نوع مقاله : مقاله پژوهشی

نویسندگان

1 دانشجوی کارشناسی ارشد، گروه آسیب‌شناسی ورزشی و حرکات اصلاحی، دانشکدۀ تربیت بدنی و علوم ورزشی، دانشگاه گیلان، رشت، ایران

2 . استادیار، گروه آسیب‌شناسی ورزشی و حرکات اصلاحی، دانشکدۀ تربیت بدنی و علوم ورزشی، دانشگاه گیلان، رشت، ایران

چکیده

هدف این پژوهش بررسی تأثیر تمرینات پیلاتس و آزادسازی مایوفاشیال بر تعادل، استقامت عضلات تنه و انعطاف‌پذیری افراد مبتلا به مولتیپل اسکلروزیس بود. 24 فرد مبتلا به مولتیپل اسکلروزیس با شدت بیماری صفر تا سه و دامنة سنی 20 تا 50 سال به‌صورت هدفمند انتخاب و به‌طور تصادفی به دو گروه تجربی و کنترل با تعداد مساوی تقسیم شدند. گروه تجربی تمرینات را طی 24 جلسه انجام دادند. ثبات مرکزی با آزمون مک­گیل، تعادل با آزمون برخاستن و راه ­رفتن زمان‌دار و انعطاف‌پذیری همسترینگ با آزمون نشستن و رساندن دست­ها در پیش و پس‌آزمون ارزیابی شد. تحلیل آماری داده‌ها با آزمون تی وابسته و تحلیل کوواریانس و با نرم‌افزار اس پی اس اس نسخة 26 انجام شد. اجرای هشت هفته تمرینات پیلاتس و آزادسازی مایوفاشیال تفاوت معناداری در تعادل عملکردی گروه تجربی و کنترل ایجاد کرد (01/0>P). با توجه به یافته­های پژوهش حاضر می­توان نتیجه گرفت که این برنامة تمرینی در بهبود تعادل بیماران مبتلا به ام اس مؤثر خواهد بود و از این رو، برای این دسته از بیماران توصیه می­شود.
 

کلیدواژه‌ها

عنوان مقاله [English]

The effect of eight weeks of Pilates exercises and myofascial release on balance, trunk muscle endurance and flexibility in people with multiple sclerosis

نویسندگان [English]

  • amir hasan hosswini 1
  • parisa sedaghati 2

1 Student

2 Assistant Professor

چکیده [English]

The purpose of this study was to determine the effect of Pilates exercises and myofascial release on balance, trunk muscle endurance and flexibility in people with multiple  sclerosis, 24 patients with MS with expanded disability status scale (EDSS) between zero and three were selected and randomly divided into control and experimental groups. The experimental group participated in 24 training sessions, central stability, functional balance and hamstring flexibility were measured using McGill, timed up and go (TUG) test and seat and reach (SRT) before and after the exercise period in both groups. Paired t-test and analysis of covariance were used to analyze the data. Performing eight weeks of Pilates exercises and myofascial release made a significant difference in the functional balance of the experimental and control groups (P < 0.01). While in the control group, no significant difference was observed. According to the findings of this study, it can be concluded that this exercise program will be effective in improving functional balance of MS patients. Therefore, this treatment plan is recommended for this group of patients.
 

کلیدواژه‌ها [English]

