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Journal of Bodywork and Movement... Jul 2024Studies with focus on effects of manual therapy techniques on postural control and muscle activity in patients with chronic ankle instability (are lacking. The purpose... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
Studies with focus on effects of manual therapy techniques on postural control and muscle activity in patients with chronic ankle instability (are lacking. The purpose of this study was to evaluate the feasibility of a planned cross-over study to assess efficacy of manual therapy techniques applications in patients with chronic ankle instability.
METHODS
This feasibility study used a randomized controlled, blinded assessor cross-over design. Criteria of success under evaluation were adherence and attrition rates and adverse events. while preliminary treatment effects of manual therapy techniques on muscular activity (measured by surface electromyography) and on dynamic balance (measured by time to stabilization test) were secondary aims.
RESULTS
Thirteen participants (mean age: 24.4 ± 3.8 years) with chronic ankle instability volunteered in this feasibility study. Success criteria showed a high adherence (98.7%) and low attrition (0%). No missing data were reported but four out of 26 data sets could not be used for statistical analysis because of non-readability of the recorded data. Preliminary treatment effect showed divergent results for surface electromyography and time to stabilization. One significant result (p = 0.03, ES = 1.48) in peroneus longus muscle activity after jump landing between 30 and 60 ms could be determined.
CONCLUSIONS
This study showed that the study protocol is feasible but should be modified by offering participants the opportunity to familiarize to the jumps and to the test repetitions. This study generates better understanding of manual therapy techniques for patients with chronic ankle instability.
Topics: Humans; Joint Instability; Cross-Over Studies; Postural Balance; Adult; Male; Female; Electromyography; Ankle Joint; Young Adult; Muscle, Skeletal; Musculoskeletal Manipulations; Feasibility Studies; Ankle Injuries
PubMed: 38876670
DOI: 10.1016/j.jbmt.2024.03.020 -
Journal of Bodywork and Movement... Jul 2024To investigate the relationship between predicted risk of injury based on the dichotomous classification of the weight-bearing lunge (WBL) test scores and variables...
OBJECTIVES
To investigate the relationship between predicted risk of injury based on the dichotomous classification of the weight-bearing lunge (WBL) test scores and variables related to jumping and sprinting ability in young athletes. Furthermore, to compare the impact of the classical dichotomous classification versus a more specific quartile subdivision of the WBL test scores on the explored variables.
DESIGN
Cross-sectional study.
PARTICIPANTS
125 healthy athletes (mean age 10.38 (SD = 2.28) years) were recruited.
MAIN OUTCOME MEASURES
Ankle dorsiflexion was evaluated with the WBL test, jumping distance with the standing long jump (SLJ) test, and maximal running speed with the 14-m and 28-m sprint test.
RESULTS
Athletes with WBL test scores lower than 10 cm exhibited significantly poorer results for the SLJ test as well as lower 14-m and 28-m sprint times than those with WBL test scores higher than 10 cm (p < 0.05). Likewise, when WBL test scores were subdivided by quartiles, a positive trend between range of motion and improved performance was shown.
CONCLUSIONS
Reduced ankle dorsiflexion mobility may affect sprinting and jumping ability in young athletes. In addition, a more detailed classification of ankle restriction by quartiles is proposed in this study in order to prevent injury and enhance athletic performance.
Topics: Humans; Cross-Sectional Studies; Range of Motion, Articular; Male; Running; Female; Ankle Joint; Adolescent; Child; Weight-Bearing; Athletes; Athletic Performance
PubMed: 38876663
DOI: 10.1016/j.jbmt.2024.02.013 -
Frontiers in Human Neuroscience 2024Despite being a primary impairment in individuals with cerebral palsy (CP), selective motor control (SMC) is not routinely measured. Personalized treatment approaches in...
INTRODUCTION
Despite being a primary impairment in individuals with cerebral palsy (CP), selective motor control (SMC) is not routinely measured. Personalized treatment approaches in CP will be unattainable without the ability to precisely characterize the types and degrees of impairments in motor control. The objective of this study is to report the development and feasibility of a new methodological approach measuring muscle activation patterns during single-joint tasks to characterize obligatory muscle co-activation patterns that may underly impaired SMC.
