Patellofemoral joint loads in ACL reconstructed elite athletes during running at time of return to sport

Background: Patellofemoral joint pain and degeneration is common in patients who undergo ACL reconstruction (ACLR). The presence of patellofemoral joint pain significantly impacts on the ability to continue to participate in sport and may even have a bearing on participation in activities of daily living. What is currently unclear is the mechanisms behind this process, previous research has identified altered patellofemoral joint loading in individuals with patellofemoral joint pain when running. It is unclear if this process is occurring following ACLR. Hypothesis/Purpose: To assess the patellofemoral joint stresses during running in ACLR knees and compare the findings to non-injured knee and matched control knees. Study Design: Cohort study Methods: Thirty four elite sports practitioners who had undergone ACLR and thirty four age and sex matched controls participated in the study. The participants had their running gait assessed using 3D motion capture, and knee loads and forces calculated using inverse dynamics. Results: There was a significance difference in knee extensor moment, knee flexion angles, patellofemoral contact force (around 23% greater), and patellofemoral contact pressure (around 27% greater) between the ACLR and non-injured limb (p≤0.04) and the ACLR and control limb (p≤0.04), with no significant difference between the non-injured and control limbs (p≥0.44). Conclusion: Significantly greater levels of patellofemoral joint stress and load were found in the ACLR knee compared to the non-injured and control knees. Clinical Relevance: Altered levels of patellofemoral stress in the ACLR knee during running may predispose these individuals to patellofemoral joint pain

Braking characteristics during cutting and pivoting in female soccer players

Biomechanical studies into changing direction focus on final contact (FC), whilst limited research has examined penultimate contact (PEN). The aim of this study was to explore the kinematic and kinetic differences between PEN and FC of cutting and pivoting in 22 female soccer players (mean ± SD; age: 21 ± 3.1 years, height: 1.68 ± 0.07 m, mass: 58.9 ± 7.3 kg). Furthermore, the study investigated whether horizontal force-time characteristics during PEN were related to peak knee abduction moments during FC. Three dimensional motion analyses of cutting and pivoting on the right leg were performed using Qualysis ‘Pro-reflex’ infrared cameras (240Hz). Ground reaction forces (GRF) were collected from two AMTI force platforms (1200Hz) to examine PEN and FC. Both manoeuvres involved significantly (P < 0.05) greater knee joint flexion angles, peak horizontal GRF, but lower average horizontal GRF during PEN compared to FC. Average horizontal GRF during PEN (R = -0.569, R2 = 32%, P = 0.006) and average horizontal GRF ratio (R = 0.466, R2 = 22%, P = 0.029) were significantly related to peak knee abduction moments during the FC of cutting and pivoting, respectively. The results indicate PEN during pre-planned changing direction helps reduce loading on the turning leg where there is greater risk of injuries to knee ligaments

Does the Powers™ strap influence the lower limb biomechanics during running?

Previous research has reported a prevalence of running related injuries in 25.9% to 72% of all runners. A greater hip internal rotation and adduction during the stance phase in running has been associated with many running related injuries, such as patellofemoral pain. Researchers in the USA designed a treatment device 'the PowersTM strap' to facilitate an external rotation of the femur and to thereby control abnormal hip and knee motion during leisure and sport activities. However, to date no literature exists to demonstrate whether the PowersTM strap is able to reduce hip internal rotation during running. 22 healthy participants, 11 males and 11 females (age: 27.45 ±4.43 years, height: 1.73 ± 0.06m, mass: 66.77 ±9.24kg) were asked to run on a 22m track under two conditions: without and with the PowersTM strap. Threedimensional motion analysis was conducted using ten Qualisys OQUS 7 cameras (Qualisys AB, Sweden) and force data was captured with three AMTI force plates (BP600900, Advanced Mechanical Technology, Inc.USA). Paired sample t-tests were performed at the 95% confidence interval on all lower limb kinematic and kinetic data. The PowersTM strap significantly reduced hip and knee internal rotation throughout the stance phase of running. These results showed that the PowersTM strap has the potential to influence hip motion during running related activities, in doing so this might be beneficial for patients with lower limb injuries. Future research should investigate the influence of the PowersTM strap in subjects who suffer from running related injuries, such as patellofemoral pain