  • Multiple Sclerosis
  • Core Stability
  • Functional Balance
  • Flexibility
  1. Umphred, D.A. and C. Carlson, Neurorehabilitation for the physical therapist assistant. 2006: SLACK Incorporated.J Rehab Med. 2017; 6(2):150-159.
  2. Holland, N.J. and M. Madonna, Nursing grand rounds: multiple sclerosis. Journal of Neurosciencenursing, 2005. 37(1): p. 15-19.
  3. Ashtari, F., V. Shaygannzhad, F. Heidari, and M. Akbari, Estimating the prevalence of familial disease in Multiple sclerosis in Isfahan. Isfahan University of Medical Sciences, Iran J Neurol. 2017 Apr 4; 16(2): 90–95.  (In Persian)
  4. Jackson K, fritz I, Rodgers M M. Home balance training intervention for people with multiple scelerosis. Int J ms care .2007;( 9):111- 117.
  5. Stephens J, DuShuttle D, Hatcher C, Shmunes J, Slaninka C. Use of awareness through movement improves balance and balance confdence in people with multiple sclerosis: a randomized controlled study. Journal of Neurologic Physical Therapy. 2001; 25(2):39-49
  6. Dalgas U, Stenager E, Ingemann-Hansen T. Multiple sclerosis and physical exercise: recommendations for the application of resistance-, endurance-and combined training. Multiple sclerosis. 2008 Jan;14(1):35-53
  7. Bahraini S, Naji SA, MananI R. The effect of aromatherapy massage on fatigue in patients with multiple sclerosis. Journal of Sabzevar University of Medical Sciences. 2011; 18( 3), 172-178 (In Persian)
  8. Guinness MC, Peter S. "The diagnosis ofmultiple sclerosis: peplau's interpersonal relations model in practice". Rehabil Nurs. 1999;24(1):30-36.
  9. Frzovic, D., M.E. Morris, and L. Vowels, Clinical tests of standing balance: performance of persons with multiple sclerosis. Archives of physical medicine and rehabilitation, 2000. 81(2): p. 215-21.
  10. Sosnoff JJ, Socie MJ, Boes MK, Sandroff BM, Pula JH, Mobility, Balance and Falls in Persons with Multiple Sclerosis. PLoS ONE. 2011;6(11):
  11. Stephens J, DuShuttle D, Hatcher C, Shmunes J, Slaninka C. Use of awareness through movement improves balance and balance confidence in people with multiple sclerosis: a randomized controlled study. J Neuro Phys Ther 2001; 25(2):39-49.
  12. Emami MH TH, Kohestani S, Chitsaz A, Etemadifar M, Karimi S, et al. How frequent is celiac disease among epileptic patients. J Gastrointestin Liver Dis 2008:379-382. (In Persian)
  13. Soyuer F, Mirza M. [Relationship between lower extremity. muscle strength and balance in Multiple Sclerosis (Turkish)]. Journal of Neurologica Sciences 2006; 23(4):257-63.
  14. Eslami M, Khezri D, Hoseinnezhad M, The Effect of Two different Types of Shoes out Soles on the Frequency Content of the Ground Reaction Force Components 2015,20.1001.1.23221658.
  15. Asgari A, Haji N. Multiple sclerosis. Razi J Med Sci.2006; 18(5):24-32. [in Persian]
  16. Zamani A, S., G.A. Ghasemi, A. Karimi, and H. Salehi, Pilates exercise effect on pain and general health of female patients with chronic low back pain. Journal of Research in Rehabilitation Sciences, 2011. 7(1.) (In Persian)
  17. Freeman, Jennifer A., Fox, E., Gear, M., Hough, A. Pilates based core stability training in ambulant individuals with multiple sclerosis: Protocol for a multi-centre randomized controlled trial. BMC Neurology; (2012)6: 1-13.
  18. Guclu-Gunduz A, Citaker S, Irkec C, Nazliel B. The effects of pilates on balance, mobility and strength in patients with multiple sclerosis. NeuroRehabilitation 34 (2014) 337–342
  19. Küçük F, Kara B, Poyraz E, İdiman E, Improvements in cognition, quality of life, and physical performance with clinical Pilates in multiple sclerosis 2016 Mar;28(3):
    761-8
  20. Findley, T., Chaudhry, H., Stecco, A., & Roman, M. Fascia research - Anarrative review. Journal of bodywork an movement therapies, J Bodyw Mov Ther. 2012 Apr;16(2):270
  21. Barnes, M. F. (1997). The Basic Science of Myofascial Release. Journal of Bodywork and Movement Therapies, 1 (4), 231-238.