METHODS
Muscle activation patterns were recorded during sub-maximal voluntary isometric contraction (sub-MVIC) tasks at the hip, knee, and ankle with an interactive feedback game to standardize effort across participants. We calculated indices of co-activation, synergistic movement, mirror movement, and overflow (indices range 0-2, greater scores equal to greater impairment in SMC) for each isolated joint task in 15 children - 8 with typical development (TD) (mean age 4.7 ± 1.0 SD years) and 7 with CP (mean age 5.8 ± 0.7 SD years). Indices were compared with Mann-Whitney tests. The relationships between the indices and gross motor function (GMFM-66) were examined with Pearson's .
RESULTS
Mean indices were higher in the CP vs. the TD group for each of the six tasks, with mean differences ranging from 0.05 (abduction and plantarflexion) to 0.44 (dorsiflexion). There was great inter-subject variability in the CP group such that significant group differences were detected for knee flexion mirroring ( = 0.029), dorsiflexion coactivation ( = 0.021), and dorsiflexion overflow ( = 0.014). Significant negative linear relations to gross motor function were found in all four indices for knee extension ( = -0.56 to -0.75), three of the indices for ankle dorsiflexion ( = -0.68 to -0.78) and in two of the indices for knee flexion ( = -0.66 to -0.67), and ankle plantarflexion ( = -0.53 to -0.60).
DISCUSSION
Indices of coactivation, mirror movement, synergy, and overflow during single-joint lower limb tasks may quantify the type and degree of impairment in SMC. Preliminary concurrent validity between several of the indices of SMC and gross motor function was observed. Our findings established the feasibility of a new methodological approach that quantifies muscle activation patterns using electromyography paired with biofeedback during single-joint movement.
PubMed: 38873651
DOI: 10.3389/fnhum.2024.1330315 -
Health Science Reports Jun 2024Patellofemoral pain (PFP) is common in males, causing reduced physical activity and chronic pain. One proposed cause of PFP is aberrant biomechanics during tasks loading...
BACKGROUND AND AIMS
Patellofemoral pain (PFP) is common in males, causing reduced physical activity and chronic pain. One proposed cause of PFP is aberrant biomechanics during tasks loading the patellofemoral joint. Consistent evidence exists for females with PFP, but it is uncertain if males with PFP have altered biomechanics. This study investigated the kinematics of males with PFP compared to pain-free males during forward step-down (StDn) and single-leg squat (SLSq).
METHODS
A cross-sectional study including 40 males aged 20-39 years (28.28 ± 5.46) was conducted (20 PFP, 20 pain-free). Participants performed StDn and SLSq while motion was captured with a video-based motion capture system (Motion Analysis Corporation). Triplanar peak angles and angular ranges of motion (ROM) of the trunk, pelvis, and weight-bearing hip, knee, and ankle were dependent variables. Mixed-model ANOVA tests were used to determine the presence of significant interactions and main effects of group and task.
RESULTS
Males with PFP had significantly lower peak knee adduction angles compared to pain-free males ( = 0.01). Significant group x task interactions were found for hip and pelvis ROM ( < 0.05). PFP participants had increased hip and pelvis ROM during StDn in the frontal and transverse planes but reduced or nearly equal ROM for these variables during SLSq. Peak hip adduction, hip internal rotation, contralateral pelvic drop and anterior tilt, trunk flexion, and ankle dorsiflexion were greater during StDn compared to SLSq ( < 0.05). ROM of the hip, pelvis, trunk, and ankle were greater during StDn compared to SLSq ( < 0.05).
CONCLUSION
Males with PFP had reduced peak knee adduction angles in StDn and SLSq. Males with PFP demonstrated increased hip and pelvis ROM during StDn versus SLSq, particularly in the frontal and transverse planes. Clinicians should consider StDn as a clinical test since aberrant movement may be easier to detect than in SLSq.
PubMed: 38868539
DOI: 10.1002/hsr2.2193 -
Journal of Inflammation Research 2024Rheumatoid arthritis (RA) is a chronic autoimmune disease with abnormal differentiation of follicular helper T (Tfh) cells, Total alkaloids of Linn. (Leguminosae)...
BACKGROUND
Rheumatoid arthritis (RA) is a chronic autoimmune disease with abnormal differentiation of follicular helper T (Tfh) cells, Total alkaloids of Linn. (Leguminosae) (TASA) have potential effects on collagen-induced arthritis (CIA) mice, while the mechanism needs further elucidation. The purpose of this study is to explore the regulation of TASA on rheumatoid arthritis and related mechanism.
