for the GHJ external rotators ( n = 22 ) , and control ( n = 20 ) . We measured preintervention and postintervention GHJ horizontal adduction and internal rotation ROM , and conducted analyses of covariance , followed by Tukey honestly significant difference post hoc analysis for significant group-by-time interactions ( P<.05 ) . RESULTS The group treated with the MET for the horizontal abductors had a significantly greater increase in GHJ horizontal adduction ROM postintervention ( mean ± SD , 6.8 ° ± 10.5 ° ) compared to the control group ( -1.1 ° ± 6.8 ° ) ( P = .011 ) and a greater increase in internal rotation ROM postintervention ( 4.2 ° ± 5.3 ° ) compared to the group treated with the MET for the external rotators ( 0.2 ° ± 6.3 ° ) ( P = .020 ) and the control group ( -0.2 ° ± 4.0 ° ) ( P = .029 ) . No significant differences among groups were found for any other variables ( P>.05 ) . CONCLUSION A single application of an MET for the GHJ horizontal abductors provides immediate improvements in both GHJ horizontal adduction and internal rotation ROM in asymptomatic collegiate baseball players . Application of MET for the horizontal abductors may be useful to gain ROM in overhead athletes . LEVEL OF EVIDENCE Therapy , level 2b- OBJECTIVE The purpose of this study was to investigate effects of different manual techniques on cervical ranges of motion and pressure pain sensitivity in subjects with latent trigger point of the upper trapezius muscle . METHODS One hundred seventeen volunteers , with a unilateral latent trigger point on upper trapezius due to computer work , were r and omly divided into 5 groups : ischemic compression ( IC ) group ( n=24 ) ; passive stretching group ( n=23 ) ; muscle energy technique group ( n=23 ) ; and 2 control groups , wait- and -see group ( n=25 ) and placebo group ( n=22 ) . Cervical spine range of movement was measured using a cervical range of motion  instrument as well as pressure  pain sensitivity by means of an algometer and a visual analog scale . Outcomes were assessed pretreatment , immediately , and 24 hours after the intervention and 1 week later by a blind research er . A 4 × 5 mixed repeated- measures analysis of variance was used to examine the effects of the intervention and Cohen d coefficient was used . RESULTS A group-by-time interaction was detected in all variables ( P<.01 ) , except contralateral rotation . The immediate effect sizes of the contralateral flexion , ipsilateral rotation , and pressure pain threshold were large for 3 experimental groups . Nevertheless , after 24 hours and 1 week , only IC group maintained the effect size . CONCLUSIONS Manual techniques on upper trapezius with latent trigger point seemed to improve the cervical range of motion and the pressure pain sensitivity . These effects persist after 1 week in the IC group The main purpose of the study was to evaluate the resting bioelectrical activity of the upper trapezius muscle ( the UT muscle ) before and after one of the two interventions : postisometric muscle relaxation ( PIR ) and Kinesio Taping ( KT ) . Moreover a comparison between group results was conducted . From the initial 61 volunteers , 52 were selected after exclusion criteria and were allocated r and omly to 2 groups : PIR group and KT group . Outcome measures were assessed at baseline and completion of the intervention . The primary outcome measure was change in bioelectrical activity of UT muscle evaluated by surface electromyography ( sEMG ) . Secondary outcomes included subjective assessment of pain using visual analogue scale ( VAS ) . Significant differences were found only in KT group : the average resting bioelectrical activity decreased by 0.8 μV ( p = 0.0237 ) and the average VAS result reduced by 2.0 points ( p = 0.0001 ) . Greater decrease of VAS results was recorded in KT group compared to PIR group ( p = 0.0010 ) . Both PIR and KT intervention did not influence significantly the resting bioelectrical activity of UT muscle . KT application was better for pain relief in the studied sample compared with PIR intervention Abstract Muscle energy technique ( MET ) is a form of manual therapy frequently used to correct lumbopelvic pain ( LPP ) , herein the patient voluntarily contracts specific muscles against the resistance of the clinician . Studies on MET regarding magnitude and duration of effectiveness are limited . This study was a r and omized controlled trial in which 20 subjects with self-reported LPP were r and omized into two groups ( MET or control ) after magnitude of pain was determined . MET of the hamstrings and iliopsoas consisted of four 5-second hold/relax periods , while the control group received a sham treatment .  