  22. Dalgas U, Stenager E, Ingemann-Hansen T. Multiple sclerosis and physical exercise: recommendations for the application of resistance- endurance and combined training. Mult Scler. 2008;14(1):35-53.
  23. Robertson, M. (2008). Self-Myofascial Release: Purpose, Methods, and Techniques. Indianapolis, Indiana: Mike Robertson and Robertson Training Systems
  24. MacDonald, G. Z., Penney, M. D.H., Mullaley, M. E., Cuconato, A. L., Drake, C. D.J., Behm, D. G., & Button, D. C. An Acute Bout of Self-Myofascial Release Increases Range of Motion Without a Subsequent Decrease in Muscle Activation or Force. Journal of Strength and Conditioning Research, 2013 Mar;27(3):812-21
  25. Jung J, Choi W, Lee Y, Immediate effect of self-myofascial release on hamstring flexibilityPhys Ther Rehabil Sci 6 (1). 45-51
  26. Dębski P, Białas E, Gnat R. The parameters of foam rolling, self-myofascial release treatment: a review of the literature Volume 11 (2019): Issue 1 (January 2019)
  27. Benito A, Valldecabres R, Ceca D. Effect of vibration vs non-vibration foam rolling techniques on flexibility, dynamic balance and perceived joint stability after fatiguede Benito et al. PeerJ, 2019 Nov 26;7: e8000
  28. Depino, G. M. Webright, W. G. Arnold, B. L. Duration of Maintained Hamstring Flexibility After Cessation of an Acute Static Stretching Protocol. 2000 Jan;35(1):
    56-9.
  29. Kurtzke JF. Rating neurological impairment in multiple sclerosis: an expanded disability status Scale. Neurology 1983; 33: 1444-52.
  30. Bullo, V., Bergamin, M., Gobbo, S., Sieverdes, J. C., Zaccaria, M., Neunhaeuserer, D., et al. The effects of Pilates exercise training on physical fitness and wellbeing in the elderly: A systematic review for future prescription. PreV Med, 2015 Jun;75:
    1-11.
  31. Fleming, K, Coote S, Herring P, an eight-week randomised controlled trial of home-based pilates for symptoms of anxiety, depression, and fatigue among people with MS with minimal-to-mild mobility disability, MSJ 2021, Vol. 27(14) 2267–2279.
  32. Olmsted, L.C., Carcia, C.R., Hertel, J., Shultz, S.J. " Efficacy of the star excursion balance tests in detecting reach deficits in subjects with chronic ankle instability".
    J Athl Train. 2002 Oct-Dec; 37(4): 501–506.
  33. McGill SM, Childs A, Liebenson C. Endurance times for low back stabilization exercises: clinical targets for testing and training fro m a normal database. Archives of physical medicine and rehabilitation. 1999 Aug 1;80(8):941-4.
  34. Zarei H, Rajabi R, Minoonejad H The effect of 6- week training with ground balance ladder on postural control and risk of falls in elderly Vol 1, No 4, Spring 2017
    (in persian)
  35. Mostert S, Kesselring J. Effect of pulsed magneticfield therapy on the level of fatigue in patients with multiple sclerosis--a randomized controlled trial. MultScler. 2005;11(3):302-5. DOI: 10. 1191/ 1352 4585 ms1156oa PMID: 15957511
  36. Sherer, E (2013). Effects of utilizing a myofascial foam roll on hamstring flexibility. [Thesis]: USA, Eastern Illinois University, Graduate school, Kinesiology and Sports Studies.
  37. Brendon Skinner, Richard Moss, Lucy HammondA systematic review and meta-analysis of the effects of foam rolling on range of motion, recovery and markers of athletic performance J BodyM Ther 2020 Jul;24(3):105-122
  38. ericson M, Kennedy A, Rosentreter K. effect of deep heating and foam rolling vs. static stretching of the gastrocnemius and soleus complex in improving active ankle dorsiflexion range of motion. 2014.
  39. Chadwick، J , Brandi, R , Frances ,M , Brown ,S ,Macgrego ,C  Effects of Static Stretching and Foam Rolling on Ankle Dorsiflexion Range of Motion Med Sci Sports Exerc . 2019 Aug;51(8):1752-1758.
  40. Mohr, A. R (2011). Effectiveness of foam rolling in combination with a static stretching protocol of the hamstrings. [Thesis]: Doctoral dissertation, Oklahoma State University.