METHODS
The proportion of Tfh and B lymphocytes in peripheral blood lymphocytes of RA patients was examined by flow cytometry. We constructed the collagen induced arthritis DBA/1J mice model. Between days 15 and 45 following the first immunization, the mice were treated intraperitoneally with saline, TASA (100, 50, and 25 mg/kg), and dexamethasone (DXM) for 30 days. Molecular biological techniques such as FCM, PCR, ELISA, and Western-blotting were used to examine Tfh cells and associated signal pathways.
RESULTS
Our results indicated that the follicular helper T cells and B lymphocytes in rheumatoid arthritis patients were significantly increased compared with the healthy control. The percentage of Tfh cells are correlated with RA related inflammatory factors. Total alkaloids of Linn. could significantly attenuate joint swelling. Meanwhile, it reduced the frequencies of spleen Tfh, B lymphocytes and the expression of TLR2, TLR9, p-NF-κBp65, CXCR5, Bcl-6, ICOS of ankle joints in CIA mice.
CONCLUSION
Total alkaloids of Linn. may down-regulate the frequency and function of Tfh cells and inhibit GCB cells via TLRs/NF-κB signal pathway to relieve the immune-pathological progression of CIA mice.
PubMed: 38860009
DOI: 10.2147/JIR.S449330 -
Frontiers in Surgery 2024To investigate the short-term clinical efficacy of robot-assisted retrograde drilling and arthroscopic microfracture for osteochondral lesions of the talus (OCLT).
OBJECTIVE
To investigate the short-term clinical efficacy of robot-assisted retrograde drilling and arthroscopic microfracture for osteochondral lesions of the talus (OCLT).
METHODS
This study was divided into two groups: experimental group: robot-assisted retrograde drilling group; control group: arthroscopic microfracture group. A total of 6 OCLT patients who were treated with robot navigation-assisted retrograde drilling and 10 OCLT patients who were treated with arthroscopic microfracture between October 2020 and October 2021 were retrospectively analyzed. There were 11 males and five females, with a mean age of 36 years. The patients were followed up for 6-12 months to compare the changes in the OCLT lesion area by magnetic resonance imaging (MRI), visual analogue scale/score (VAS) and American Orthopedic Foot and Ankle Society score (AOFAS) before and after surgery.
RESULTS
All 16 patients were followed up for an average of 8 months, and no complications such as joint infection, nerve injury, or active bleeding occurred during the follow-up period. Only one patient suffered discomfort involving transient postoperative pain in the operative area, but did not experience long-term numbness or chronic pain. Postoperative MRI revealed that none of the patients had severe signs of osteonecrosis, osteolysis or cystic changes of the talus, with lesion areas smaller than those before surgery. The difference was statistically significant (< 0.01). The patients in the experimental group showed a more significant improvement in the last 3 months than in the first 3 months of the follow-up period. At the last follow-up, the VAS score was 3 points in the experimental group and 2.2 points in the control group, and the AOFAS score was 88.6 points in the experimental group and 88 points in the control group, all of which were significantly higher than those before operation, and the differences were statistically significant, but there was no statistically significant difference between the groups.
CONCLUSION
Both robot navigation-assisted retrograde drilling and arthroscopic microfracture for bone marrow stimulation (BMS) to treat OCLT in all patients obtained satisfactory effects in the short term. In addition, the follow-up revealed that with excellent efficacy and few complications, robot navigation-assisted retrograde drilling was safe and minimally invasive, and greatly reduced operative time. Consequently, robot navigation-assisted retrograde drilling for BMS was a safe and effective procedure for the treatment of OCLT.
PubMed: 38859999
DOI: 10.3389/fsurg.2024.1404513 -
PloS One 2024Weber Type B fractures often arise from external rotation with the foot supinated or pronated. Altered tibiofibular joint kinematics in Weber B fractures are responsible...