Tests for current and worst pain , and pain with provocation were administered at baseline , immediately following intervention and 24 hours after intervention . Separate 2x3 ANOVAs were used to assess results as change scores . Visual analog score ( VAS ) for worst pain reported in the past 24 hours decreased for the MET group ( 4.3mm±19.9 , p=.03 ) and increased for the sham ( control ) group ( 17.1mm±21.2 , p=.03 ) . Subjects receiving MET demonstrated a decrease in VAS worst pain over the past 24 hours , thereby suggesting that MET may be useful to decrease LPP over 24 hours BACKGROUND AND PURPOSE Stretching protocol s for elderly people ( > or = 65 years of age ) have not been studied to determine the effectiveness of increasing range of motion ( ROM ) . The purpose of this study was to determine which of 3 duration s of stretches would produce and maintain the greatest gains in knee extension ROM with the femur held at 90 degrees of hip flexion in a group of elderly individuals . SUBJECTS Sixty-two subjects ( mean age = 84.7 years , SD = 5.6 , range = 65 - 97 ) with tight hamstring muscles ( defined as the inability to extend the knee to less than 20 degrees of knee flexion ) participated . Subjects were recruited from a retirement housing complex and were independent in activities of daily living . METHODS Subjects were r and omly assigned to 1 of 4 groups and completed a physical activity question naire . The subjects in group 1 ( n = 13 , mean age = 85.1 years , SD = 6.4 , range = 70 - 97 ) , a control group , performed no stretching . The r and omly selected right or left limb of subjects in group 2 ( n = 17 , mean age = 85.5 years , SD = 4.5 , range = 80 - 93 ) , group 3 ( n = 15 , mean age = 85.2 years , SD = 6.5 , range = 65 - 92 ) , and group 4 ( n = 17 , mean age = 83.2 years , SD = 4.6 , range = 68 - 90 ) was stretched 5 times per week for 6 weeks for 15 , 30 , and 60 seconds , respectively . Range of motion was measured once a week for 10 weeks to determine the treatment and residual effects . Data were analyzed using a growth curve model . RESULTS A 60-second stretch produced a greater rate of gains in ROM ( 60-second stretch = 2.4 degrees per week , 30-second stretch = 1.3 degrees per week , 15-second stretch = 0.6 degrees per week ) , which persisted longer than the gains in any other group ( group 4 still had 5.4 degrees more ROM 4 weeks after treatment than at pretest as compared with 0.7 degrees and 0.8 degrees for groups 2 and 3 , respectively ) . DISCUSSION AND CONCLUSION Longer hold times during stretching of the hamstring muscles result ed in a greater rate of gains in ROM and a more sustained increase in ROM in elderly subjects . These results may differ from those of studies performed with younger population s because of age-related physiologic changes OBJECTIVE To determine the short- and long-term effectiveness of the muscle energy technique ( MET ) compared with corticosteroid injections ( CSIs ) for chronic lateral epicondylitis ( LE ) . DESIGN R and omized controlled trial with 1 year of follow-up . SETTING Outpatient clinic of a university 's department of physical medicine and rehabilitation . PARTICIPANTS Patients with chronic LE ( N=82 ; 45 women , 37 men ) . INTERVENTIONS Eight sessions of MET , or a single CSI was applied . MAIN OUTCOME MEASURES Grip strength , pain intensity , and functional status were assessed using the pain-free grip strength ( PFGS ) , a visual analog scale ( VAS ) , and the Disabilities of the Arm , Shoulder and H and ( DASH ) question naire , respectively . Measurements were performed before beginning treatment and at 6 , 26 , and 52 weeks afterward . RESULTS When the baseline PFGS , VAS , and DASH scores were compared with the scores at the 52-week follow-up , statistically significant improvements were observed in both groups over time . The patients who received a CSI showed significantly better effects at 6 weeks according to the PFGS and VAS scores , but declined thereafter . At the 26- and 52-week follow-ups , the patients who received the MET were statistically significantly better in terms of grip strength and pain scores . At 52 weeks , the mean PFGS score in the MET group was significantly higher ( 75.08±26.19 vs 62.24±21.83 ; P=.007 ) and the mean VAS score was significantly lower ( 3.28±2.86 vs 4.95±2.36 ; P=.001 ) than those of the CSI group . Although improvements in the DASH scores were more pronounced in the MET group , the differences in DASH scores between the groups were not statistically significant . CONCLUSIONS This study showed that while both MET and CSI improved measures of strength , pain , and function compared with baseline , subjects receiving MET had better scores at 52 weeks for PFGS and the VAS for pain . We conclude that MET appears to be an effective intervention in the treatment of LE ABSTRACT Objective : To compare the efficacy of a manual therapy and an exercise therapy program in improving  postural hyperkyphosis among young adults . Methods : Forty-six women between the ages of 18 to 30 years with thoracic kyphosis diagnosed by flexicurve ruler were r and omly assigned to either an exercise therapy or a manual therapy group . The exercise therapy program focused on stretching and strengthening exercises in 15 sessions over 5 weeks . The manual therapy group received 15 sessions of manual techniques including massage , mobilization , muscle energy and myofascial release .  