  41. Krill, M (2013). The Effects of The Stick™ on Hamstring Length. (Doctoral dissertation, Florida Gulf Coast University).
  42. Sullivan, K. M., Silvey, D. B., Button, D. C., & Behm, D. G. Roller‐massager application to the hamstrings increases sit‐and‐reach range of motion within five to ten seconds without performance impairments. Int j sports phys ther 2013 Jun;8(3):228-36.
  43. Keys, P. M (2014). The effect of myofascial release VS static stretching on hamstring range of motion. USA, Graduate School Southern Illinois University Carbondale, A Research Paper Submitted in Partial Fulfillment of the Requirements for the Degree of Master of Science in Education in the field of Kinesiology.
  44. Miller, J. K., & Rockey, A. M (2006). Foam rollers show no increase in the flexibility of the hamstring muscle group. UW-L Journal of Undergraduate Research, 9.
  45. Evans, D. F (2014). Self Myofascial Release: Effects on Hamstring Range of Motion and Torque.
  46. Sharp, V. A Comparative Study Between Self Myofascial Release and Emmett Technique Effectiveness in the Management of Fascial (Iliotibial band) Tightness. Kanada, Ontario, Kingston, Queen's University. 2012 Oct;20(5):291-8.
  47. Peacock, C. A., Krein, D. D., Silver, T. A., Sanders, G. J., & von Carlowitz, K. P. A. An acute bout of self-myofascial release in the form of foam rolling improves performance testing. Int J of Exerc Sci, 2014; 7(3): 202–211
  48. Weppler, C. H., & Magnusson, S. P. Increasing muscle extensibility: a matter of increasing length or modifying sensation. Phys ther, (2010) 90(3), 438-449.
  49. Knight, C. A., Rutledge, C. R., Cox, M. E., Acosta, M., & Hall, S. J. Effect of superficial heat, deep heat, and active exercise warm-up on the extensibility of the plantar flexors. Phys Ther, (2001)81(6), 1206-1214.
  50. Schleip, R Fascial plasticity–a new neurobiological explanation: Part 1. Journal of Bodywork and movement therapies, (2003). 7(1), 11-19.
  51. Stone, JA (2000). Myofascial Release. Athletic Therapy Today. 5: 34-35.
  52. Barnes, M. F. The basic science of myofascial release: morphologic change in connective tissue. Journal of Bodywork and Movement Therapies, (1997)1(4),
    231-238.
  53. Curran P F, Fiore R D, Crisco J J. A comparison of the pressure exerted on soft tissue by myofascial rollers. J sport rehabil, 2008, 17(4) ,432.
  54. Silkwood-Sherer D, Warmbier H. Effects of hippotherapy on postural stability, in persons with multiple sclerosis a pilot study. J Neurol Phys Ther. 2007; 31(2): 77-84.
  55. Seminary J, Doucett A. pilates adapted for parkinson's disease and multiple sclerosis. 2013.55
  56. Farsi A, Shahidian P, Mosavi M, Jamshidi A Effect of Pilates Training Based on Core Stability on Balance and Electromyography of Women with Multiple SclerosisJ Rehab Med.2017;6(3):165_173(In Persian)
  57. Kibler WB, Press J, Sciascia A. The role of core stability in athletic function. Sports Med. 2006;36(3):189-198.
  58. Blum L, Korner-Bitensky N. Usefulness of the Berg Balance Scale in stroke rehabilitation: a systematic review. Phys Ther. 2008; 88(5):559-66.
  59. Kalron A, Rosenblum U, Frid L and Achiron. A Pilates exercise training vs. physical therapy for improving walking and balance in people with multiple sclerosis: CLIN REHABIL 2017 Mar;31(3):319_328.
  60. Gheitasi M, Bayattork M, Andersen L, Iman S. Effect of Twelve weeks Pilates training on functional balance of male patients with Multiple Sclerosis. J Bodyw Mov Ther 2021 Jan; 25:41-45
  61. Mount J, Dacko S. Effects of dorsiflexor endurance exercises on foot drop secondary to multiple sclerosis: a pilot NeuroRehabilitation 2006; 21(1): 43-50.
  62. Newman MA, Dawes H, van den Berg M, Wade DT, Burridge J, Izadi H. Can aerobic treadmill training reduce the effort of walking and fatigue in people with multiple sclerosis: a pilot study. Mult Scler 2007; 13(1): 113-9.