Weber Type B fractures often arise from external rotation with the foot supinated or pronated. Altered tibiofibular joint kinematics in Weber B fractures are responsible for syndesmotic damage seen in Weber B fractures. Weber B fractures are managed using open reduction and internal fixation if displaced. The syndesmosis is injured in up to 40% of cases resulting in an unstable injury with a syndesmotic diastasis. This systematic review aimed to evaluate the current literature on syndesmotic fixation in Weber B fractures, assess the outcomes and complications of syndesmotic fixation and assess the necessity of syndesmotic fixation in Weber B fractures. A search was carried out on the EMBASE, PubMed and CINAHL databases and eight studies assessing the outcomes of syndesmotic fixations versus no syndesmotic fixation with 292 Weber B ankle fractures were included in this systematic review. Results showed significant heterogeneity so a narrative review was conducted. Results of these studies showed that functional, radiological, and quality-of-life outcomes and incidences of post-traumatic osteoarthritis in patients with syndesmotic screws were similar to those of patients not managed with syndesmotic screws. Only one favoured syndesmotic fixation in all cases of diastasis. As such, syndesmotic fixation with screws may not be necessary in the management of Weber B fractures. Screws are also associated with breakage, loosening, local irritation and infections. Suture button devices and antiglide fixation techniques appear to be valid alternatives to syndesmotic screws. It was found that there was no need for routine hardware removal unless the hardware was causing significant side effects for the patient.
Topics: Humans; Ankle Fractures; Fracture Fixation, Internal; Ankle Injuries; Ankle Joint; Bone Screws; Treatment Outcome
PubMed: 38857233
DOI: 10.1371/journal.pone.0304148 -
Theranostics 2024Gouty arthritis causes severe pain and inflammation. Alginate oligosaccharides (AOSs) are natural products derived from alginate and have anti-inflammatory properties....
Gouty arthritis causes severe pain and inflammation. Alginate oligosaccharides (AOSs) are natural products derived from alginate and have anti-inflammatory properties. We explored the potential effects of AOSs with different degrees of polymerization (Dp) on gouty arthritis and associated mechanisms. We established a mouse model of gouty arthritis by injecting monosodium urate (MSU) into ankle joint. Nocifensive behavior, gait and ankle swelling were used to study AOS's effects. Biochemical assays, imaging, live cell Ca imaging, electrophysiology, RNA-sequencing, etc. were used for mechanism exploration. AOS2 (Dp=2), AOS3 (Dp=3) and AOS4 (Dp=4) all inhibited ankle swelling, whereas AOS2&3 produced the most obvious analgesia on model mice. AOS3, which was picked for further evaluation, produced dose-dependent ameliorative effects on model mice. AOS3 reversed gait impairments but did not alter locomotor activity. AOS3 inhibited NLRP3 inflammasome activation and inflammatory cytokine up-regulation in ankle joint. AOS3 ameliorated MSU-induced oxidative stress and reactive oxygen species (ROS) production both and and reversed the impaired mitochondrial bioenergetics. AOS3 activated the Nrf2 pathway and promoted Nrf2 disassociation from Keap1-bound complex and Nrf2 nuclear translocation, thus facilitating antioxidant gene expression via Nrf2-dependent mechanism. gene deficiency abolished AOS3's ameliorative effects on pain, inflammation and oxidative stress in ankle joints of model mice. AOS3 reduced TRPV1 functional enhancement in DRG neurons and constrained neuroactive peptide release. AOS3 ameliorates gouty arthritis via activating Nrf2-dependent antioxidant signaling, resulting in suppression of ROS-mediated NLRP3 inflammasome activation and TRPV1 enhancement. AOS3 may be novel therapeutics for gouty arthritis.
Topics: Animals; Arthritis, Gouty; Mice; Oligosaccharides; Disease Models, Animal; Alginates; Inflammation; NLR Family, Pyrin Domain-Containing 3 Protein; Male; Arthralgia; Uric Acid; Mice, Inbred C57BL; Anti-Inflammatory Agents; Inflammasomes; Ankle Joint; NF-E2-Related Factor 2; Oxidative Stress
PubMed: 38855180
DOI: 10.7150/thno.95611 -
Lancet (London, England) Jun 2024After surgery for a broken ankle, patients are usually instructed to avoid walking for 6 weeks (delayed weight-bearing). Walking 2 weeks after surgery (early...
BACKGROUND
After surgery for a broken ankle, patients are usually instructed to avoid walking for 6 weeks (delayed weight-bearing). Walking 2 weeks after surgery (early weight-bearing) might be a safe and preferable rehabilitation strategy. This study aimed to determine the clinical and cost effectiveness of an early weight-bearing strategy compared with a delayed weight-bearing strategy.