Kyphosis angle and back extensor muscle strength were measured with a motion analysis system and a dynamometer 
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Research is limited and controversial on the effectiveness of various stretching methods on muscle lengthening . OBJECTIVE Study ing the effectiveness of static stretch and muscle energy technique on the flexibility of hamstring muscles . METHODS Thirty young females ( 20 - 25 yrs old ) participated voluntarily in this study . Subjects were r and omly assigned to two groups : static stretch group ( controls ; n=15 ) and muscle energy technique ( MET ) group ( experimental ; n=15 ) . The control group underwent ten sessions of static stretches of hamstring muscle , and the experimental group was assigned to ten sessions of MET at 50 % voluntary isometric contraction . Hamstring flexibility was evaluated by passive knee extension test at baseline and again following interventions . RESULTS Both treatment methods were capable of significantly improving the shortness of hamstring muscles ( P < 0.01 ) ; and no considerable difference was observed between the methods . CONCLUSION Ten sessions of hamstring stretches in normal young women using either static stretch or MET had similar effect on restoring flexibility to hamstrings Evidence -based practice involves the use of evidence from systematic review s and r and omised controlled trials , but the extent of this evidence in physiotherapy has not previously been surveyed . The aim of this survey is to describe the quantity and quality of r and omised controlled trials and the quantity of systematic review s relevant to physiotherapy . The Physiotherapy Evidence Data base ( PEDro ) was search ed . The quality of trials was assessed with the PEDro scale . The search identified a total of 2,376 r and omised controlled trials and 332 systematic review s. The first trial was published in 1955 and the first review was published in 1982 . Since that time , the number of trials and review s has grown exponentially . The mean PEDro quality score has increased from 2.8 in trials published between 1955 and 1959 to 5.0 for trials published between 1995 and 1999 . There is a substantial body of evidence about the effects of physiotherapy . However , there remains scope for improvements in the quality of the conduct and reporting of clinical trials STUDY DESIGN R and omized controlled trial . OBJECTIVES To compare a muscle energy technique ( MET ) for the glenohumeral joint ( GHJ ) horizontal abductors and an MET for the GHJ external rotators to improve GHJ range of motion ( ROM ) in baseball players . BACKGROUND Overhead athletes often exhibit loss of GHJ ROM in internal rotation , which has been associated with shoulder pathology . Current stretching protocol s aim ed at improving flexibility of the posterior shoulder have result ed in inconsistent outcomes . Although utilization of MET has been hypothesized to lengthen tissue , there are limited empirical data describing the effectiveness of such stretches for treating posterior shoulder tightness . METHODS Sixty-one Division I baseball players were r and omly assigned to 1 of 3 groups : MET for the GHJ horizontal abductors ( n = 19 ) , MET for the GHJ external rotators ( n = 22 ) , and control ( n = 20 ) . We measured preintervention and postintervention GHJ horizontal adduction and internal rotation ROM , and conducted analyses of covariance , followed by Tukey honestly significant difference post hoc analysis for significant group-by-time interactions ( P<.05 ) . RESULTS The group treated with the MET for the horizontal abductors had a significantly greater increase in GHJ horizontal adduction ROM postintervention ( mean ± SD , 6.8 ° ± 10.5 ° ) compared to the control group ( -1.1 ° ± 6.8 ° ) ( P = .011 ) and a greater increase in internal rotation ROM postintervention ( 4.2 ° ± 5.3 ° ) compared to the group treated with the MET for the external rotators ( 0.2 ° ± 6.3 ° ) ( P = .020 ) and the control group ( -0.2 ° ± 4.0 ° ) ( P = .029 ) . No