The impact of conditionality on the welfare rights of EU migrants in the UK

This paper highlights and explores how conditionality operating at three levels (the EU supra-national level, the UK national level and in migrants’ mundane ‘street level’ encounters with social security administrators), come together to restrict and have a negative impact on the social rights of EU migrants living in the UK. Presenting analysis of new data generated in repeat qualitative interviews with 49 EU migrants resident in the UK, the paper makes an original contribution to understanding how the conditionality inherent in macro level EU and UK policy has seriously detrimental effects on the everyday lives of individual EU migrants

Welfare conditionality and disabled people in the UK: claimants' perspectives

In order to fully understand the impact of the extension of conditionality in the UK to include people with impairments, it is vital to give voice to those with direct experience of the welfare system. The case studies that follow are taken from interviews carried out as part of a project called Welfare Conditionality: Sanctions, Support and Behaviour Change. This is a major five-year programme of research running from 2013-2018, funded under the Economic and Social Research Council’s Centres and Large Grants Scheme (ESRC grant ES/K002163/2)

Housing works : assessing the impact of housing association employment support

Social housing providers in the UK have a long history of delivering support to their residents beyond housing, including providing employment related assistance. A small but growing area of research investigates the role of employment support outside the mainstream welfare system. However, little is known about the support provided, the impact it has on individuals’ prospects in the labour market, and related outcomes for housing providers, the taxpayer and wider society. As increasing numbers of people are expected to engage in work search and other work preparation activities in exchange for continued receipt of welfare benefits, the impact of housing provider employment support needs to be better understood. The membership of Give us a Chance (GUAC) have, as housing associations, been involved in a range of initiatives to improve the employment and life chance outcomes of their residents, including working with employment support organisations and the voluntary and community sector. However, there is considerable variation in the way that housing association employment support is currently provided, and a wide range of tools and measures are used to show the value of these initiatives, from specific organisational measures through to more generic approaches, such as the Housing Associations’ Charitable Trust (HACT) measures and the New Economy Cost Benefit Analysis (CBA) model. Hence, it is often difficult to compare the value of projects based on different approaches and measured using different tools. This research had two key aims: to contribute to an understanding of what helps people to move closer to, enter or sustain employment and to demonstrate the value of housing association investment in employment related support for residents. The project had the following linked objectives: 1. Provide a review of housing association employment related support activity; 2. Undertake a review of the impact measures currently used for employment related support across the social housing sector; and 3. Provide an understanding of ‘what works’ in terms of employment related support and the measures used among GUAC members

The influence of an off the shelf lateral wedge orthotic on knee loading during running

Knee injuries are prevalent in sports and associated with degenerative changes to the joint (Silverwood et al.,2015). High external knee adduction moments (EKAMs), knee adduction angular impulses (KAAIs) and knee flexion moments (KFMs) have been associated with increased cartilage deterioration (Chehab, Favre, Erhart-Hledik, & Andriacchi, 2014). Lateral wedge insoles (LWIs) have demonstrated reductions in biomechanical loading (EKAM, KAAI) associated with osteoarthritis progression during walking in individuals with osteoarthritis (OA; Jones, Chapman, Forsythe, Parkes, & Felson, 2014). Younger individuals who sustain a knee injury during sport are likely to return to physical activity following treatment (Kim, Nagao, Kamata, Maeda, & Nozawa, 2013). With increased risk of developing knee OA, identifying preventative measures to delay the progression of OA during dynamic tasks such as running is required