METHODS
This was a pragmatic, multicentre, randomised, non-inferiority trial including 561 participants (aged ≥18 years) who received acute surgery for an unstable ankle fracture in 23 UK National Health Service (NHS) hospitals who were assigned to either a delayed weight-bearing (n=280) or an early weight-bearing rehabilitation strategy (n=281). Patients treated with a hindfoot nail, those who did not have protective ankle sensation (eg, peripheral neuropathy), did not have the capacity to consent, or did not have the ability to adhere to trial procedures were excluded. Neither participants nor clinicians were masked to the treatment. The primary outcome was ankle function measured using the Olerud and Molander Ankle Score (OMAS) at 4 months after randomisation, in the per-protocol population. The pre-specified non-inferiority OMAS margin was -6 points and superiority testing was included in the intention-to-treat population in the event of non-inferiority. The trial was prospectively registered with ISRCTN Registry, ISRCTN12883981, and the trial is closed to new participants.
FINDINGS
Primary outcome data were collected from 480 (86%) of 561 participants. Recruitment was conducted between Jan 13, 2020, and Oct 29, 2021. At 4 months after randomisation, the mean OMAS score was 65·9 in the early weight-bearing and 61·2 in the delayed weight-bearing group and adjusted mean difference was 4·47 (95% CI 0·58 to 8·37, p=0·024; superiority testing adjusted difference 4·42, 95% CI 0·53 to 8·32, p=0·026) in favour of early weight-bearing. 46 (16%) participants in the early weight-bearing group and 39 (14%) in the delayed weight-bearing group had one or more complications (adjusted odds ratio 1·18, 95% CI 0·80 to 1·75, p=0·40). The mean costs from the perspective of the NHS and personal social services in the early and delayed weight-bearing groups were £725 and £785, respectively (mean difference -£60 [95% CI -342 to 232]). The probability that early weight-bearing is cost-effective exceeded 80%.
INTERPRETATION
An early weight-bearing strategy was found to be clinically non-inferior and highly likely to be cost-effective compared with the current standard of care (delayed weight-bearing).
FUNDING
National Institute for Health and Care Research (NIHR), NIHR Barts Biomedical Research Centre, and NIHR Applied Research Collaboration Oxford and Thames Valley.
PubMed: 38848738
DOI: 10.1016/S0140-6736(24)00710-4 -
PloS One 2024Change of direction, stops, and pivots are among the most common non-contact movements associated with anterior cruciate ligament (ACL) injuries in soccer. By observing...
Change of direction, stops, and pivots are among the most common non-contact movements associated with anterior cruciate ligament (ACL) injuries in soccer. By observing these dynamic movements, clinicians recognize abnormal kinematic patterns that contribute to ACL tears such as increased knee valgus or reduced knee flexion. Different motions and physical demands are observed across playing positions, which may result in varied lower limb kinematic patterns. In the present study, 28 college and sub-elite soccer players performed four dynamic motions (change of direction with and without ball, header, and instep kick) with the goal of examining the effect of on-field positioning, leg dominance, and gender in lower body kinematics. Motion capture software monitored joint angles in the knee, hip, and ankle. A three-way ANOVA showed significant differences in each category. Remarkably, centrally positioned players displayed significantly greater knee adduction (5° difference, p = 0.013), hip flexion (9° difference, p = 0.034), hip adduction (7° difference, p = 0.016), and dorsiflexion (12° difference, p = 0.022) when performing the instep kick in comparison to their laterally positioned counterparts. These findings suggest that central players tend to exhibit a greater range of motion when performing an instep kicking task compared to laterally positioned players. At a competitive level, this discrepancy could potentially lead to differences in lower limb muscle development among on-field positions. Accordingly, it is suggested to implement position-specific prevention programs to address these asymmetries in lower limb kinematics, which can help mitigate dangerous kinematic patterns and consequently reduce the risk of ACL injury in soccer players.
Topics: Humans; Soccer; Biomechanical Phenomena; Male; Female; Young Adult; Lower Extremity; Adult; Anterior Cruciate Ligament Injuries; Range of Motion, Articular; Knee Joint; Adolescent; Athletes; Ankle Joint; Hip Joint
PubMed: 38848409
DOI: 10.1371/journal.pone.0304511