63.DeBolt L, Crist R. Long-term exercise, physical activity, and fitness in multiple sclerosis. Research Quarterly for Exercise and Sport 2008; 79(Suppl 1).

  1. Umphred, D.A. and C. Carlson, Neurorehabilitation for the physical therapist assistant. 2006: SLACK Incorporated.J Rehab Med. 2017; 6(2):150-159.
  2. Holland, N.J. and M. Madonna, Nursing grand rounds: multiple sclerosis. Journal of Neurosciencenursing, 2005. 37(1): p. 15-19.
  3. Ashtari, F., V. Shaygannzhad, F. Heidari, and M. Akbari, Estimating the prevalence of familial disease in Multiple sclerosis in Isfahan. Isfahan University of Medical Sciences, Iran J Neurol. 2017 Apr 4; 16(2): 90–95.  (In Persian)
  4. Jackson K, fritz I, Rodgers M M. Home balance training intervention for people with multiple scelerosis. Int J ms care .2007;( 9):111- 117.
  5. Stephens J, DuShuttle D, Hatcher C, Shmunes J, Slaninka C. Use of awareness through movement improves balance and balance confdence in people with multiple sclerosis: a randomized controlled study. Journal of Neurologic Physical Therapy. 2001; 25(2):39-49
  6. Dalgas U, Stenager E, Ingemann-Hansen T. Multiple sclerosis and physical exercise: recommendations for the application of resistance-, endurance-and combined training. Multiple sclerosis. 2008 Jan;14(1):35-53
  7. Bahraini S, Naji SA, MananI R. The effect of aromatherapy massage on fatigue in patients with multiple sclerosis. Journal of Sabzevar University of Medical Sciences. 2011; 18( 3), 172-178 (In Persian)
  8. Guinness MC, Peter S. "The diagnosis ofmultiple sclerosis: peplau's interpersonal relations model in practice". Rehabil Nurs. 1999;24(1):30-36.
  9. Frzovic, D., M.E. Morris, and L. Vowels, Clinical tests of standing balance: performance of persons with multiple sclerosis. Archives of physical medicine and rehabilitation, 2000. 81(2): p. 215-21.
  10. Sosnoff JJ, Socie MJ, Boes MK, Sandroff BM, Pula JH, Mobility, Balance and Falls in Persons with Multiple Sclerosis. PLoS ONE. 2011;6(11):
  11. Stephens J, DuShuttle D, Hatcher C, Shmunes J, Slaninka C. Use of awareness through movement improves balance and balance confidence in people with multiple sclerosis: a randomized controlled study. J Neuro Phys Ther 2001; 25(2):39-49.
  12. Emami MH TH, Kohestani S, Chitsaz A, Etemadifar M, Karimi S, et al. How frequent is celiac disease among epileptic patients. J Gastrointestin Liver Dis 2008:379-382. (In Persian)
  13. Soyuer F, Mirza M. [Relationship between lower extremity. muscle strength and balance in Multiple Sclerosis (Turkish)]. Journal of Neurologica Sciences 2006; 23(4):257-63.
  14. Eslami M, Khezri D, Hoseinnezhad M, The Effect of Two different Types of Shoes out Soles on the Frequency Content of the Ground Reaction Force Components 2015,20.1001.1.23221658.
  15. Asgari A, Haji N. Multiple sclerosis. Razi J Med Sci.2006; 18(5):24-32. [in Persian]
  16. Zamani A, S., G.A. Ghasemi, A. Karimi, and H. Salehi, Pilates exercise effect on pain and general health of female patients with chronic low back pain. Journal of Research in Rehabilitation Sciences, 2011. 7(1.) (In Persian)
  17. Freeman, Jennifer A., Fox, E., Gear, M., Hough, A. Pilates based core stability training in ambulant individuals with multiple sclerosis: Protocol for a multi-centre randomized controlled trial. BMC Neurology; (2012)6: 1-13.
  18. Guclu-Gunduz A, Citaker S, Irkec C, Nazliel B. The effects of pilates on balance, mobility and strength in patients with multiple sclerosis. NeuroRehabilitation 34 (2014) 337–342
  19. Küçük F, Kara B, Poyraz E, İdiman E, Improvements in cognition, quality of life, and physical performance with clinical Pilates in multiple sclerosis 2016 Mar;28(3):
    761-8
  20. Findley, T., Chaudhry, H., Stecco, A., & Roman, M. Fascia research - Anarrative review. Journal of bodywork an movement therapies, J Bodyw Mov Ther. 2012 Apr;16(2):270
  21. Barnes, M. F. (1997). The Basic Science of Myofascial Release. Journal of Bodywork and Movement Therapies, 1 (4), 231-238.