Telemedicine in Primary Health: The Virtual Doctor Project Zambia

This paper is a commentary on a project application of telemedicine to alleviate primary health care problems in Lundazi district in the Eastern province of Zambia. The project dubbed 'The Virtual Doctor Project' will use hard body vehicles fitted with satellite communication devices and modern medical equipment to deliver primary health care services to some of the neediest areas of the country. The relevance and importance of the project lies in the fact that these areas are hard-to-reach due to rugged natural terrain and have very limited telecommunications infrastructure. The lack of these and other basic services makes it difficult for medical personnel to settle in these areas, which leads to an acute shortage of medical personnel. We comment on this problem and how it is addressed by 'The Virtual Doctor Project', emphasizing that while the telemedicine concept is not new in sub-Saharan Africa, the combination of mobility and connectivity to service a number of villages 'on the go' is an important variation in the shift back to the 1978 Alma Ata principles of the United Nations World Health Organization [WHO]

How does acute pain influence biomechanics and quadriceps function in individuals with patellofemoral pain?

Objectives: Beside pathophysiological factors, pain is believed to play a crucial role in the progression of patellofemoral pain (PFP). However, the isolated effect of pain on biomechanics and quadriceps function has not been investigated in PFP. Thus, this study aimed to investigate the effect of pain on quadriceps function and lower limb biomechanics in individuals with PFP. Methods: Twenty-one individuals with PFP (11 males and 10 females, age: 29.76 ±6.36 years, height: 1.74 ± 0.09m, mass: 70.12 ±8.56kg) were measured at two different occasions: when not and when experiencing acute pain. Peak quadriceps torque (concentric, eccentric and isometric) and arthrogenic muscle inhibition (AMI) was assessed. Three-dimensional motion analysis and surface electromyography of the quadriceps and hamstrings muscles were collected during running, a single-leg-squat and step-down task. The normality was assessed using the Shapiro-Wilk test and a MANOVA was performed at the 95% confidence interval. Results: AMI increased significantly in acute pain. The net muscle activation of the knee extensors and flexors decreased during running in acute pain. The lower limb biomechanics and the quadriceps torque did not change in acute pain. Discussion: It appears that even if individuals with PFP experience pain they can still deliver maximal quadriceps contractions and maintain their moving patterns without biomechanical changes. However, the overall reduced activation of the quadriceps and the increased AMI indicate the presence of quadriceps inhibition in acute pain. Key words: patellofemoral pain, knee, PFP, AKP, inhibition, quadriceps, strength, pai

Influence of the Powers™ strap on pain and lower limb biomechanics in individuals with patellofemoral pain

Background: Abnormal biomechanics, especially hip internal rotation and adduction are known to be associated with patellofemoral pain (PFP). The PowersTM strap was designed to decrease hip internal rotation and to thereby stabilise the patellofemoral joint. Objectives: This study aimed to investigate whether the PowersTM strap influenced pain and lower limb biomechanics during running and squatting in individuals with PFP. Methods: 24 individuals with PFP were recruited using advertisements that were placed at fitness centres. They were asked to perform a single leg squat task (SLS) and to run on an indoor track at their own selected speed during two conditions: with and without the PowersTM strap. Immediate pain was assessed with the numeric pain rating scale. Three-dimensional motion and ground reaction force data were collected with 10 Qualisys cameras and 3 AMTI force plates. Results: Immediate pain was significantly reduced with the PowersTM strap (without the PowersTM strap: 4.04±1.91; with the PowersTM strap: 1.93±2.13). The PowersTM strap condition significantly increased hip external rotation by 4.7° during the stance phase in running and by 2.5° during the single leg squat task. Furthermore, the external knee adduction moment during the SLS and running increased significantly. Conclusion: This study assessed the effect of the PowersTM strap on lower limbs kinematics and kinetics in individual with PFP. The results suggest that the PowersTM strap has the potential to improve abnormal hip motion. Furthermore, the PowersTM strap demonstrated an ability to significantly reduce pain during functional tasks in patients with PFP