significant differences among groups were found for any other variables ( P>.05 ) . CONCLUSION A single application of an MET for the GHJ horizontal abductors provides immediate improvements in both GHJ horizontal adduction and internal rotation ROM in asymptomatic collegiate baseball players . Application of MET for the horizontal abductors may be useful to gain ROM in overhead athletes . LEVEL OF EVIDENCE Therapy , level 2b- OBJECTIVE The purpose of this study was to investigate effects of different manual techniques on cervical ranges of motion and pressure pain sensitivity in subjects with latent trigger point of the upper trapezius muscle . METHODS One hundred seventeen volunteers , with a unilateral latent trigger point on upper trapezius due to computer work , were r and omly divided into 5 groups : ischemic compression ( IC ) group ( n=24 ) ; passive stretching group ( n=23 ) ; muscle energy technique group ( n=23 ) ; and 2 control groups , wait- and -see group ( n=25 ) and placebo group ( n=22 ) . Cervical spine range of movement was measured using a cervical range of motion  instrument as well as pressure  pain sensitivity by means of an algometer and a visual analog scale . Outcomes were assessed pretreatment , immediately , and 24 hours after the intervention and 1 week later by a blind research er . A 4 × 5 mixed repeated- measures analysis of variance was used to examine the effects of the intervention and Cohen d coefficient was used . RESULTS A group-by-time interaction was detected in all variables ( P<.01 ) , except contralateral rotation . The immediate effect sizes of the contralateral flexion , ipsilateral rotation , and pressure pain threshold were large for 3 experimental groups . Nevertheless , after 24 hours and 1 week , only IC group maintained the effect size . CONCLUSIONS Manual techniques on upper trapezius with latent trigger point seemed to improve the cervical range of motion and the pressure pain sensitivity . These effects persist after 1 week in the IC group The main purpose of the study was to evaluate the resting bioelectrical activity of the upper trapezius muscle ( the UT muscle ) before and after one of the two interventions : postisometric muscle relaxation ( PIR ) and Kinesio Taping ( KT ) . Moreover a comparison between group results was conducted . From the initial 61 volunteers , 52 were selected after exclusion criteria and were allocated r and omly to 2 groups : PIR group and KT group . Outcome measures were assessed at baseline and completion of the intervention . The primary outcome measure was change in bioelectrical activity of UT muscle evaluated by surface electromyography ( sEMG ) . Secondary outcomes included subjective assessment of pain using visual analogue scale ( VAS ) . Significant differences were found only in KT group : the average resting bioelectrical activity decreased by 0.8 μV ( p = 0.0237 ) and the average VAS result reduced by 2.0 points ( p = 0.0001 ) . Greater decrease of VAS results was recorded in KT group compared to PIR group ( p = 0.0010 ) . Both PIR and KT intervention did not influence significantly the resting bioelectrical activity of UT muscle . KT application was better for pain relief in the studied sample compared with PIR intervention Abstract Muscle energy technique ( MET ) is a form of manual therapy frequently used to correct lumbopelvic pain ( LPP ) , herein the patient voluntarily contracts specific muscles against the resistance of the clinician . Studies on MET regarding magnitude and duration of effectiveness are limited . This study was a r and omized controlled trial in which 20 subjects with self-reported LPP were r and omized into two groups ( MET or control ) after magnitude of pain was determined . MET of the hamstrings and iliopsoas consisted of four 5-second hold/relax periods , while the control group received a sham treatment .  Tests for current and worst pain , and pain with provocation were administered at baseline , immediately following intervention and 24 hours after intervention . Separate 2x3 ANOVAs were used to assess results as change scores . Visual analog score ( VAS ) for worst pain reported in the past 24 hours decreased for the MET group ( 4.3mm±19.9 , p=.03 ) and increased for the sham ( control ) group ( 17.1mm±21.2 , p=.03 ) . Subjects receiving MET demonstrated a decrease in VAS worst pain over the past 24 hours , thereby suggesting that MET may be useful to decrease LPP over 24 hours BACKGROUND AND PURPOSE Stretching protocol s for elderly people ( > or = 65 years of age ) have not been studied to determine the effectiveness of increasing range of motion ( ROM ) . The purpose of this study was to determine which of 3 duration s of stretches