  22. Dalgas U, Stenager E, Ingemann-Hansen T. Multiple sclerosis and physical exercise: recommendations for the application of resistance- endurance and combined training. Mult Scler. 2008;14(1):35-53.
  23. Robertson, M. (2008). Self-Myofascial Release: Purpose, Methods, and Techniques. Indianapolis, Indiana: Mike Robertson and Robertson Training Systems
  24. MacDonald, G. Z., Penney, M. D.H., Mullaley, M. E., Cuconato, A. L., Drake, C. D.J., Behm, D. G., & Button, D. C. An Acute Bout of Self-Myofascial Release Increases Range of Motion Without a Subsequent Decrease in Muscle Activation or Force. Journal of Strength and Conditioning Research, 2013 Mar;27(3):812-21
  25. Jung J, Choi W, Lee Y, Immediate effect of self-myofascial release on hamstring flexibilityPhys Ther Rehabil Sci 6 (1). 45-51
  26. Dębski P, Białas E, Gnat R. The parameters of foam rolling, self-myofascial release treatment: a review of the literature Volume 11 (2019): Issue 1 (January 2019)
  27. Benito A, Valldecabres R, Ceca D. Effect of vibration vs non-vibration foam rolling techniques on flexibility, dynamic balance and perceived joint stability after fatiguede Benito et al. PeerJ, 2019 Nov 26;7: e8000
  28. Depino, G. M. Webright, W. G. Arnold, B. L. Duration of Maintained Hamstring Flexibility After Cessation of an Acute Static Stretching Protocol. 2000 Jan;35(1):
    56-9.
  29. Kurtzke JF. Rating neurological impairment in multiple sclerosis: an expanded disability status Scale. Neurology 1983; 33: 1444-52.
  30. Bullo, V., Bergamin, M., Gobbo, S., Sieverdes, J. C., Zaccaria, M., Neunhaeuserer, D., et al. The effects of Pilates exercise training on physical fitness and wellbeing in the elderly: A systematic review for future prescription. PreV Med, 2015 Jun;75:
    1-11
    .
  31. Fleming, K, Coote S, Herring P, an eight-week randomised controlled trial of home-based pilates for symptoms of anxiety, depression, and fatigue among people with MS with minimal-to-mild mobility disability, MSJ 2021, Vol. 27(14) 2267–2279.
  32. Olmsted, L.C., Carcia, C.R., Hertel, J., Shultz, S.J. " Efficacy of the star excursion balance tests in detecting reach deficits in subjects with chronic ankle instability".
    J Athl Train. 2002 Oct-Dec; 37(4): 501–506.
  33. McGill SM, Childs A, Liebenson C. Endurance times for low back stabilization exercises: clinical targets for testing and training fro m a normal database. Archives of physical medicine and rehabilitation. 1999 Aug 1;80(8):941-4.
  34. Zarei H, Rajabi R, Minoonejad H The effect of 6- week training with ground balance ladder on postural control and risk of falls in elderly Vol 1, No 4, Spring 2017
    (in persian)
  35. Mostert S, Kesselring J. Effect of pulsed magneticfield therapy on the level of fatigue in patients with multiple sclerosis--a randomized controlled trial. MultScler. 2005;11(3):302-5. DOI: 10. 1191/ 1352 4585 ms1156oa PMID: 15957511
  36. Sherer, E (2013). Effects of utilizing a myofascial foam roll on hamstring flexibility. [Thesis]: USA, Eastern Illinois University, Graduate school, Kinesiology and Sports Studies.
  37. Brendon Skinner, Richard Moss, Lucy HammondA systematic review and meta-analysis of the effects of foam rolling on range of motion, recovery and markers of athletic performance J BodyM Ther 2020 Jul;24(3):105-122
  38. ericson M, Kennedy A, Rosentreter K. effect of deep heating and foam rolling vs. static stretching of the gastrocnemius and soleus complex in improving active ankle dorsiflexion range of motion. 2014.
  39. Chadwick، J Brandi, R , Frances ,M , Brown ,S ,Macgrego ,Effects of Static Stretching and Foam Rolling on Ankle Dorsiflexion Range of Motion Med Sci Sports Exerc . 2019 Aug;51(8):1752-1758.
  40. Mohr, A. R (2011). Effectiveness of foam rolling in combination with a static stretching protocol of the hamstrings. [Thesis]: Doctoral dissertation, Oklahoma State University.
