Georgios Tsigaras

Background: Tibial bone stress injury (TBSI) with associated bone marrow edema (BME) is a common and clinically challenging condition in athletes, often requiring prolonged load restriction and delayed return to sport. Evidence for adjunctive interventions that improve both symptoms and MRI-derived recovery remains limited. The aim of this study was to investigate whether adding Functional Magnetic Stimulation (FMS) to standardized rehabilitation improves pain, function, and MRI-derived outcomes over 16 weeks in athletes with MRI-confirmed TBSI. Materials and Methods: Forty athletes with Fredericson grade 2–3 TBSI were randomized to FMS plus rehabilitation (n = 20) or rehabilitation alone (n = 20). Both groups completed a 4-week load-based rehabilitation program, while the FMS group additionally received eight 30 min FMS sessions at 40 Hz. Outcomes were assessed at baseline, 4 weeks, and 16 weeks. The primary outcome was activity-related pain (NPRS), while secondary outcomes included lower-limb function (LEFS-GR), BME extent, and Fredericson grade. Continuous outcomes were analyzed using two-way mixed ANOVA, whereas Fredericson grade was analyzed using an ordinal generalized estimating equation model. The level of statistical significance was set at p < 0.05. Results: Groups were comparable at baseline. Significant group × time interactions favored FMS for NPRS, F(2, 76) = 12.46, p < 0.001, η²p = 0.247; LEFS-GR, F(1.08, 41.09) = 81.56, p < 0.001, η²p = 0.682; and BME extent, F(1.44, 54.85) = 49.33, p < 0.001, η²p = 0.565. At 16 weeks, the FMS group showed lower NPRS scores, higher LEFS-GR scores, and lower BME extent than controls. Fredericson grade also showed a significant group × time effect, Wald χ²(2) = 20.38, p < 0.001. The FMS group had significantly lower cumulative odds of classification in a higher Fredericson grade at 4 weeks (OR = 0.045, 95% CI: 0.012–0.163, p < 0.001), whereas the corresponding difference at 16 weeks remained directionally favorable but did not reach statistical significance (OR = 0.033, 95% CI: 0.001–1.029, p = 0.052). Conclusions: The addition of FMS to load-based rehabilitation was associated with greater clinical and functional improvements, greater reductions in BME extent, and a more favorable longitudinal trajectory in MRI severity classification than rehabilitation alone in athletes with TBSI. However, because the study did not include a sham-FMS condition and participants could not be blinded, the self-reported pain and functional outcomes should be interpreted cautiously. FMS may represent a useful adjunct to structured rehabilitation, although sham-controlled and longer-term studies should determine its effects on return-to-sport progression and recurrence risk.

Background: Vision is a key sensory system for postural regulation; however, the effects of degraded visual input and complete visual occlusion on static balance are not fully understood. The aim of the present study was to compare postural control during single-leg stance under two reduced-vision conditions (eyes open in darkness vs. complete visual occlusion) in healthy young adults and examine the potential influence of sex and mild visual deficits. Materials and Methods: This within-subject laboratory study included 42 healthy young adults (21 males, 21 females; mean age 20.67 ± 0.48 years). Participants performed three valid 20 s single-leg stance trials on a force platform under two visual conditions: eyes open in darkness and complete visual occlusion using an opaque mask. The order of conditions was randomized and counterbalanced, and the mean value of the three valid trials under each condition was used for analysis. Postural sway outcome variables included CoP Area, Oscillation Width, Oscillation Height, Total Displacement, and Mean Velocity. A two-way mixed-design ANOVA examined the effects of visual condition and sex. Additional mixed ANCOVA analyses were performed using body weight as a covariate to verify whether the sex-related findings remained after adjustment for body weight. Exploratory subgroup analyses based on mild visual deficits were performed using independent-samples t-tests. Results: No significant overall main effect of visual condition was observed for any postural sway variable (all p > 0.05). However, a significant condition × sex interaction was found for CoP Area (F(1,40) = 9.910, p = 0.003, η²p = 0.199), indicating different response patterns between males and females across conditions. Significant main effects of sex were also found for Total Displacement (F(1,40) = 9.212, p = 0.004, η²p = 0.187) and Mean Velocity (F(1,40) = 9.090, p = 0.004, η²p = 0.185), with males showing higher values overall. The sex-related findings for CoP Area, Total Displacement, and Mean Velocity remained significant after adjustment for body weight. No significant sex effects were found for Oscillation Width or Oscillation Height, and no significant differences were observed between participants with and without mild visual deficits in either condition (all p > 0.05). Conclusions: Altered visual input did not produce a uniform overall effect on postural sway during single-leg stance in healthy young adults. Instead, the findings indicate a more differentiated pattern, with a sex-specific response for CoP Area and overall sex-related differences in Total Displacement and Mean Velocity that were not explained by body weight. Mild visual deficits were not associated with significant balance alterations under the present experimental conditions. These findings support a more nuanced interpretation of postural regulation under reduced visual input and highlight the importance of considering individual characteristics, particularly sex, in balance assessment.

Background and Objectives: Lumbar disk herniation with radiculopathy (LDHR) is a prevalent neuromusculoskeletal condition characterized by nociceptive and neuropathic pain components. Manual therapy (MT) is commonly used in its management, whereas Functional Magnetic Stimulation (FMS) represents an emerging modality with limited evidence in radiculopathy. The aim of this study was to examine the short-term effects of combining MT with FMS compared with MT alone on pain intensity, neuropathic pain features, neural mechanosensitivity, and functional disability in individuals with chronic LDHR. Materials and Methods: Forty adults with MRI-confirmed unilateral LDHR were randomly allocated to an MT + FMS group or an MT-only group. Both groups received ten treatment sessions over three weeks. Outcomes included lumbar and leg pain intensity (NPRS), functional disability (RMDQ), neuropathic pain symptoms (S-LANSS), and straight leg raise (SLR) range of motion. Measurements were obtained at baseline and at week 3. Group and time effects were examined using a two-way mixed ANOVA with significance set at p < 0.05. Results: Significant group × time interactions were observed for all outcomes (p < 0.01), indicating greater improvements in the MT + FMS group. Reductions in lumbar and leg pain, disability, and S-LANSS scores exceeded established MCID thresholds, while SLR gains surpassed published MDC values, reflecting both statistical and clinical relevance. Only the MT + FMS group improved below the neuropathic pain diagnostic cutoff (S-LANSS < 12). Conclusions: The findings of this trial suggest that incorporating FMS into a manual therapy program may provide additional short-term clinical benefits for individuals with chronic LDHR. Further research with larger samples, longer follow-up periods, and mechanistic assessments is needed to confirm these preliminary results and to better understand the underlying mechanisms.