would produce and maintain the greatest gains in knee extension ROM with the femur held at 90 degrees of hip flexion in a group of elderly individuals . SUBJECTS Sixty-two subjects ( mean age = 84.7 years , SD = 5.6 , range = 65 - 97 ) with tight hamstring muscles ( defined as the inability to extend the knee to less than 20 degrees of knee flexion ) participated . Subjects were recruited from a retirement housing complex and were independent in activities of daily living . METHODS Subjects were r and omly assigned to 1 of 4 groups and completed a physical activity question naire . The subjects in group 1 ( n = 13 , mean age = 85.1 years , SD = 6.4 , range = 70 - 97 ) , a control group , performed no stretching . The r and omly selected right or left limb of subjects in group 2 ( n = 17 , mean age = 85.5 years , SD = 4.5 , range = 80 - 93 ) , group 3 ( n = 15 , mean age = 85.2 years , SD = 6.5 , range = 65 - 92 ) , and group 4 ( n = 17 , mean age = 83.2 years , SD = 4.6 , range = 68 - 90 ) was stretched 5 times per week for 6 weeks for 15 , 30 , and 60 seconds , respectively . Range of motion was measured once a week for 10 weeks to determine the treatment and residual effects . Data were analyzed using a growth curve model . RESULTS A 60-second stretch produced a greater rate of gains in ROM ( 60-second stretch = 2.4 degrees per week , 30-second stretch = 1.3 degrees per week , 15-second stretch = 0.6 degrees per week ) , which persisted longer than the gains in any other group ( group 4 still had 5.4 degrees more ROM 4 weeks after treatment than at pretest as compared with 0.7 degrees and 0.8 degrees for groups 2 and 3 , respectively ) . DISCUSSION AND CONCLUSION Longer hold times during stretching of the hamstring muscles result ed in a greater rate of gains in ROM and a more sustained increase in ROM in elderly subjects . These results may differ from those of studies performed with younger population s because of age-related physiologic changes OBJECTIVE To determine the short- and long-term effectiveness of the muscle energy technique ( MET ) compared with corticosteroid injections ( CSIs ) for chronic lateral epicondylitis ( LE ) . DESIGN R and omized controlled trial with 1 year of follow-up . SETTING Outpatient clinic of a university 's department of physical medicine and rehabilitation . PARTICIPANTS Patients with chronic LE ( N=82 ; 45 women , 37 men ) . INTERVENTIONS Eight sessions of MET , or a single CSI was applied . MAIN OUTCOME MEASURES Grip strength , pain intensity , and functional status were assessed using the pain-free grip strength ( PFGS ) , a visual analog scale ( VAS ) , and the Disabilities of the Arm , Shoulder and H and ( DASH ) question naire , respectively . Measurements were performed before beginning treatment and at 6 , 26 , and 52 weeks afterward . RESULTS When the baseline PFGS , VAS , and DASH scores were compared with the scores at the 52-week follow-up , statistically significant improvements were observed in both groups over time . The patients who received a CSI showed significantly better effects at 6 weeks according to the PFGS and VAS scores , but declined thereafter . At the 26- and 52-week follow-ups , the patients who received the MET were statistically significantly better in terms of grip strength and pain scores . At 52 weeks , the mean PFGS score in the MET group was significantly higher ( 75.08±26.19 vs 62.24±21.83 ; P=.007 ) and the mean VAS score was significantly lower ( 3.28±2.86 vs 4.95±2.36 ; P=.001 ) than those of the CSI group . Although improvements in the DASH scores were more pronounced in the MET group , the differences in DASH scores between the groups were not statistically significant . CONCLUSIONS This study showed that while both MET and CSI improved measures of strength , pain , and function compared with baseline , subjects receiving MET had better scores at 52 weeks for PFGS and the VAS for pain . We conclude that MET appears to be an effective intervention in the treatment of LE ABSTRACT Objective : To compare the efficacy of a manual therapy and an exercise therapy program in improving  postural hyperkyphosis among young adults . Methods : Forty-six women between the ages of 18 to 30 years with thoracic kyphosis diagnosed by flexicurve ruler were r and omly assigned to either an exercise therapy or a manual therapy group . The exercise therapy program focused on stretching and strengthening exercises in 15 sessions over 5 weeks . The manual therapy group received 15 sessions of manual techniques including massage , mobilization , muscle energy and myofascial release .  Kyphosis angle and back extensor muscle strength were measured with a motion analysis system and a dynamometer 
    Output:
    