  41. Krill, M (2013). The Effects of The Stick™ on Hamstring Length. (Doctoral dissertation, Florida Gulf Coast University).
  42. Sullivan, K. M., Silvey, D. B., Button, D. C., & Behm, D. G. Roller‐massager application to the hamstrings increases sit‐and‐reach range of motion within five to ten seconds without performance impairments. Int j sports phys ther 2013 Jun;8(3):228-36.
  43. Keys, P. M (2014). The effect of myofascial release VS static stretching on hamstring range of motion. USA, Graduate School Southern Illinois University Carbondale, A Research Paper Submitted in Partial Fulfillment of the Requirements for the Degree of Master of Science in Education in the field of Kinesiology.
  44. Miller, J. K., & Rockey, A. M (2006). Foam rollers show no increase in the flexibility of the hamstring muscle group. UW-L Journal of Undergraduate Research, 9.
  45. Evans, D. F (2014). Self Myofascial Release: Effects on Hamstring Range of Motion and Torque.
  46. Sharp, V. A Comparative Study Between Self Myofascial Release and Emmett Technique Effectiveness in the Management of Fascial (Iliotibial band) Tightness. Kanada, Ontario, Kingston, Queen's University. 2012 Oct;20(5):291-8.
  47. Peacock, C. A., Krein, D. D., Silver, T. A., Sanders, G. J., & von Carlowitz, K. P. A. An acute bout of self-myofascial release in the form of foam rolling improves performance testing. Int J of Exerc Sci, 2014; 7(3): 202–211
  48. Weppler, C. H., & Magnusson, S. P. Increasing muscle extensibility: a matter of increasing length or modifying sensation. Phys ther, (2010) 90(3), 438-449.
  49. Knight, C. A., Rutledge, C. R., Cox, M. E., Acosta, M., & Hall, S. J. Effect of superficial heat, deep heat, and active exercise warm-up on the extensibility of the plantar flexors. Phys Ther, (2001)81(6), 1206-1214.
  50. Schleip, R Fascial plasticity–a new neurobiological explanation: Part 1. Journal of Bodywork and movement therapies, (2003). 7(1), 11-19.
  51. Stone, JA (2000). Myofascial Release. Athletic Therapy Today. 5: 34-35.
  52. Barnes, M. F. The basic science of myofascial release: morphologic change in connective tissue. Journal of Bodywork and Movement Therapies, (1997)1(4),
    231-238.
  53. Curran P F, Fiore R D, Crisco J J. A comparison of the pressure exerted on soft tissue by myofascial rollers. J sport rehabil, 2008, 17(4) ,432.
  54. Silkwood-Sherer D, Warmbier H. Effects of hippotherapy on postural stability, in persons with multiple sclerosis a pilot study. J Neurol Phys Ther. 2007; 31(2): 77-84.
  55. Seminary J, Doucett A. pilates adapted for parkinson's disease and multiple sclerosis. 2013.55
  56. Farsi A, Shahidian P, Mosavi M, Jamshidi A Effect of Pilates Training Based on Core Stability on Balance and Electromyography of Women with Multiple SclerosisJ Rehab Med.2017;6(3):165_173(In Persian)
  57. Kibler WB, Press J, Sciascia A. The role of core stability in athletic function. Sports Med. 2006;36(3):189-198.
  58. Blum L, Korner-Bitensky N. Usefulness of the Berg Balance Scale in stroke rehabilitation: a systematic review. Phys Ther. 2008; 88(5):559-66.
  59. Kalron A, Rosenblum U, Frid L and Achiron. A Pilates exercise training vs. physical therapy for improving walking and balance in people with multiple sclerosis: CLIN REHABIL 2017 Mar;31(3):319_328.
  60. Gheitasi M, Bayattork M, Andersen L, Iman S. Effect of Twelve weeks Pilates training on functional balance of male patients with Multiple Sclerosis. J Bodyw Mov Ther 2021 Jan; 25:41-45
  61. Mount J, Dacko S. Effects of dorsiflexor endurance exercises on foot drop secondary to multiple sclerosis: a pilot NeuroRehabilitation 2006; 21(1): 43-50.
  62. Newman MA, Dawes H, van den Berg M, Wade DT, Burridge J, Izadi H. Can aerobic treadmill training reduce the effort of walking and fatigue in people with multiple sclerosis: a pilot study. Mult Scler 2007; 13(1): 113-9.

63.eBolt L, Crist R. Long-term exercise, physical activity, and fitness in multiple sclerosis. Research Quarterly for Exercise and Sport 2008; 79(Suppl 1).