Intra-articular injection of photo-activated platelet-rich plasma in patients with knee osteoarthritis: a double-blind, randomized controlled pilot study

Improvements in knee osteoarthritis (OA) symptoms with platelet-rich plasma (PRP) have been attributed to its ability to modify intra-articular inflammatory processes. Photo-activation of peripheral blood also improves inflammatory mediators associated with OA, however combined photo-activated PRP (PA-PRP) has not been investigated. This pilot study assessed the feasibility, safety and symptomatic and functional change following injections of PA-PRP compared to hyaluronic acid (HA) in people with knee osteoarthritis (OA)

Current ankle sprain prevention and management strategies of netball athletes: a scoping review of the literature and comparison with best-practice recommendations

Background: Ankle sprains are the most commonly reported injury in netball. Approximately four in five netball athletes will sustain an ankle sprain, up to half will go on to sustain recurrent ankle sprains, and nine in ten report perceived ankle instability. Historically, prevention and management strategies of ankle sprains and injuries have been investigated for a variety of sports, however, no literature reviews have investigated these in netball athletes, or compared these with current best-practice within the literature. Therefore, this scoping review aims to understand how netball athletes currently prevent and manage ankle sprains and to compare these approaches with best-practice recommendations. Methods: A literature search was conducted using MEDLINE, CINAHL, and SPORTDiscus databases using keywords to capture studies with data or information related to the prevention and management of ankle sprains and injuries in netball. Results: The search strategy captured 982 studies across all databases, with 30 netball studies included in this scoping review. Studies suggest netball athletes are not commonly referred to health professionals, do not undertake adequate rehabilitation, and almost immediately return to court following an ankle sprain or injury. Current best-practices suggest injury prevention programs and external ankle support effectively reduce ankle sprains and injuries; however, poor compliance and implementation may be a significant barrier. Currently, there is a lack of evidence that netball-specific footwear reduces the risk of ankle sprains. Conclusion: The findings suggest netball athletes do not implement current best-practice prevention and management strategies following an ankle sprain. This is despite evidence of the effectiveness of injury prevention programs, external ankle support, and adequate rehabilitation in reducing ankle sprain rates. Current-best practice prevention and management of ankle sprains should be considered by clinicians, coaches, and athletes to reduce the prevalence and chronicity of ankle sprains in netball

Clinical assessment and management of foot and ankle osteoarthritis: a review of current evidence and focus on pharmacological treatment

Foot and ankle osteoarthritis (OA) is a common and disabling problem that adversely affects physical function and significantly reduces quality of life. Although the knee was considered to be the lower-limb site most often affected by OA, recent population data showed foot OA is as prevalent as knee OA, and rates increase with advancing years. The most common foot OA sites include the first metatarsophalangeal joint and the midfoot, with the ankle affected less often. Despite the high prevalence and disabling nature of foot and ankle OA, the condition has been neglected by clinical researchers, and there are very few trials investigating non-surgical foot or ankle OA treatment options. There are no accepted clinical diagnostic criteria for foot or ankle OA so imaging remains common. Clinical guidelines based on knee and hip OA research recommend education, exercise, and weight loss in the first instance. Topical non-steroidal anti-inflammatory drugs (NSAIDs) or capsaicin may be used as an adjunct. Failing these approaches, acetaminophen (paracetamol) should be recommended; however, if there is inadequate symptomatic relief, then clinicians should trial an oral NSAID or a cyclo-oxygenase-2 inhibitor. Given that adverse events and co-morbidities are common in the elderly, older patients should be closely monitored. Some studies have investigated intra-articular injections for foot and ankle OA, and there is some evidence to suggest hyaluronic acid may be effective in the short term for ankle OA. With the lack of research on foot or ankle OA treatments, however, robust clinical trials are urgently needed.</p

Reliability of an inexpensive and portable dynamic weight bearing asymmetry assessment system incorporating dual Nintendo Wii Balance Boards

Weight bearing asymmetry (WBA) during dynamic tasks is prevalent in a variety of clinical populations. However, accurate measurement has previously been out of reach of the clinician due to the costly equipment and technical expertise required. The aim of this study was to assess the test–retest reliability of WBA data obtained using an inexpensive and simple to use dual force plate system incorporating unmodified Nintendo Wii Balance Boards (NWBB) and customized software. A secondary outcome measure, individual limb COP path velocity, which represents the postural sway under each limb was also examined. Twenty-three participants performed squats both with and without visual WBA feedback on two separate occasions. Weight-bearing asymmetry as a percentage of body mass and individual limb center of pressure (COP) path velocity were recorded during these trials, with intraclass correlation coefficient (ICC2,1) analysis performed to assess test–retest reliability. This system provided reliable values for both outcome measures when performed with and without real-time visual feedback of WBA (ICC2,1 range = 0.75–0.91). In conclusion, recording WBA and COP path velocity data using NWBB is reliable. Given that tens of millions of NWBB have been sold worldwide, and that reprogramming them for clinical purposes is within the reach of most software developers, similar systems may soon become commonplace in the clinical setting

Feasibility of ballistic strengthening exercises in neurologic rehabilitation

Reduced muscle strength and power generation are common after neurologic injury and contribute to significant mobility limitations. Strength training is a core component of physical rehabilitation practice to improve mobility and functional outcomes. Strategies designed to improve strength and function in neurologic patients are typically composed of resistive concentric strength exercises such as leg press (LP) or leg curls.1–5 However, these types of exercises do not necessarily replicate the movement patterns found in everyday functional tasks such as walking.6,7 Many studies have demonstrated that strength training is safe and effective for improving muscle strength in a number of neurologic conditions.3–5,8–10 Despite these training gains, recent systematic reviews have found only minor changes in capacity to walk in neurologic populations.7,11–16</sup

The effects of enhanced plantar sensory feedback and foot orthoses on midfoot kinematics and lower leg neuromuscular activation

Excessive foot pronation has been associated with injuries of the lower extremity. No research has investigated the effect of enhancing plantar sensory feedback on foot pronation. The aim of this study was to determine whether a shoe with enhanced plantar sensory feedback reduces midfoot pronation. Midfoot kinematics and electromyography of the peroneus longus, tibialis anterior and medial gastrocnemius of 21 males (age: 21.0 ± 4.0 years, height: 176.8 ± 5.0 cm, mass: 73.3 ± 6.5 kg) were recorded whilst walking in a neutral shoe, a neutral shoe with a prefabricated foot orthotic and a neutral shoe with nodules located on the plantar-medial insole (experimental shoe). Friedman's ANOVA and Wilcoxon tests were used to evaluate differences between shoe conditions. Mean midfoot-tibia angles during ground contact were significantly more supinated when wearing the experimental shoe (+7.14°, p = 0.023) or orthotic (+3.83°, p = 0.006) compared to the neutral shoe. During the loading phase, midfoot angles were significantly more supinated when wearing the experimental shoe compared to the orthotic (+5.53°, p = 0.008) or neutral shoe (+6.20°, p = 0.008). In the midstance phase, midfoot supination was significantly higher in the orthotic compared to the neutral shoe (+2.79°, p = 0.006). Finally, supination was increased during the propulsive phase when wearing the experimental shoe compared to the orthotic (+7.43°, p = 0.010) or neutral shoe (+10.83°, p = 0.009). No significant (p < 0.05) differences in muscle activation were observed. These results suggest that increasing plantar sensory feedback to the medial aspect of the foot reduces midfoot pronation during an acute bout of walking. Further work is needed to explore whether these effects remain over longer time periods